Active Infectious Tuberculosis
Infectious disease involving the lungs, pleura, larynx, or intrathoracic lymph nodes can be Class A based on culture, molecular, clinical, imaging, and public-health findings.
INA §212(a)(1)(A)(i) Immigration Medical Inadmissibility
Communicable Disease of Public Health Significance
Immigration inadmissibility does not apply to every infectious disease. The current routine Class A diseases are active infectious tuberculosis, infectious syphilis, gonorrhea, and infectious Hansen disease. Certain quarantinable diseases and emerging diseases designated through the federal public-health framework may also qualify. The exact test result, disease stage, infectiousness, treatment, physician classification, and current CDC Technical Instructions determine whether the applicant is Class A, Class B, or medically cleared.
Nationwide and international immigration representation through Messersmith Law Firm, P.A.
The Regulatory Definition
Only Designated Diseases Create This Ground
INA §212(a)(1)(A)(i) applies when an applicant is determined, under HHS regulations, to have a communicable disease of public health significance. The controlling definition appears in 42 C.F.R. §34.2 and is implemented through current CDC Technical Instructions.
The regulation includes active tuberculosis, infectious syphilis, gonorrhea, infectious Hansen disease, diseases listed in a presidential executive order as quarantinable, and qualifying communicable diseases that CDC determines present an international public-health emergency and a threat of importation.
- Active tuberculosis
- Infectious syphilis
- Gonorrhea
- Infectious Hansen disease
- Designated quarantinable diseases
- Qualifying emerging diseases announced through federal procedures
The Four Routinely Screened Diseases
Current Class A Communicable-Disease Categories
Infectious Syphilis
Applicants meeting current serologic and clinical criteria without adequate treatment remain Class A until acceptable treatment is documented.
Gonorrhea
Untreated infection confirmed through required immigration testing is Class A. Completion of required treatment produces Class B classification.
Infectious Hansen Disease
Untreated paucibacillary or multibacillary disease is Class A. Appropriate treatment underway permits Class B classification.
A Narrow Disease List
An Infection Is Not Inadmissible Merely Because It Is Contagious
Influenza, hepatitis, chlamydia, malaria, and many other infections are not automatically permanent Class A conditions. Some may become relevant through quarantine, outbreak, public-health-emergency, vaccination, or medical-hold rules.
Chlamydia may be detected through combined testing and treatment may be offered, but CDC instructions state that it is not a Class A immigration condition.
Tuberculosis
Positive IGRA Does Not Equal Active Infectious TB
The domestic process generally begins with an interferon-gamma release assay for applicants age two or older. Symptoms, known HIV infection, a positive IGRA, or specified findings can require chest imaging and referral to the local health department.
An abnormal x-ray, symptoms, known HIV infection, or extrapulmonary TB can require three early-morning sputum specimens. Negative molecular testing does not by itself rule out infectious TB; required cultures must complete incubation.
- Positive culture or clinically diagnosed infectious disease: Class A
- Completed infectious-TB treatment: Class B0
- Suggestive findings but negative cultures and no disease diagnosis: Class B1
- Positive IGRA with non-suggestive x-ray and no infectious disease: Class B2 latent TB
- Extrapulmonary disease requires chest and sputum analysis under current instructions
Tuberculosis Classification Errors
Common TB Medical-Exam Problems
BCG Used to Dismiss IGRA
BCG history does not replace required IGRA analysis and generally does not explain away a positive IGRA.
Skin Test Substituted for IGRA
The current domestic immigration process generally requires IGRA rather than a tuberculin skin test.
Required X-Ray Omitted
Positive IGRA, symptoms, known HIV infection, or other findings can require chest imaging.
Incomplete Sputum Process
Three specimens, health-department oversight, and complete culture incubation may be required.
Old Tests Reused
The immigration exam is a snapshot in time, and required testing generally must occur in the current process.
Latent TB Labeled Class A
A positive IGRA without infectious disease generally produces Class B2, not inadmissibility.
Syphilis
Required Age-Based Testing and Treatment
Current civil-surgeon instructions require testing of all applicants age eighteen through forty-four. Applicants younger than eighteen or age forty-five and older are tested when there is reason to suspect infection.
The civil surgeon must order both nontreponemal and treponemal testing during the immigration examination, and the tests must be performed on the same blood sample. Outside or earlier testing can inform history but ordinarily does not replace the required testing.
- Traditional or reverse algorithm may be used
- Current CDC criteria determine whether infection is established
- Unknown or inadequate treatment may require Class A classification
- Required treatment must be documented
- After acceptable treatment, the applicant is generally Class B
Gonorrhea
NAAT Testing and Directly Observed Treatment
Current civil-surgeon instructions require testing for all applicants age eighteen through twenty-four. Applicants outside that range are tested when there is reason to suspect infection.
The civil surgeon must order the NAAT during the examination. Testing performed earlier or ordered by another provider does not substitute for the required test. Untreated infection is Class A. Treatment must be completed before the report is signed.
