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School of Industrial & Labor Relations-------- Director, Institute for Workplace Studies

Cornell University

16 East 34th Street, 4th floor--------------------Stuart Basefsky

New York, NY 10016 -------------------------------Director, IWS News Bureau

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Congressional Research Service (CRS)

 

IMMIGRATION POLICIES AND ISSUES ON HEALTH-RELATED GROUNDS FOR EXCLUSION

Ruth Ellen Wasem

Specialist in Immigration Policy

August 13, 2014

http://fas.org/sgp/crs/homesec/R40570.pdf?

[Full-text, 16 pages]

 

Summary

News of humans infected with Ebola in West Africa, avian influenza in China, polio in the

Middle East, and dengue fever in the Caribbean are examples of reports that heighten concerns

about the health screenings of people arriving in the United States. Under current law, foreign

nationals who wish to come to the United States generally must obtain a visa and submit to an

inspection to be admitted. One of the reasons why a foreign national might be deemed

inadmissible is on health-related grounds. The diseases that trigger inadmissibility in the

Immigration and Nationality Act (INA) are those communicable diseases of public health

significance as determined by the Secretary of Health and Human Services (HHS).

 

Currently there are seven diseases deemed a communicable disease of public health significance:

chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum,

active tuberculosis, and infectious syphilis. Other diseases incorporated by reference are cholera;

diphtheria; infectious tuberculosis; plague; smallpox; yellow fever; viral hemorrhagic fevers

(Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named);

severe acute respiratory syndrome (SARS); and “[i]nfluenza caused by novel or reemergent

influenza viruses that are causing, or have the potential to cause, a pandemic.” The INA also

renders inadmissible foreign nationals who are not vaccinated against vaccine-preventable

diseases. Vaccinations are statutorily required for mumps, measles, rubella, polio, tetanus,

diphtheria, pertussis, influenza type B and hepatitis B. Vaccinations against other diseases may

also be required if recommended by the Advisory Committee for Immunization Practices (ACIP).

 

The Centers for Disease Control and Prevention (CDC) in HHS take the lead in protection against

communicable diseases among foreign nationals who come to the United States. The CDC are

responsible for providing the technical instructions to civil surgeons and panel physicians who

conduct medical examinations for immigration purposes. Foreign nationals who are applying for

visas at U.S. consulates are tested by in-country physicians who have been designated by the

State Department. The physicians enter into written agreements with the consular posts to

perform the examinations according to HHS regulations and guidance. Foreign nationals in the

United States who are adjusting to legal permanent resident status are tested by civil surgeons

designated by U.S. Citizenship and Immigration Services, an agency within the Department of

Homeland Security (DHS). CDC, in conjunction with Customs and Border Protection (CBP) in

DHS, operates 20 quarantine stations and has health officials on call for all ports of entry.

 

From an immigration standpoint, an outbreak of an infectious disease places substantial

procedural and resource pressures on CBP, which is charged with screening admissions of all

travelers at land, sea, and air ports of entry (POE). CBP officers screened approximately 362

million individuals in FY2013 for admissions into the United States. CBP works in conjunction

with the CDC to monitor travelers and attempt to contain any diseases that may be spread by

travelers coming from abroad. In the current context of the Ebola outbreak in West Africa, CDC

has emphasized exit-based airport screening from areas with Ebola, and not screening at POEs in

the United States. At this point, CDC assures that Ebola poses little risk to the U.S. general

population.

 

Congress has acted legislatively on the health-related grounds for exclusion several times in the

recent past. Congress also plays an important oversight role, particularly when concerns arise

regarding contagious diseases or potential pandemics.

 

Contents

Introduction ...................................................................................................................................... 1

Health-Related Grounds for Exclusion ............................................................................................ 2

Legislative History .................................................................................................................... 2

HIV/AIDS.................................................................................................................................. 3

Specified Communicable Diseases ............................................................................................ 3

Tuberculosis (TB) ...................................................................................................................... 4

Medical Examinations for Visas ...................................................................................................... 5

Waivers of the Health Grounds.................................................................................................. 6

Vaccination Requirements ......................................................................................................... 7

Port of Entry Procedures .................................................................................................................. 8

 

Tables

Table A-1. CDC Quarantine Stations by City and Location .......................................................... 11

 

Appendixes

Appendix A. CDC Quarantine Stations ......................................................................................... 11

Appendix B. CDC Technical Guidance ......................................................................................... 12

 

Contacts

Author Contact Information........................................................................................................... 13

Acknowledgments ......................................................................................................................... 13

 

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