The US Immigration Medical Exam is a mandatory medical exam required for green card applicants or for those who are seeking adjustment of their status to that of permanent residence in the U.S. including those seeking asylum. It is also required for certain non immigrant visas. In the U.S., it is conducted by a USCIS approved civil surgeon while outside the U.S. a physician on the panel of USCIS conducts it.
What does it include?
It includes a list of tests including a tuberculin skin test or IGRA test to detect tuberculosis. If the initial tuberculosis tests are positive, the applicant needs to undergo a chest x ray. Pregnant women can opt out of the radiograph if they do not wish to undergo it provided they present a certificate of their pregnancy signed by their doctor or obstetrician.
Followed by the TB tests is a body check up of ears, eyes, throat, nose, lymph nodes, lungs, heart and the external genital area. These tests are carried out to determine the presence of other communicable diseases, which at times the applicant himself may not be aware of.
Later, the applicant is tested for drug abuse and a mental evaluation is done based on the medical history. Finally, a set of vaccines is administered. These vaccines are compulsory, according to the Immigration and Nationality Act, and as demanded by the Center for Disease Control and Prevention (CDC). Immigration doctors carry out this step with precision based on the technical instructions laid down by the CDC.
Why is it conducted?
The immigration medical exam is conducted for the purposes of ensuring that the immigrant is not inadmissible on the grounds of public health and safety. It is important that the immigrant does not bring in diseases that have been eradicated in the US or those that are under process of being eradicated or those that may possibly cause an outbreak.
The CDC implements a list of inadmissible health related problems that need to be vaccinated for as suggested by the Advisory Community on Immunization Practices (ACIP), in accordance with the regulations laid down in the Immigration and Nationality Act. These are checked for and vaccinated during the immigration medical.
Vaccination for vaccine-preventable diseases includes at least the following diseases: Mumps, Measles, Rubella, Polio, Tetanus and Diphtheria toxoids, Pertussis, Influenza type B and Hepatitis B.
Recent outbreaks in the US
After TB outbreaks in Los Angeles, South Carolina and most recently Wisconsin, a new type of TB, multi drug-resistant, has been detected. This type of TB cannot be easily cured with regular TB drugs and treating it costs thousands of dollars per patient. In addition, TB in itself is a highly contagious disease. It needs at least a year’s treatment to completely recover. Around half of the total TB cases in the country, affect people in Florida, Texas, California and New York, all places with high immigrant population. TB is air-borne so it can’t be completely eradicated. However, state and local health departments, health care officials, nurses and doctors especially USCIS immigration doctors are asked to be careful when dealing with individuals from immigrant communities. An early detection can help address the spread of the disease. This is one of the main reasons that TB check up is the first thing done in the immigration medical exam.
Among the diseases to be vaccinated for, there is Pertussis or the Whooping Cough disease. This too is highly contagious and mostly affects children under age 10. It is caused by bacteria called Bordetella pertussis.
According to CDC reports, since the year 1959, 2012 has had the maximum number of Pertussis cases nearly 18,000 right in the first half of the year. To control this outbreak in the country, it is mandatory to administer Pertussis vaccine during immigration medical exam, especially, to children under the age 10.
Quite like Pertussis, Influenza is also a very common disease. Seasonal flu seems harmless and innocent; however, each year it causes hospitalizations and likely deaths in the US. It is difficult to ascertain how many exact deaths are caused by influenza. CDC estimates that from the mid 70s up to 2006-2007 flu season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000 people. Death certificate data and weekly influenza virus surveillance information was used to estimate how many flu-related deaths occurred among people whose underlying cause of death was listed as respiratory or circulatory disease on their death certificate.
The ACIP has considered the above factors above and more when recommending the list of diseases that need to be vaccinated or checked for when allowing immigrants to reside in the U.S. as it may have serious long term implications for the residents of the country.