Tarrant County Public Health’s Tuberculosis Elimination is working in cooperation with the Texas Department of State Health Services (DSHS) to provide incoming displaced persons from around the world with screenings for general health, nutrition and tuberculosis (TB). General health screening includes Testing for HIV, blood pressure, vision testing, parasite testing, preexisting conditions and medication usage, and pregnancy. Blood tests, weights and heights are evaluated for nutrition. Skin testing, immigration medical evaluation and chest x-rays as needed are done to evaluate for tuberculosis. Immunizations for immigration requirements are done in TB/Refugee, for people that have newly arrived, or older arrivals with certain eligibilities. Adults as well as children are serviced in the TB/Refugee program.

Refugees come to the United States for a variety of reasons, the most widely known reason being escaping from war torn areas, or political/personal persecution. That being the case several categories has been established to classify the people entering the United States.

• Refugee
• Asylee
• Class B Immigrant
• Class B Refugee

1. Refugee- by definition is escaping an area of conflict.
   1. apply to United States for refugee status
   2. go through a screening process for disease and vaccinations
   3. can take up to 10 years
2. Asylees- are under the protection of the United States Government
   1. had a visa to enter the United States or are here illegally
   2. asked the government for asylum due to threats to their personal safety
3. Class B Immigrant- are immigrants into the United States but have a medical condition that must be addressed soon after arrival i.e.: Abnormal chest x-ray, pregnancy, HTN, Cancer, HIV.
4. Class B Refugees- are considered the same as regular refugees except for abnormal medical findings on their pre-departure physical that is done in the country of origin.

All Immigrants are generally family sponsored where refugees and asylees are generally assisted by a Volage (volunteer agency).

When a Refugee, Asylee, comes to Tarrant County they are generally met by their sponsor, in the case of refugees and asylees it is their Volage, who have called and made an appointment for an initial visit with our staff. This first visit includes:

1. TB skin test
2. Supplies for parasite testing
3. Depending on country of origin HIV/STD screen
4. HCT level for general nutrition
5. Medical interview
6. Height, weight and eye test
7. And a referral to JPS international health clinic for medical examination and treatment.

  The second visit is 2-3 days later and it includes:

1. Reading of the TB skin test
2. Collection of sample for parasite testing
3. Frist set of vaccinations for immigration
4. Open chart if client has a positive skin test.
5. A medical clinic appointment is made for the client to return to the clinic to see the Doctor

TCHD Refugee services also do the form Supplemental I-693 for application for Green Cards. The following is a list of required vaccinations that must be completed prior to applying for a Green Card.

1. For adults born 1956 and before
   1. 3 doses of Td.
   2. 2 doses of Varicella.
2. For adults 18 year old and up, but born after 1956
   1. 3 doses of Td.
   2. 2 doses of MMR
   3. 2 doses of Varicella.
3. 3. For children (13 years to under 18 years)
   1. 3 doses of Hep B
   2. 3 doses of Td
   3. 3 doses OPV/IPV
   4. 2 doses of MMR
   5. 2 doses of Varicella
4. For children (6 years to under 13 years)
   1. a. 3 doses Hep B
   2. 3 doses of Td
   3. 3 doses of OPV/IPV
   4. 2 doses MMR
   5. 1 dose Varicella
5. 5. For children (4 years to under 6 years)
   1. 3 doses Hep B
   2. 4 doses DTP/DTaP
   3. 4 doses OPV/IPV
   4. 2 doses MMR
   5. 1 dose Varicella
6. For children (1 year old to under 4 years old)
   1. 3 doses of Hep B
   2. 4 doses of DTP/DTaP
   3. 4 doses of OPV/IPV
   4. 2 doses HIB
   5. 1 dose MMR
   6. 1 dose Varicella

Finally for all clients that do test positive for TB, and are started on treatment, their care is managed and medications maintained, and all follow up lab work is done by the Refugee Services Staff.

For more information, contact: