New Technical Instructions for Civil Surgeons for 2018




In early 2018, the Center for Disease Control (CDC) Notice to United States Citizenship and Immigration Services (USCIS) Civil Surgeons informed of changes to the Tuberculosis (TB) Component of the Technical Instructions (TIs).  It is anticipated that starting October 1, 2018 the changes will go into effect to now require civil surgeons to use an  IGRA (Interferon Gamma Release Assay) for testing for cell-mediated immunity to tuberculosis.  This means that the tuberculin skin test (TST) familiar to many in the screening for tuberculosis will No longer be accepted.  The IGRA requirement will also apply to children younger than 5 years of age.


Also a CDC reminder to civil surgeons:
...The new 2018 Civil Surgeon TB TIs state the following: Civil surgeons must not refer applicants to a health department for IGRA testing or chest x-ray; all IGRAs and chest x-rays ordered by civil surgeons must be performed independently of a health department.

Another reminder from CDC concerns Latent TB Infection (LTBI):
Basically the CDC reminds civil surgeons that Department of Health (DOH) offices expect civil surgeons to refer cases of LTBI to them (This has not been happening as expected in many cases, although it is part of the TIs).  The TIs consider applicants (with no known HIV and no signs or symptoms of TB disease) with a positive TST or positive IGRA and with chest x-ray not suggestive of TB to have LTBI.  The civil surgeon should communicate the results and need for referral to DOH with the applicant, and also remind applicant that referral for LTBI to DOH will not prevent the completion of their I-693 Form or delay submission to USCIS.

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