Figure 2. Domestic screening protocol for refugees who had an IGRA test prior to departure (most children aged 2–14 years)

Alternative Text

Figure 2’s flowchart outlines the domestic screening algorithm for most refugee children aged 2-14 years.
If there are ANY signs or symptoms of TB disease, then the refugee should receive a clinical evaluation for TB disease. If there are not any signs or symptoms of TB disease, then was there a documented pre-departure IGRA?
•	If no, then screen for LTBI with IGRA.
•	If yes and the IGRA was negative, has it been >6 months since the pre-departure IGRA?
o	If no, then rescreen for LTBI with IGRA (or TST) 6-12 months after initial test.
o	If yes, then rescreen for LTBI with IGRA.
•	If yes and the IGRA was positive, then review the pre-departure CXR.
•	If pre-departure CXR was negative, offer LTBI treatment, if no contraindications*
•	If pre-departure CXR was positive, is the evidence suggestive of TB and completed DOT?
o	If no (B1*), consider repeating CXR and evaluate for further signs and symptoms of TB disease.
o	If yes (B0**), no further action if no signs or symptoms of TB disease.
•	If repeating CXR and evaluating for further signs and symptoms of TB disease, are the findings concerning for TB disease?
o	If no, offer LTBI treatment, if no contraindications.
o	If yes, consider overseas results and current clinical and CXR findings to determine if further investigation and sputum testing are warranted.
*In rare circumstances, refugees may receive LTBI treatment prior to departure. In this case, if no signs or symptoms of TB disease, further evaluation is not needed.
**Refugees that received tuberculosis therapy as DOT, carefully supervised by a US panel physician, will be classified as B0. Those treated outside the panel physician system will be classified as B1 TB, Pulmonary. State and local TB officials will be notified via the EDN of arrivals with Class B status.
Note: Either IGRA or TST are acceptable tests. However, IGRA is preferred for children ≥5 years of age.