Revised Technical Instructions for Panel Physicians related to Severe Acute Respiratory Syndromes based on Executive Order 13674

The President of the United States signed Executive Order 13674 on July 31, 2014.

The primary changes made by Executive Order 13674  was to replace “Severe Acute Respiratory Syndrome” (SARS) with “severe acute respiratory syndromes” and to specify that it is not limited to a single disease.  Under the updated Executive Order, HHS/CDC will have clear authority to isolate or quarantine individuals with SARS, Middle Eastern Respiratory Syndrome (MERS), or other severe acute respiratory syndromes.

Executive Order 13674 gives clear legal authority to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) to make MERS a communicable disease of public health significance. Diseases defined as a communicable disease of public health significance are inadmissible health-related conditions for U.S. immigration purposes. They are also quarantinable diseases. The authority to make this change is provided by 42 Code of Federal Regulations (CFR) Part 34.

Therefore, panel physicians should follow the updated instructions provided in the 2008 Addendum to the Technical Instructions for Medical Examination of Aliens: Updated Screening for Communicable Diseases of Public Health Significance. This addendum defines how panel physicians should screen for MERS and other severe acute respiratory syndromes.

As provided in the 2008 Addendum to the Technical Instructions for Medical Examination of Aliens: Updated Screening for Communicable Diseases of Public Health Significance, the overseas examination should continue to include a medical history, physical examination, and screening/diagnostic testing. The examination should also include:

• inquiry regarding contact an applicant has had with anyone who has or had a severe acute respiratory syndrome, such as MERS; any signs and symptoms suggestive of a severe acute respiratory syndrome; or any prior diagnostic evaluation and/or treatment for these diseases
• physical examination for communicable diseases of public health significance including, but not limited to, evaluation for fever, inspection for lesions and rash, and palpation of lymph node
• further testing to confirm a suspected diagnosis of a severe acute respiratory syndrome, if needed

Panel physicians should not perform specific screening tests or begin treatment for MERS on applicants without clinical indication. Any changes to requirements for screening tests and treatments should not be made without notification from HHS/CDC.

Background Information about 42 CFR Part 34

Under 42 CFR Part 34, a communicable disease of public health significance includes quarantinable diseases as defined by Presidential Executive Order.

This legal authority allows the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) to determine additional medical screening, testing, and treatment for diseases defined by Presidential Executive Order using a risk-based approach. This approach is based on medical and epidemiologic factors. Requirements only apply to medical examinations outside the United States and in geographic areas where the risk is high.

Under the risk-based approach, HHS/CDC may require immigrant applicants outside the United States to have additional screening, testing, and treatment for specific communicable diseases of public health significance. Screening decisions will be based on:

• the seriousness of the disease’s public health impact
• whether the emergence of the disease was unusual or unexpected
• risk of the spread of disease to the United States
• transmissibility and virulence of the disease
• impact of the disease at the geographic location of medical screening
• other specific pathogenic factors that would bear on a disease’s ability to threaten the health and security of the United States (e.g., travel history of the applicant or population of concern)

HHS/CDC will alert panel physicians when new or additional screening, testing, and treatment protocols for communicable diseases of public health significance are issued.

Technical Instructions for screening, testing, and treatment of the additional disease(s) under the risk-based approach will be provided to panel physicians. Until these instructions are made available by HHS/CDC, the panel physicians should continue to follow the 2008 Addendum to the Technical Instructions for Medical Examination of Aliens: Updated Screening for Communicable Diseases of Public Health Significance. Updates and information on a specific disease and additional medical screening, testing, and treatment protocol for the disease will be available on the CDC/DGMQ’s website.