- NAAT ordered by the civil surgeon
- Untreated gonorrhea: Class A
- Onsite directly observed treatment
- Completed treatment: Class B
- Suspected treatment failure requires culture and susceptibility testing
Hansen Disease
Specialist Evaluation and Seven Days of Appropriate Treatment
Suspected Hansen disease must be referred to an experienced clinician or clinic. The specialist’s evaluation, clinical classification, biopsy findings where appropriate, treatment regimen, and report must return to the civil surgeon before the exam can be completed.
Untreated paucibacillary and multibacillary forms are Class A. Once the applicant completes at least seven days of recommended therapy including daily rifampin and treatment is underway, the condition can be reported as Class B.
- Referral to an experienced Hansen disease provider
- Histopathologic and clinical classification where required
- Untreated disease: Class A
- At least seven days of proper treatment: Class B
- Continued care coordinated with the National Hansen’s Disease Program
HIV and Historical Changes
HIV Infection Is Not an Immigration Class A Disease
HHS removed HIV infection from the inadmissibility list effective January 4, 2010. Routine HIV testing is not required as part of the immigration exam, and HIV infection alone does not require Form I-601 waiver processing.
Chancroid, granuloma inguinale, and lymphogranuloma venereum are also no longer among the specifically named diseases in the current regulation.
Emerging and Quarantinable Diseases
How a Disease Outside the Routine Four Can Become Relevant
Executive-Order Disease
The regulation incorporates diseases listed in the current presidential executive order under federal quarantine law.
International Emergency
CDC may determine that a disease meeting regulatory factors threatens importation and could affect U.S. public health.
Medical Hold
HHS may defer inspection at a port of entry until the health concern is resolved.
Updated Instructions
CDC can publish new testing, classification, treatment, and reporting rules in response to a public-health threat.
Temporary Quarantine
Isolation, testing, observation, or travel delay may resolve a concern without lasting Class A inadmissibility.
Date-Specific Review
The announcement and Technical Instruction in effect on the exam or admission date determine the consequence.
Treatment and Reclassification
Many Class A Communicable Diseases Are Temporary
The most effective response is often to complete treatment specified by current CDC instructions and return to the designated physician for reclassification. Treatment can remove the inadmissible classification without requiring waiver discretion.
The physician must document diagnosis, laboratory evidence, treatment regimen, dates, clinical response, and final classification. A private doctor’s letter does not automatically change the official report.
INA §212(g)(1)
Communicable-Disease Waiver
A waiver may permit immigration despite a continuing Class A condition when statutory eligibility and public-health safeguards are established.
Eligible Relationship or Category
Eligibility may arise through qualifying relationships to a U.S. citizen, lawful permanent resident, or immigrant-visa holder, or another statutory category.
U.S. Medical Provider
A physician or facility may need to accept responsibility for evaluation, treatment, and follow-up shortly after arrival or adjustment.
Public-Health Coordination
CDC and health departments may impose reporting, treatment, travel, escort, bond, or other protective conditions.
Favorable Discretion
USCIS considers risk, compliance, treatment, immigration history, family need, humanitarian factors, and practical safeguards.
Prompt U.S. Evaluation
Current CDC guidance requires health-waiver applicants to be evaluated by the identified provider within thirty days after arrival or adjustment.
Form I-601
Immigrant and adjustment applicants generally request the waiver on Form I-601 with medical and treatment documentation.
A Waiver Is Often Unnecessary After Treatment
Applicants who complete infectious-TB treatment no longer need a waiver for that condition. Syphilis, gonorrhea, and Hansen disease can also generally be reclassified after treatment.
Challenging an Incorrect Finding
Correct the Classification Through Medical Evidence and the Authorized Process
A legal brief cannot substitute for the required medical classification. Identify the diagnostic, testing, documentation, treatment, or Technical Instruction error and obtain the appropriate correction, specialist report, reexamination, or medical review.
- Obtain the completed medical report and supporting tests
- Identify the exact Class A code and factual basis
- Compare the testing sequence with current instructions
- Obtain complete prior-treatment records and a specialist opinion
- Return to the designated physician for correction when appropriate
- Respond with the corrected official record
Evidence Checklist
Documents Needed for Communicable-Disease Review
Official Immigration Medical Evidence
- Complete Form I-693 or Department of State medical forms
- Class A or Class B code and physician remarks
- IGRA, x-ray, sputum smear, culture, and molecular results
- Syphilis nontreponemal and treponemal results and titers
- Gonorrhea NAAT, culture, and susceptibility results
- Hansen disease specialist evaluation and histopathology
- Health-department referral and clearance records
- RFE, refusal, medical-hold, or public-health notice
Treatment, Correction, and Waiver Evidence
- Medication, dose, date, adherence, and directly observed therapy records
- Prior diagnosis and complete treatment documentation
- Specialist opinions addressing infectiousness and classification
- Corrected civil-surgeon or panel-physician report
- U.S. physician or facility acceptance for continuing care
- Health-department approval where required
- Qualifying relationship and immigration-status evidence
- Form I-601, treatment plan, finances, and discretionary evidence
Related Health-Related Pages
Review the Complete Immigration Medical Issue
Health-Related Grounds
Review all four medical inadmissibility categories and remedies.
