Reporting latent tuberculosis infection from status adjustment medical examinations to Public Health
Information for civil surgeons
This FAQ sheet was developed to help address common questions that civil surgeons may have about reporting latent tuberculosis infection (LTBI) results found during medical examinations for adjustment of status to permanent resident. During this exam civil surgeons must fill out the USCIS Form I-693. Certain conditions, including LTBI, are reportable to the county health department of jurisdiction.
If the applicant is found to have a latent tuberculosis infection (LTBI) during the medical examination (positive interferon gamma release assay [IGRA] blood test and normal chest x-ray), civil surgeons must report these results to the health department in which the applicant resides. According to the CDC Tuberculosis Technical Instructions, civil surgeons are required to report (at minimum) the applicant's name, contact information, IGRA results, and chest x-ray results.
In order to facilitate successful follow-up and disease surveillance by Public Health — Seattle & King County (PHSKC), we request additional information via our online survey, such as the applicant's country of origin, and whether they have medical insurance and/or a primary care provider (PCP). Including all the information requested will reduce the need for us to follow-up with your office to verify information and will make our follow-up with the applicant easier.
As stated in the CDC TB Technical Instructions for civil surgeons, you are required to report all cases of LTBI. PHSKC requests additional information to aid in our follow-up and disease-surveillance efforts.
Civil surgeons are required to inform the applicant of their positive IGRA result and that their LTBI diagnosis will be reported to the health department. Civil surgeons should advise the applicant that follow-up treatment is important to prevent tuberculosis disease.
We recommend civil surgeons provide applicants with a copy of their IGRA and chest x-ray results, in addition to a copy of the I-693 Form, in order to facilitate follow-up care with their PCP. According to the Technical Instructions, it is acceptable to provide a copy of the I-693 form to the applicant.
Though seeking and completing treatment for LTBI is not required to complete the status adjustment process, it is important for preventing and controlling TB disease in our country. For this reason, our online survey asks you to provide information about the applicant’s current primary care provider (PCP) so that we can follow up and monitor treatment progress if it is already or will be initiated. We use the applicant's contact information to follow-up about LTI treatment initiation and completion via text messaging. Texting allows us to reach individuals who have free texting but limited call time, those who do not answer calls from blocked or unfamiliar numbers, and also allows applicants to respond to text messages 24/7, at a time that is most convenient for them. Pur texting platform is HIPAA compliant and consent is received before discussing protected health information. The applicant may also opt out of texting and request a phone call from us instead.
If the applicant reports that they do not have insurance and/or do not have a PCP, we are happy to provide information and resources, to either you or the applicant, in order to help the applicant find insurance coverage or medical care. In the online survey we have included a "Comments" section for you to note such requests.
We will also utilize this information to understand the demand for LTBI treatment among immigrant and refugee communities. This information will be used to allocate resources accordingly to PHSKC TB control and prevention programs.
While they are not required to do so, if the applicant has reported they have an HIV infection, they must be reported to PHSKC for sputum smears and cultures, even if their IGRA is negative and their chest x-ray is normal.
Applicants must be tested with IGRA, and not a TB Skin Test (TST), except in rare instances when an exception can be made. Unlike TST, prior BCG vaccination does not affect the results of IGRA. It is important that applicants understand this since many of them may have received the BCG vaccine in their country of origin.
Please do not report results of applicants from other counties using the PHSKC survey. If the applicant resides in a different WA state county, you should complete the Latent Tuberculosis Infection (LTBI) Reporting Form for Civil Surgeons and fax it to the appropriate county of jurisdiction.
See contact information for other counties (PDF). For your convenience, links to both resources are included in the online survey (under the "Does this patient reside in King County" question, choose "No," and the links will pop up).
Treating LTBI is one of the pillars of TB prevention and control efforts, especially among populations at high risk of progression to active TB disease. Without treatment, on average 1 in 10 people with LTBI will get sick with TB disease in the future. More than 80% of people who get sick with TB disease in the United States each year get sick from longstanding, untreated LTBI.1
In recent years, shorter treatment regimens with fewer side effects have proven effective in treating patients with LTBI. These new treatment regimens address previous concerns about isoniazid (INH)- related hepatotoxicity, poor adherence, and INH resistance. It is now easier than ever to complete prophylactic treatment.
Please refer to the LTBI treatment guidance in Washington State2 that was developed by the WA Department of Health for the latest treatment guidance. The applicant's PCP can help determine the best treatment regimen for them. Shorter treatment regimens increase patient adherence and reduce likelihood of side effects.
PHSKC can offer resources to applicants who do not have insurance, such as connecting them with agencies who can help determine if they are eligible for Medicaid or cost-sharing plans offered by Washington Healthplanfinder marketplace.
PHSKC can also offer information on community health clinics throughout King County. These clinics provide low-cost care to those in need, regardless of immigration or insurance status.
If the applicant reports already completing treatment for LTBI, please report this in the "Comments" section of the survey. Please provide as much information as possible (i.e., "Treatment completed in US in 2009." or "Treatment completed in country –x– in 1989.").
Please report all LTBI results within two weeks of the applicant's medical examination. This will allow PHSKC to follow-up with the applicant within a timely matter.
2Washington Department of Health (DOH). Latent tuberculosis infection (LTBI) treatment guidance in Washington State: Promoting rifamycin-based, shorter-course regimens. May 2019. Version 3. Available at:https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Tuberculosis/TBProviderToolkit