Refugee Health Program Information for Counties

Panel physicians who complete overseas medical exams for refugees and other newcomers must document tuberculosis screening results and treatment provided (if patients are diagnosed and prescribed treatment). All medical documentation is available to state and local health departments through the CDC's Electronic Disease Notification system, and hard copies of the documentation are provided to refugees for their medical providers in the U.S.

All refugees, immigrants, and other newcomers are evaluated for tuberculosis overseas and given a classification based on the findings and their status. Individuals are given a Class B status (see below table) if their evaluation suggests a risk of tuberculosis infection. Individuals who arrive with a Class B tuberculosis condition should be evaluated by their county/local health department soon after arrival to the U.S., and the Class B Tuberculosis Worksheet (PDF) should be completed by the local health department and returned to the Bureau of Tuberculosis Control for all arrivals with a Class B condition.

Tuberculosis Classifications

Classification	Clinical Findings
No Classification	Individuals with no clinical findings suggestive of tuberculosis or latent tuberculosis infection (LTBI).
Class A, Tuberculosis Disease	Individuals with confirmed active tuberculosis disease. This class is not cleared for travel until treatment is completed unless a waiver is granted.
Class B0, Pulmonary	Individuals diagnosed with tuberculosis overseas who completed directly observed therapy treatment under the supervision of a panel physician.
Class B1, Pulmonary	Individuals with signs/symptoms, physical exam findings, or chest x-ray findings suggestive of tuberculosis disease OR with a known HIV infection with negative sputum smears and cultures and no tuberculosis diagnosis. Also includes individuals who were diagnosed with tuberculosis by the panel physician and are returning after treatment and completion of a one-year wait.
Class B1, Extrapulmonary	Individuals diagnosed with extrapulmonary tuberculosis with normal chest x-ray findings and negative sputum smears and cultures.
Class B2, Latent Tuberculosis Infection (LTBI)	Individuals with positive Interferon-Gamma Release Assays (IGRAs) or tuberculin skin tests (TSTs), but otherwise negative evaluations for tuberculosis. Test results, treatment status, and medications should be documented.
Class B3, Contact Evaluation	Individuals who are recent contacts of known tuberculosis disease cases, regardless of test results.

For more information on domestic tuberculosis screening and evaluation, and an overview of overseas screening, visit the Centers for Disease Control and Prevention's domestic guidance for tuberculosis. Additional information on tuberculosis can be found on the Department of Health's tuberculosis webpage.

Top 5 Countries of Origin by County of Destination, 2018 – 2022

Albany	Erie	Monroe	Oneida	Onondaga
Afghanistan	Afghanistan	Afghanistan	Afghanistan	Afghanistan
Ukraine	Democratic Republic of the Congo	Ukraine	Ukraine	Ukraine
Democratic Republic of the Congo	Myanmar	Democratic Republic of the Congo	Myanmar	Democratic Republic of the Congo
Pakistan	Tanzania	Tanzania	Thailand	Syria
Syria	Syria	Myanmar	Sudan	Tanzania