Review the health-related hub →Vaccination Requirement
Review vaccines, blanket waivers, records, and religious objections.
Review vaccination rules →Mental Disorder and Harmful Behavior
Review diagnosis, behavior, recurrence, Class A findings, and waivers.
Review harmful behavior →Drug Abuse or Addiction
Review controlled-substance disorders, remission, and waiver limits.
Review substance-related grounds →Class A Medical Condition
Review treatment, reclassification, correction, and waiver strategy.
Review Class A conditions →Medical Exam Problem
Review deficient forms, physician errors, RFEs, and reexamination.
Review medical-exam problems →Experienced Immigration Counsel
Representation for Communicable-Disease Inadmissibility
Messersmith Law Firm, P.A. represents adjustment and immigrant-visa applicants facing Class A tuberculosis, syphilis, gonorrhea, or Hansen disease findings; medical holds; deficient examinations; incorrect classifications; and Form I-601 waiver issues.
These cases often require coordination with civil surgeons, panel physicians, health departments, infectious-disease specialists, tuberculosis programs, the National Hansen’s Disease Program, USCIS, CDC, and consular officers.
The strongest strategy may be treatment and reclassification, proof that disease is latent or noninfectious, correction of testing or documentation errors, a new designated examination, or a detailed waiver plan.
Frequently Asked Questions
Questions About Communicable-Disease Inadmissibility
The result depends on the disease, infectiousness, examination date, testing method, treatment, official classification, immigration category, and current instructions.
Which communicable diseases can make an immigration applicant inadmissible?
The routinely screened diseases are active infectious tuberculosis, infectious syphilis, gonorrhea, and infectious Hansen disease. Quarantinable diseases listed by executive order and certain diseases declared by CDC to present a public health emergency of international concern may also qualify.
Does a positive tuberculosis blood test make someone inadmissible?
Not by itself. A positive IGRA with no symptoms, no known HIV infection, and a chest x-ray not suggestive of infectious disease is generally Class B2 latent tuberculosis infection. Active infectious tuberculosis is the Class A condition.
Must latent tuberculosis be treated before Form I-693 is completed?
No. Treatment is medically encouraged, and the applicant must be reported to the appropriate health department, but CDC instructions state that completion of latent-TB treatment is not required before medical clearance because latent infection is not a Class A condition.
When does syphilis create a Class A condition?
An applicant with laboratory findings meeting the CDC syphilis criteria and no adequate documented treatment is Class A until properly treated. After acceptable treatment is completed and documented, the applicant is generally classified as Class B.
Who must be tested for syphilis during the domestic immigration exam?
Under current CDC civil-surgeon instructions, all applicants age 18 through age 44 must be tested. Applicants younger than 18 or age 45 and older must be tested when there is reason to suspect infection.
Who must be tested for gonorrhea?
Under current CDC civil-surgeon instructions, all applicants age 18 through age 24 must be tested. Applicants outside that range must be tested when there is reason to suspect infection. The civil surgeon must order the required NAAT during the immigration examination.
How is Hansen disease treated for immigration purposes?
Untreated Hansen disease is Class A. Under current CDC instructions, once the applicant has completed at least seven days of recommended therapy including daily rifampin and appropriate treatment is underway, the condition may be classified as Class B.
Is HIV infection a communicable-disease ground of inadmissibility?
No. HIV was removed from the immigration list effective January 4, 2010. Routine HIV testing is not required for immigration medical screening, and HIV infection by itself does not require a health-related waiver.
Can a Class A communicable disease be waived?
Potentially. INA Section 212(g)(1) and Form I-601 provide discretionary relief for certain qualifying applicants. The filing may require an eligible family relationship, a complete treatment and public-health plan, acceptance by a U.S. physician or facility, and compliance with conditions imposed by USCIS after consultation with CDC.
Is treatment usually better than filing a waiver?
Often yes. Syphilis, gonorrhea, and Hansen disease can generally be reclassified after the required treatment, and applicants who complete treatment for infectious tuberculosis no longer need a waiver for that condition. A waiver is usually reserved for exceptional circumstances when treatment cannot be completed before admission or adjustment.
Case-Specific Medical and Legal Review
A Positive Test Does Not Automatically Mean Immigration Inadmissibility
Identify the designated disease, confirm required testing and infectiousness criteria, distinguish Class A from Class B, document treatment, obtain official reclassification or correction, and determine whether a waiver is necessary or treatment can resolve the case faster.
This page provides general information and does not create an attorney-client relationship or constitute legal or medical advice. Immigration consequences depend on the specific disease, tests, treatment, examination, classification, agency, immigration category, and law involved.