TB Class B Arrivals: The Role of Local Public Health (LPH)

On this page:
What is a TB Class B designation? 
Why do Class B TB arrivals need a follow-up evaluation in the U.S.?
What type of medical follow-up is recommended for TB Class B arrivals?
What is LPH's role regarding TB Class B arrivals to their county?
Further questions

What is a TB Class B designation?

The U.S. Department of State requires all refugees and immigrants coming to the United States to have a pre-immigration medical exam to rule out diseases of public health significance, one of which is infectious TB disease (i.e., pulmonary or laryngeal TB disease). The pre-immigration exam is not intended to diagnose or treat extrapulmonary TB, non-infectious pulmonary TB, or latent TB infection (LTBI). Adults age 15 years or older are required to have a chest X-ray (CXR), and children ages 2 through 14 years are required to have an interferon-gamma release assay (IGRA) or TB skin test (TST). Individuals with any abnormal CXR finding or positive TB test during this overseas screening receive additional evaluation to rule out active pulmonary TB disease prior to resettlement.

If the pre-immigration TB evaluation is normal, no further follow-up is needed before arrival in the U.S. For nonimmigrants without refugee status, no domestic TB follow-up is required. For immigrants with refugee status, a TB assessment is included in the domestic refugee health examination. If infectious TB disease is diagnosed during the pre-immigration exam, complete treatment is required before the individual is cleared for travel. If during the pre-immigration exam an individual has abnormal CXR findings or a positive TB test and infectious TB disease is ruled out, a TB Class B designation is given according to exam results:

• Class B0: The individual was diagnosed with TB by the panel physician or presented to the panel physician while on TB treatment and successfully completed Division of Global Migration and Quarantine (DGMQ)-defined directly observed therapy (DOT) prior to departure.
• Class B1: The individual has signs or symptoms, physical exam findings, or CXR findings suggestive of TB disease, but has negative sputum smears and cultures. Or, the individual has a history of treatment for active TB disease but did not receive it through DGMQ-defined DOT.
• Class B2: The individual has a positive IGRA or TST, but other evaluation for active TB disease is negative.
• Class B3: The individual is a recent contact of an infectious TB case; an individual can have this designation along with another TB Class designation.
   

For more information on TB Class B designation, visit CDC: Refugee Health Domestic Tuberculosis Guidance.

Why do TB Class B arrivals need a follow-up evaluation in the U.S.?

The Centers for Disease Control and Prevention (CDC) recommends that immigrants and refugees with TB Class B designations receive a TB evaluation soon after arriving in the U.S. The purpose is to evaluate the person for active TB disease and LTBI, and to treat these conditions, if found. It is recommended this evaluation is completed within 30 days after arrival to the U.S.

What type of medical follow-up is recommended for TB Class B arrivals?

Recommendations for providers who perform domestic screening evaluations for TB are based on the type of TB Class designation (i.e., B1, B2 or B3). For detailed information about evaluation protocols, please consult MDH's Recommended Medical Follow-up for TB Class B Arrivals (PDF).

What is LPH's role regarding TB Class B arrivals to their county?

LPH's role is to help arrange a TB evaluation for the newly arrived immigrant with a local medical provider, to ensure that the results of the evaluation are submitted to MDH, and to facilitate medical treatment for TB disease or LTBI if identified. This process will be slightly different for refugees and immigrants.

For Refugee Arrivals

TB screening should be part of the full domestic refugee health examination protocol. Arrange for the refugee health exam with a provider per the protocol in your county. For TB Class B1 arrivals, be sure to forward to the provider the TB Follow-up Worksheet (PDF), also available on eSHARE. The provider should fill out the worksheet and the Minnesota Initial Refugee Health Assessment Form (PDF); both should be returned to MDH after completion of the exam.

For Immigrant Arrivals

LPH will need to play a more direct role in the process than for refugees, as immigrants do not have the support of a resettlement agency and may not have health insurance. While this process may vary by county based on resources, these are the general steps:

1. Attempt to contact the immigrant or sponsor listed on their paperwork (phone or letter if no/incorrect phone number). Explain the purpose of the exam and its importance. Many immigrants will have received a letter about their TB Class B designation upon arrival, but may not fully understand the need for the evaluation or how to obtain it.
2. Ask about insurance status, whether they have a preferred provider, and whether they need an interpreter. If they are not yet connected to care, assess their resources and facilitate setting up an appointment for a TB evaluation with a provider in your area. If they don't have insurance and have limited ability to pay, consider referring them to facilities with sliding-fee scales.
3. Once an appointment has been arranged, forward the paperwork MDH sent you – copy of the pre-immigration exam plus the TB Follow-up Worksheet (PDF) – to the provider. It may also be helpful to forward a copy of the recommendations as well as Instructions for Completing the TB Follow-up Worksheet (PDF).
4. After the appointment, complete the TB Follow-up Worksheet (PDF) and return it to MDH.

LPH is not expected to help immigrants establish primary care – only to facilitate TB evaluations with local providers. This evaluation, while highly recommended, is optional; immigrants are allowed to refuse.

If LPH is not able to initiate a TB evaluation for the arrival, please indicate the reason (e.g., not located, lost to follow-up, refused, returned to country of origin) on the back of the TB Follow-up Worksheet (PDF) and return to MDH.

Further questions

Additional questions regarding TB Class B follow-up can be directed to the Minnesota Department of Health TB Program at 651-201-5414.