Alameda County TB control officer Dr. Robert Benjamin warned that tuberculosis among H-1B visa holders has dramatically increased.

"During the dot-com boom, we in Alameda County and I know other Bay Area counties saw a dramatic increase in tuberculosis among the (H-1B) visa immigrants," said Benjamin, the Alameda County TB control officer." [New TB threat: Global ties bring an ancient disease to Silicon Valley By Mike Swift, San Jose Mercury News, April 18, 2008]

Dr. Benjamin laments the fact that H-1Bs aren't screened for TB.

"I don't know how or why, but at some point a decision was made by the State Department that if a U.S. company sponsors a highly educated, highly skilled worker, that they don't need screening . . . . I think that just because they are highly educated and have a job doesn't mean they can't have TB."

Dr. Benjamin is correct that H-1Bs aren't required to be screened for TB, but he is wrong that the State Dept. changed their policy – H-1B nonimmigrants have never been required to be screened for infectious diseases, although some employers may ask that their H-1Bs be tested.

Believe it or not, there is a rationale to justify the avoidance of screening H-1Bs for TB. To understand the reasoning, however flawed it may be, it has to be understood that nonimmigrants, on temporary visas, and immigrants, who seek permanent residency, are considered very differently. H-1B visas are nonimmigrant, which in theory means that they come to this country temporarily and therefore are considered a lower risk of being a disease vector than a permanent immigrant.

H-1Bs are unlikely to ever get tested for TB unless they apply for a change of status to a green card. Once they apply for a green card they must get a TB test. Even if they test positive for TB they won't necessarily be rejected because they can apply for a waiver by filing "I-601, Application for Waiver of Grounds of Inadmissibility".

All of this means that H-1B visas holders can be here for six years without ever being tested for tuberculosis. So, if in the period of six years the H-1B coughs, sneezes, or shouts the germs will spray into the air. Anyone who breathes their aerosol can be infected with the disease.

You may be wondering what kind of idiot politician would allow this to happen. I gotta surprise for you – it's not politicians, it's the AMA! Many of their politically correct physicians decided that the risk of tuberculosis is outweighed by the advantages of open border politics.

TB screening of nonimmigrant visitors, who are unlikely to have active TB and even less likely to transmit it, will be of extremely low yield, would significantly deviate from the US "open-door" policy for nonimmigrants, and would have great logistical and political implications. [Screening nonimmigrant visitors to the United States for tuberculosis: report of the Council on Scientific Affairs., Tan L, Altman RD, Nielsen NH; Council on Scientific Affairs, American Medical Association., Arch Intern Med. 2001 Feb 12;161(3):334-40.]

Of course medical researchers and doctors wouldn't rely on crass politics to fully justify this non testing policy. They did a cost vs. benefit analysis to figure out that testing nonimmigrants is just too dang expensive.

Screening and monitoring the nonimmigrant foreign-born population would divert valuable resources from now established, successful TB control programs for foreign-born immigrants.

PubMed doesn't allow free access to the entire medical study, so I wasn't able to see which group of shameless corporations paid for the study.