Medical exclusion of immigrants

The current communicable diseases of public health significance include the following: Tuberculosis, Syphilis, Chancroid, Gonorrhea, Granuloma Inguinale, Lymphogranuloma Venereum, Hansen's Disease (Leprosy) and “quarantinable diseases designated by any Presidential Executive Order”. In 2009, 482 of the 993 potential LPRS that were originally denied for communicable disease were accepted. ==Vaccinations==

The vaccination requirement includes the following vaccinations: Mumps, Measles, Rubella, Tetanus, diphtheria, Meningococcal disease, Pneumococcal disease, Haemophilus influenzae type B, Rotavirus, Varicella, Influenza, Hepatitis A and B, Pertussis, and Polio. ==Examination==

The examination “consists of a physical examination, an evaluation (skin test/chest x-ray examination) for tuberculosis, and blood test for syphilis”. All immigrants are required to have this examination conducted by a panel physician overseas before they come to America. Foreign nationals pay for their own exam but the cost is covered by the US government for refugees. I-693, the Report of Medical Examination and Vaccination Record, is used to report the medical examination to officials. There is no filing fee for the I-693 form. ==Regulation==

Medical inspections fall under the authority of Customs and Border Protection (CBP) division the Department of Homeland Security (DHS), as it is responsible for the inspection of all people who enter the country. The medical exam guidelines are created by the Centers for Disease Control’s Division of Global Migration and Quarantine. The Department of Health and Human Services is responsible for “promulgating” the regulations. ==Legislative history==

Statutory health exclusion began with the Immigration Act of 1891, which barred “‘persons suffering from a loathsome or a dangerous contagious disease’”. Insanity was described “as a deranged condition, characterized by delusions, depression, or homicidal tendencies”. In 1907, the premise of exclusion based on mental health was expanded with the addition of “imbeciles, the feebleminded, and the physically or mentally defective." The Immigration Act of 1917 added the “classification of constitutional psychopathic inferiority” and lowered the criteria to be classified as insane to one previous attack of insanity (compared to previous two or more in 1907). This led to an increase in the percentage of rejected immigrants that were rejected based on medical criteria from two percent in 1898 to 57 percent in 1913 and finally to 69 percent in 1915. The inferior stock mentality was adopted in the quota system of the Immigration Act of 1924, which marked the beginning of examination of immigrants in their home countries. In the Immigration and Nationality Act of 1952 (INA), seven of the 31 grounds for exclusion were health-related. A few decades later, under the Immigration Act of 1990, the health related grounds were “streamlined and modernized all of the grounds for inadmissibility into nine broad categories”. Under the act, “Congress recodified the health-related ground for inadmissibility to include any alien “who is determined (in accordance with regulations prescribed by the Secretary of Health and Human Services) to have a communicable disease of public health significance”. In 1993, the National Institutes of Health Revitalization Act added HIV as excludable. This was done by a Congressional amendment that added exclusion based on “’infection with the etiological agent for acquired immune deficiency syndrome’”. HIV was later removed from the exclusions in 2009 and effective by law on January 4, 2010. The vaccination requirement was added with the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. Vaccinations were required for “nine ‘vaccine-preventable diseases’” including: “mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B”. ==Historical inspection process==

===Ellis Island=== There were four inspection lines separated by iron railings, which then converge into two lines As the immigrants, primarily European, walked through the lines there were six details of quick glance inspection: “the scalp, face, neck, hands, gait, and general condition, both mental and physical”. The “immigrants traveling third class, or steerage, were subjected to a medical inspection designed to weed out the diseased or mentally unfit once they arrived at the entry port”. ===Angel Island === This was a port with a large proportion of Chinese, Japanese and Korean immigrants. At the border, “entrants were stripped naked, showered with kerosene, examined for lice and nits, and vaccinated against smallpox”. These baths lasted into the 1920s. In 1917 an inspection and quarantine was issued based on a threat for typhus. The threat lasted for several months, the medical inspection continued into the 1930s after there was no longer a serious threat. Medical inspection of Mexican immigrants was not opposed because health was a prerequisite for labor. The inspections were also differentiated by class, as “a sizeable number of Mexicans—especially recognized commuters, those who were well dressed, and those who rode first class on the train—were exempted from the disinfection drill”. ==References==