TB Class B Arrivals: The role of local public health (LPH)

Posted 9/13

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TB Class B Arrivals: The Role of Local Public Health (LPH) (PDF: 34KB/2 Pages)

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 active pulmonary TB. Adults age 15 years or older are required to have a chest X-ray (CXR), and children ages 2 through 15 years old are required to have a TB skin test (TST).

If the pre-immigration TB exam is negative, no further follow-up is needed upon arrival in the U.S. If infectious TB disease is diagnosed during the pre-immigration exam, full treatment is required before the individual is cleared to travel. If the pre-immigration TB exam has positive findings other than infectious TB disease, a TB Class B designation is given according to exam results:

  • Class B1: The individual had an abnormal CXR with evidence of TB, and/or the individual has a history of treatment for active TB disease.
  • Class B2: The individual was diagnosed with latent TB infection (LTBI). These are typically children whose TST result was positive and CXR was normal.
  • 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.
The pre-immigration exam is not intended to diagnose or treat extrapulmonary TB, non-infectious pulmonary TB, or LTBI.


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

The Centers for Disease Control and Prevention (CDC) recommends that immigrants and refugees with Class B TB designations receive a full TB evaluation soon after arriving in the U.S. The purpose of this is to evaluate the person for active pulmonary TB, extrapulmonary TB, and LTBI, and to treat these conditions, if found. This evaluation should be done within 30 days after arrival in the U.S., if possible.

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

Recommendations for providers who perform the evaluation are based on the type of TB Class designation (i.e., B1, B2 or B3). Please consult MDH’s Recommended Medical Follow-up for TB Class Arrivals (PDF:35KB/1 page) page for detailed information about evaluation protocols.

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 new arrival to the U.S. with a local provider, to ensure that the results of the evaluation are submitted to MDH, and to facilitate medical treatment for TB-related conditions that are 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 assessment protocol. Arrange for the refugee health exam with a provider per the protocol in your county. For Class B1 arrivals, be sure to forward to the provider the TB Class Follow-up Worksheet (PDF:19KB/2 pages) that was sent with the original pre-immigration exam paperwork. The provider should fill out both the “TB Class Follow-up Worksheet” and the Refugee Health Assessment Form (PDF: 183KB/4 pages); 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 Class B designation upon arrival, but may not fully understand the need for the evaluation or how to obtain it.
  1. Ask if they have a preferred provider. If not, 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.
  1. Once an appointment has been arranged, forward the paperwork MDH sent you (copy of the pre-immigration exam plus the TB Class Follow-up Worksheet (PDF:19KB/2 pages)) to the provider. It may also be helpful to forward a copy of the recommendations as well as Instructions for Completing the TB Class Follow-up Worksheet (PDF: 33KB/1 page).
  1. After the appointment, complete theTB Class Follow-up Worksheet (PDF:19KB/2 pages) 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 theTB Class Follow-up Worksheet (PDF:19KB/2 pages) 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.

Updated Monday, 16-Sep-2013 14:54:43 CDT