September 18, 2009

Joint Council is pleased to inform you that following a joint advocacy effort by many the CDC has chosen to revise it 2007 Tuberculosis Technical Instructions. Please click here for the Addendum: Instructions for Applicants 10 Years of Age or Younger of the 2007 TB Technical Instructions. Note that these are only the revised instructions for applicants 10 years and younger so please refer to the full set of instructions at http://www.cdc.gov/ncidod/dq/panel.htm for more general information.

Joint Council would like to thank the many organizations and individuals who worked to ensure that the issues regarding the 2007 Tuberculosis Technical Instructions were resolved. Our appreciation and thanks includes but is certainly not limited to:

Dr. Jeffery Starke
The Worldwide Orphans Foundation led by Dr. Jane Aronson
Dr. Dana Johnson, University of Minnesota International Adoption Clinic
Members of U.S. Congress
National Council for Adoption
Center for Adoption Policy
EACH
The signatures of Joint Council's Build Families, Not Barriers petition
U.S. Department of State
Department of Homeland Security
Center for Disease Control and Prevention
The Scruggs Family
The Grace Children’s Foundation

Background:
In 2007, the Centers for Disease Control and Prevention (CDC) issued Technical Instructions for Tuberculosis (TB) Screening and Treatment for Panel Physicians.

The primary goal of the new protocols is to minimize the number of immigrants entering the U.S. with multi-drug-resistant TB thereby curtailing the spread of this infectious disease among the U.S. citizenry. In May and June of 2009, CDC announced that immigrants over the age of 2 from Ethiopia and China would be subject to new TB protocols.

These new protocols require a series of tests for all immigrants, including children adopted abroad by U.S. citizens. For children adopted abroad by U.S. citizens, the tests will delay the adoption by a minimum of seven days depending on the test results could delay the issuance of visa to twelve (12) months or more.

Children adopted abroad by U.S. citizens are a unique immigrant population. Given the population’s unique situation, the implementation of these instructions is not in the best interest of these vulnerable children and should not be implemented for this population for the following reasons:

1. Adopted children of American citizens, much like children born to American citizens abroad, pose a negligible threat to the public health of the United States.

2. The CDC instructions deny U.S.-based medical treatment for children adopted by U.S. citizens.

3. The most vulnerable of all children are orphans who are older and have special needs. The new protocols will result in further developmental and physical delays for the children of American citizens.

4. The instructions do not apply to American citizens living abroad or their children and should not apply to children adopted by U.S. citizens.

5. The risk of TB transmission, even in active cases, is minimal for infected children under the age of 12 years.

6. After two weeks of treatment, and three negative AFB smears an infected person is no longer contagious. The CDC instructions therefore, are unnecessary when applied to adopted children of American citizens as the children will undoubtedly be treated immediately upon their entrance into the United States.

7. The new TB protocols will result in an increase in travel expenses for U.S.-citizen adoptive parents and unknown delays during adoption processes.

The CDC instructions, therefore, are unnecessary when applied to adopted children of American citizens. The new protocols are a significant and unnecessary roadblock, which may deny these children access to a permanent family. Implementing the protocols for this population is an excessive means of protecting against multi-drug resistant TB.

Countries Affected by TB Protocols:

Country	Population	Start date
Botswana	All applicants	March 3, 2008
China	All applicants	July 1, 2009
Dominican Republic	All applicants	February 2, 2009
Ethiopia	Refugees (Eritreans)	March 10, 2009
	All applicants	April 1, 2009
Hong Kong SAR	All applicants	November 3, 2008
Japan	All applicants	June 1, 2009
Jordan	All applicants	April 5, 2009
Kenya	Refugees (includes Ethiopians, Somalis, and Sudanese)	January 1, 2008
	All applicants	April 10, 2009
Lesotho	All applicants	March 3, 2008
Macau SAR	All applicants	November 3, 2008
Malaysia	Refugees (Burmese)	January 1, 2009
Mexico	All applicants	October 1, 2007
Mozambique	All applicants	March 3, 2008
Namibia	All applicants	March 3, 2008
Nepal	Refugees (Bhutanese)	December 13, 2007
Philippines	All applicants	October 1, 2007
South Africa	All applicants	March 3, 2008
Swaziland	All applicants	March 3, 2008
Taiwan	All applicants	April 1, 2009
Tanzania	Refugees (Burundian)	January 1, 2008
	All applicants	June 5, 2008
Thailand	Refugees (includes Burmese and Hmong refugees)	April 9, 2007
Turkey	All applicants	February 4, 2008
Uganda	All applicants	March 2, 2009
Vietnam	All applicants	February 1, 2008

Related Links:
CDC Website on TB protocol
Build Families, Not Barriers Petition
Joint Council's Summary Report on TB