CDC answers interview questions regarding TB policy for internationally adopted children

Representatives from the CDC in Atlanta answered interview
questions regarding the TB testing policy for immigrants,
including internationally adopted children.*

To continue coverage of the CDC's TB policy for immigrants and how it affects internationally adopted children like Harper Yue Ye Scruggs and Jaylee, the little girl from the Philippines that the Crombie family has been delayed in adopting, the International Adoption Examiner requested an interview with Dr. Drew Posey, the author of the Centers for Disease Control and Prevention 2007 Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians. A CDC public relations representative responded that Dr. Posey was not reachable by email or cell phone, but that she would have some of the other experts at their agency answer the questions. After several delays, some of the questions were answered via email. In response, follow-up questions have been issued by this Examiner, which have not yet been answered.  Below is the first installment of this interview:

Part 1 -

Q: Why is the policy applied to children when there is little history of them being able to spread the disease?

A: Although children are rarely infectious, there is a possibility that they can transmit TB to others. There have been several cases in which a child was found to be infectious and transmitted TB to others. This illustrates the need to exercise caution when assuming that children with TB are not contagious.*
 
The primary responsibility of CDC is to protect the health of the U.S. public. Thus, CDC has applied Technical Instructions for TB screening and treatment to reduce the spread of TB disease in adults and children. In response to the Institute of Medicine (IOM) report, "Ending Neglect" and many studies over the past decade, we revised the TB Technical Instructions in 2007 to use more precise methods to identify tuberculosis. The main goal in lowering the age for TB screening in the 2007 Instructions was to detect, diagnose and treat TB cases as early as possible.  This was especially important for immigrants from countries with a high TB burden.  

*Follow-up question issued by the International Adoption Examiner that has yet to be answered by CDC:

1. You mentioned that there have been several cases in which a child was found to be infectious and transmitted TB to others. How many cases exactly have been reported throughout the history of the world?

Q:  Why is the policy only applied to ages two and up? Why would a two year-old child be more contagious than a 1 ½ year-old? How were the ages for this policy determined? 

A: The policy of obtaining sputum specimens for persons suspected of having TB disease actually applies to all ages.  Any child* with signs and symptoms of TB is subject to further screening to determine presence of TB disease. However, children ages 2-14 in countries with a high burden of TB*  must go through a specific screening process listed in the 2007 TB Technical Instructions.
 
CDC technical instructions were based on the opinions and advice of both CDC and U.S. TB experts*. 

 *Follow-up questions issued by the International Adoption Examiner that have yet to be answered by CDC:

1. You stated that any child with signs and symptoms of TB is subject to further screening to determine presence of TB disease. Shouldn't this statement read, "Any immigrant child", including legally adopted children of American parents, since you do not require foreign borns who are biological children of US citizens to be tested, nor do you require it of children visiting from other countries?
2. Shouldn't the same change in terminology be made when referring to children from countries with a high burden of TB, as you do not require this testing of any other children coming from these countries except immigrants, which include legally adopted children of American citizens?
3. What are the names of the US TB experts that gave their input into the writing of the technical instructions?
4. Do any of these experts specialize in pediatric TB?

Q: Are there any documented cases of another passenger contracting TB from a child flying with diagnosed disease?

A: To our knowledge, there are no documented cases of in-flight transmission from a child to another person.  However, there are documented cases* of adults transmitting tuberculosis on airplanes and documented cases* of children transmitting tuberculosis to other adults and children.  To protect the public, CDC does not want potentially infectious persons with tuberculosis, whether adults or children, on airplanes.

*Follow-up questions issued by the International Adoption Examiner that have yet to be answered by CDC:

1. You stated that there are documented cases of adults transmitting TB on airplanes. How many documented cases are there? 
2. You stated that there are documented cases of children transmitting TB to adults and other children. How many documented cases are there in the history of the world?

Read more responses from the CDC in the next installment of this interview.

*****PLEASE ALSO READ THIS ARTICLE FOR EXPERT INFORMATION ON PEDIATRIC TUBERCULOSIS: Interview with pediatric tuberculosis expert Dr. Jeffrey Starke******

  To take action against the CDC's TB policy for internationally adopted children:

1. Sign the Build Families, Not Barriers Petition
2. contact members of congress to ask them to take action to exempt this population of adoptees from the policy.
   

*photo of CDC headquarters in Atlanta - Wikipedia (Original uploader was at nl.en.wikipedia)

**To read the latest updates on this topic and all topics related to International Adoption, click on the subscribe button above this article.**