HEALTH CARE INFORMATION

Dear New ESU International Student,
Welcome to Emporia State University and the ESU Student Health Service. Our mission is to provide quality health care for all ESU students. Preventative health care is part of that mission. For this reason Emporia State University Administration has adopted a mandatory tuberculosis testing policy. This policy is available online at http://www.emporia.edu/shc/international.htm

The policy requires testing of all students that have spent more than four months in a country with a high incidence of tuberculosis. INTERNATIONAL STUDENTS FROM HIGH RISK COUNTRIES MUST COMPLETE TESTING REQUIREMENTS TO BE ABLE TO REMAIN IN CLASS. This testing must be done in the US. Test results from outside the United States will not be accepted. To simplify the testing process, the ESU Student Health Service will have a TB test clinic for International students during your enrollment process. (Contact the Health Center for further details at 620-341-5223, or shc@emporia.edu.) The skin test is $5.00 and if your skin test is positive, you will be sent to the local Flint Hills Community Health Center to have a chest x ray (for which there is a charge) and to receive free TB medication. If you are tested in the United States prior to arriving at Emporia State University, bring the test results to the ESU Student Health Center as soon as you arrive at ESU.

For your information, healthcare is VERY EXPENSIVE in the United States. ESU requires that all International Students purchase health insurance prior to coming to ESU. The Kansas Board of Regents policy through United Healthcare-Student Resources (http://www.uhcsr.com) is the only policy accepted at ESU Student Health Service. To purchase this policy, contact them at 1-888- 344-6104.

The following list of countries have a low incidence of TB. Students from these countries do not have to be tested unless they have spent more than four months in any country other than that listed below. STUDENTS FROM ANY COUNTRY NOT LISTED BELOW MUST BE TESTED.
American Region:
Canada
St Kitts and Nevis
Virgin Islands (USA)
USA
Saint Lucia
Jamaica
European Region:
Belgium
Denmark
Finland
France
Germany
Greece
Iceland
Ireland
Italy
Liechtenstein
Luxembourg
Malta
Monaco
Netherlands
Norway
Sweden
Switzerland
United Kingdom
Western Pacific Region:
American Samoa
Australia
New Zealand

We look forward to having you on campus at Emporia State University.

ESU Policy on TB testing for At-risk Students

Effective: July 1, 2005

Tuberculosis (TB) continues to be a highly infectious, potentially life threatening disease. Because of the increase in TB worldwide, and in response to the Centers for Disease Control (CDC) recommendations regarding strategies for TB control, Emporia State University (ESU) is instituting a mandatory prevention and treatment policy for all at-risk students.

Testing Requirements
Mantoux tuberculin skin testing (PPD) is required for the following groups of students at Emporia State. (A chest x-ray will be required if the skin test is positive.)
IMPORTANT: Please be certain to inform the health service staff if you have EVER had a positive TB skin test or have EVER been treated for TB. In either case, you should not receive the TB skin test.
. New and re-entering foreign-born, non-immigrant undergraduate, and graduate students from high risk countries (see definition).
. Any Emporia State student who has participated in international travel to a high-risk area and remained in a high-risk area (see definition below) for greater than 4 months as part of an official university program. Testing should be done 6-12 weeks after the student's return.
. Any Emporia State student who has lived in a high-risk area (see definition) for greater than four months, who has not had subsequent PPD testing.
. Graduate students from high-risk countries who were previously enrolled as undergraduates at Emporia State must undergo a verbal screening, even if previously tested as an undergraduate.

Testing Recommendations
Mantoux tuberculin skin testing is recommended for the following groups at Emporia State. ( A chest x-ray will be recommended if the skin test is positive.)
. Any student not included in the groups listed above who has traveled to a high-risk area within the past year.
. Any faculty or staff member who has traveled to a high-risk area within the past year. Faculty and staff may access TB skin testing through their regular health care provider, or through Emporia State University Student Health Service.
. All non-immigrant visiting scholars from high-risk countries (see definition).
. Persons with positive PPD skin tests will be asked to have their children (if any) evaluated at the Lyon County Health Department for possible tuberculosis.

