TB test is a requirement for international, med students

October of freshman year is full of stress — roommates, midterms and, for some students, waiting to find out if you have tuberculosis.

For some, this test is a requirement for their field of study. For others, it is a consequence of their nation of origin.

The Student Health Service requires all incoming students to complete a questionnaire designed to identify students at risk for tuberculosis.

All incoming students in the Schools of Medicine, Nursing, Dentistry and Social Policy and Practice, as well as those who have worked with vulnerable populations in the United States or who have certain medical conditions, are also required to undergo a tuberculosis skin test.

A student’s nation or origin represents a controversial condition for skin testing. Based on World Health Organization guidelines, SHS requires all international students from countries in South America, Africa, Asia and the former Soviet Bloc to receive a skin test.

College junior Jane Lee was born in South Korea, but has lived in the United States since the age of three. She was surprised that she was required to get a skin test despite her long residency in the United States.

“You have to get this test because you’re from an unsanitary country, was how they made it sound,” Lee said.

SHS Director Evelyn Wiener attributes these negative reactions of some international students to false beliefs about the Bacillus Calmette-Guerin vaccination routinely administered in infancy in some countries.

There is disagreement in the international community about the effectiveness of BCG in preventing tuberculosis, while a BCG vaccine administered in the past few years can induce a false positive reaction on a skin test.

“They have been instructed by their providers back home that BCG is effective. It’s not. They’ve been instructed that it’s going to make their skin test reactive. It isn’t,” Wiener said. “We try very much to recognize that there are differences between the medical culture in one country and the medical culture in another.”

Wiener said the testing of international students from countries with endemic tuberculosis is justified. SHS periodically identifies active cases of tuberculosis, almost exclusively among foreign-born students who received the BCG vaccine.

Of all tuberculosis cases in Philadelphia in 2007, 51.9 percent were found in foreign-born people, according to the Pennsylvania Department of Public Health. Of those cases, most came from people born in Asia or Africa. Only 9 percent of the Philadelphia population is foreign-born, according to the 2000 U. S. Census.

For some international students, the test highlights differences at a time when new students are struggling to find their place at Penn. Lee said she felt “betrayed” when she realized she needed to receive a skin test.

“Here I am, having been living in the States for so long, having been really acclimated as much as possible … and yet, there’s just subtle reminders that you’re an outsider, you’re a foreigner, you don’t really belong,” she said. “It’s just another instance of that.”

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