1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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
Telephone: CDC-INFO ( )/TTY:
Visit: | Contact CDC at: CDC-INFO or
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

12. Answers C A B D E
Bonus. E