Definition of high-risk country*
All countries of the world are high risk with the EXCEPTION of:
American Region:
Canada USA
St Kitts and Nevis Saint Lucia
Virgin Islands (USA) Jamaica
European Region:
Belgium Iceland Monaco
Denmark Ireland Netherlands
Finland Italy Norway
France Liechtenstein Sweden
Germany Luxemborg Switzerland
Greece Malta United Kingdom
Western Pacific Region:
American Samoa Australia
Sources: American College Health Association in conjunction with the Centers for Disease Control and Prevention and the World Health Organization

Implementation
All students who have lived outside the USA, or participated in an ESU sponsored program in a high risk area for greater than four months are considered high risk

All high risk students will be expected to attend a Student Health Service sponsored TB screening clinic in August (or January) before attending class at ESU and will be expected to participate in the TB screening and if necessary, testing. If they do not comply, they will not be allowed to continue classes. TB tests performed in other countries are not accepted.
Testing
ESU will use only the Mantoux purified protein derivative (PPD) test. After the test is administered, it must be read within 48-72 hours. Any reading outside this time frame is not acceptable and must be repeated.

If the PPD is done at another health care facility in the US, the date of test and the results must be documented on an official form and validated with the signature or stamp of the physician or other authorized official.
Having a prior history of BCG (Bacillus Calmette-Guerin vaccine) is not a contraindication to PPD skin testing or chemoprophylaxis.
The PPD test done in a foreign country will only be accepted if the PPD is positive and equal to or greater than 10 mm and all documentation is as described above. Documented negative tests from other countries will not be accepted and must be repeated.
If the PPD results are positive, the student must have a chest x-ray. If the student has had a history of a positive skin tests elsewhere, he or she must have had a clear chest x-ray within the last three months for an exception to this requirement. Chest x-ray reports from other countries may be accepted at the discretion of the health care provider. Chest x-ray results from the United States will be accepted. All positive PPD results will be sent to the Lyon County Health Department, who will make arrangements for a Chest X-Ray (CXR) and bill Student Resources (SR) Insurance Company for those students who have SR insurance. Otherwise the student will be responsible for paying for the CXR.
Also exempted are individuals with a previous positive skin test who have a certificate of completion of INH preventive therapy or completion of TB therapy. These persons must undergo verbal screening.
If PPD results are positive and the chest x-ray is negative for active TB (Latent TB), the student will be encouraged by the Lyon County Health Department to take isoniazid (INH) preventative medication for 6-9 months, if there are no contraindications. The medication is free through the Lyon County Health Department. If the chest x-ray is abnormal and/or suggestive of active TB, the Lyon County Health Department will do further testing including sputum AFB (acid fast bacillus) and TB cultures.

The student with latent TB who will not accept treatment will be given a handout listing the warning signs of active TB. They will be encouraged to return to student Health promptly if any of these symptoms develop.

The student with active TB will not be allowed to attend classes for two weeks and/or until sputum tests are clear of obvious TB germs. He/she will be required to participate in directly observed therapy(DOT) at the Lyon County Health Department until therapy is completed

Persons with active TB will be strongly encouraged to have an HIV test, as HIV status must be considered in determining an appropriate TB treatment plan.

Students with active TB will be strongly encouraged to disclose the names of close contacts so these people can be informed of their possible exposure and appropriately counseled, screened and treated.

Spouses and other family members will be encouraged to be seen at their physician/Lyon County Health Department for screening/treatment.

Exceptions
A single one-semester delay for TB testing will be permitted only if the student has had a live virus vaccine such as Measles, mumps, rubella or yellow fever in the past eight weeks, or at the physicians discretion

Reading the test
The reading should be based on the diameter of induration, not erythema and should be measured in millimeters.

Classification of PPD reaction:
1. 5 or more mm is positive for the following groups:
a. Persons who have close contact with an individual with infective TB
b. Persons with HIV infection
c. Persons who have chest x-rays with fibrotic lesions likely to represent old, healed TB
2. 10 or more mm is positive for the following groups:
a. Foreign born persons from high risk areas
b. Medically under-served low-income groups
c. Intravenous drug users
d. Persons with known medical risk factors
e. Health care workers
f. American students who have traveled abroad

3. Fifteen mm or more is positive for all students with no known risk factors. It is recommended that the PPD be repeated in 4-6 months for low-risk students with 10-15 mm reactions

Preventive therapy
If a student has regularly taken the INH for at least half of the recommended period and voluntarily quits for a period of less than one year, the student can be re-started on INH preventative therapy with little concern for the development of INH resistant germs.

Once a student has had a positive PPD and negative chest x-ray, yearly screening for TB is no longer required. A student is expected to recognize symptoms of active TB and report to the Health Center if they identify possible symptoms in themselves.

If a student with a positive PPD elects to accept treatment, the treatment will be provided at no charge by the Lyon County Health Department. TB preventive therapy is a 6-9 month course of INH ant 300 mg/day and vitamin B6 at 50 mg/day. The patient will be asked to take the medication unless they have symptoms of a reaction.

TB therapy may need to be individualized given the patient's allergies and the sensitivity patterns of his/her TB germs