US Grab Bag Linda Harvey, MD, Joanna Regan, MD, MPH, Drew L. Posey, MD, MPH, Sean Toney, BS, Zachary White, MPH Medical Assessment and Policy Team Immigrant, Refugee, and Migrant Health Branch Intergovernmental Panel Physicians Training Summit March 31, 2017 National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

Learning Objectives and Agenda After this session, you should be able to Understand basic points about the screening exam Know solutions to common conundrums

Question 1 – Vaccinations An 18-year-old applicant brings his vaccination record with him to the examination. After recording the vaccinations received to date, what is your source to determine what, if any, vaccinations should be given? Your country’s immunization recommendations World Health Organization Expanded Programme on Immunization CDC Vaccine Technical Instructions Table American Committee on Immunization Procedures (ACIP) recommended schedule International College of Family Medicine (ICFM) Vaccines for Health Children

Question 2 – Mental Health You screen a 21-year-old college student renewing his non-immigrant visa (NIV). He was arrested for driving drunk 2 years ago. Your mental health professional makes him Class A because he continues to drink alcohol at parties. However, he has never met any of the substance use disorder criteria. What is his classification? No Class Class A Class B Class B Other

Question 3 – Laboratory An emaciated applicant has a chronic cough, night sweats, and an infiltrate on chest radiograph. As you arrange sputum collection, what is the best answer for two things you want to accomplish? Collect 5 ml of fluid in the sunshine Protect workers and confirm Mycobacterium tuberculosis by laboratory testing Use an outdoor space and diagnose tuberculosis Use a collection cup with a wide opening under negative air pressure Transport Falcon tube in a hard-sided container

Question 4 – US TB Treatment Guidelines and DOT You diagnose a 54-year-old man with pansusceptible tuberculosis. His dosage of ethambutol and pyrazinamide will be based on which factor? Drug resistance Chest radiograph (CXR) improvement Resolution of symptoms Weight Ability to tolerate the medications

Question 5 – Gonorrhea A 21-year-old woman has a positive nucleic acid amplification test (NAAT) for gonorrhea. She asks to be treated by her regular physician in her home town. Which is the best answer for when and where she should be treated? Today in your office When it is convenient in your office As soon as possible by her regular physician When it is convenient by her regular physician

Question 6 – Molecular Testing You manage a tuberculosis laboratory in a hot, humid city. Which of the following can help you determine if a positive sputum smear is from M. tuberculosis or nontuberculosis mycobacterium (NTM)? Hain Lifescience GenoType MTBDRplus Cepheid Xpert® MTB/RIF California Microbial Diseases Laboratory (CMDL) NTM detection assay Increasing the concentration of the decontamination solution Having applicants rinse with distilled water

Question 7 – Adoptee You successfully worked with CDC and the consular section on a Class A waiver for an adoptee. The Immigrant Visa (IV) Chief has rotated to a new country. When should you meet with the new IV Chief to discuss adoptee issues? When a case occurs When a new United States Citizenship and Immigration Services (USCIS) representative rotates to the Post When CDC asks for information on an adoptee under evaluation When an adoptive parent asks you about the Class A waiver process Immediately

Bonus – First Timers As it relates to staying current on the Technical Instructions, when can you no longer consider yourself a “first timer”? After attending a Panel Physicians Training Summit After reviewing previous CDC webinars After successfully serving as a panel physician for 3 consecutive years After implementing the cultures for tuberculosis and NAAT testing for gonorrhea Never

Thank you cdcQAP@cdc.gov http://www.cdc.gov/panelphysicians For more information, please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

Answers C A B D E Bonus. E