Medical Test Checklist For Refugees Entering The US

As refugees cross over into the US borders and arrive at the immigration centers or border facilities here is a listing of potential health screening tests that the medical examiners or physicians may order.  This listing serves as a guideline for physicians as to what to look for and also for the immigrants as to what they can expect.

physician's medical check list

General Medical Evaluation

History And Physical Examination

  • Nutrition and growth
    • Take nutritional history (e.g., restrictions, cultural dietary standards, food, allergies).
    • Collect anthropometric indices, including for kids, and, height, weight, head circumference.
  • Pregnancy test
    • Perform when clinically indicated before administration of any vaccines or medications which may present a risk.
    • Suggest prenatal vitamins and referrals for services if the test is positive.
  • Immunizations
    • Record previous vaccines, laboratory evidence of immunity, or a history of the disease.
    • Give age-appropriate vaccines as suggested. Complete any series that’s been initiated. (Don’t restart a vaccine series.)
      • Doses are valid if given according to state accepted schedules or ACIP.
      • If the patient has no past record, assume he or she is not vaccinated.
      • Laboratory evidence of immunity is an acceptable option according to the provider.

Mental Health Screening

Mental health screening is encouraged based on available services.

General Lab Testing

General laboratory testing is suggested for all refugees.

  • Recommendations for all refugees
    • Do complete blood count with differential and platelets.
    • Carry out urinalysis (optional in persons unable to provide a clean-catch specimen).
    • Consider testing glucose and serum chemistries.
  • Recommendations for infants
    • Conduct baby metabolic screening for newborns, according to state guidelines.

Disease-Specific Laboratory Testing

  • Tuberculosis
    • Review overseas records.
    • Assess for signs or symptoms of the disease, history of contacts, and physical examination (the low threshold for Evaluation).
    • Conduct a Tuberculin Skin Test or IGRA. (Utilization of IGRA in children < 5 years old isn’t encouraged.)
    • To get a positive screening test, perform chest x-ray and sputum testing as indicated.
  • Lead testing
    • Screen all refugee children six months to 16 years old.
    • Conduct an added lead test on all children aged six months — 6 years within 3-6 weeks of placement in a permanent residence, no matter the results of the initial lead test.
  • Malaria

Note: All SSA refugees who came from nations that are epidemic for Plasmodium falciparum and that don’t have a contraindication should be supposed to have obtained pre-departure presumptive antimalarial treatment with artesunate-combination therapy (ACT).

  • Refugees who need presumptive treatment or post-arrival testing include the following: (The most sensitive test for individuals with sub-clinical malaria is polymerase chain reaction (PCR); if PCR isn’t available, traditional blood movies or a quick antigen test may be used but have limited sensitivity in asymptomatic persons).
    • SSA refugees are receiving no possible treatment before departure. This includes any lactating or pregnant women, or kids weighing less than 5 kg at the time of departure, for whom possible treatment was contraindicated.
    • Any refugee from a malaria-endemic country with symptoms or signs of disease should get a comprehensive evaluation.
  • Refugees not needing post-arrival testing or possible treatment, including the following:
  • Intestinal and Tissue Invasive Parasites (ITIP)

Notes:

  • Post-arrival testing for invasive parasites (IP) will be based on the area of passing and pre-departure assumptive therapy obtained.
  • Currently, all refugees with no contraindications in South and Southeast Asia and the Middle East, and Africa get a single dose of albendazole before departure. Also, all SSA foreigners without contraindications obtain treatment. The only population currently getting presumptive therapy for Strongyloides is Burmese refugees, who get ivermectin if they do not have contraindications. For those who have contraindications or who didn’t get complete pre-departure treatment, the next ITIP screening is advocated:
    • For refugees who had no pre-departure presumptive treatment:
      • Nematodes/Roundworms (all refugees): Conduct stool ova and parasites evaluation (2 or more samples) or offer presumptive treatment.
      • Strongyloides (all refugees): Supply presumptive treatment or carry out testing for Strongyloides (e.g., Strongyloides agar/culture method, two or more parasites and stool ova examinations, and/or serologies for Strongyloides).
      • Schistosomiasis (SSA refugees): Offer presumptive treatment or plan serologies for schistosomiasis (for refugees who didn’t get praziquantel).
      • Absolute eosinophil count (periodically suggested as part of the hematology testing and isn’t sensitive or particular for invasive parasites, but a persistently raised count symbolizes the requirement for more investigation).
    • For refugees who received incomplete presumptive treatment:
      • Strongyloides (all refugees): Offer presumptive treatment or conduct diagnostics for Strongyloides (e.g., serologies for Strongyloides, two or more parasites and stool ova examinations, and/or Strongyloides culture/agar method).
      • Schistosomiasis: Give presumptive treatment or take serologies for schistosomiasis ( who didn’t receive praziquantel).
      • Absolute eosinophil count ( suggested as part of the hematology testing and isn’t sensitive or precise for invasive parasites, but a persistently raised count means the requirement for more investigation).
    • For refugees who obtained complete pre-departure presumptive therapy:
      • Absolute eosinophil count (routinely suggested as part of the hematology testing and isn’t sensitive or particular for invasive parasites, but a persistently raised count symbolizes the necessity for additional investigation)
    • STDs
      • Obtain history for symptoms and signs and conduct a physical examination.
        • Syphilis
          • If no documents, acquire RPR (rapid plasma regain) or VDRL (venereal disease research lab) for the following:
            • All refugees greater than 15 years old
            • Refugees less than 15 years old if
              • history of sexual abuse or sexually active
              • mum who tests or tested positive
              • Vulnerability in a country endemic for additional treponemal subspecies (e.g., yaws, bejal, print).
            • Conduct confirmation testing for positive treponemal tests.
  • Chlamydia
    • Conduct a pee nucleic addition test for the following:
  • Women less than 25 years old containing risks (e.g., new or multiple partners)
  • Women less than 25 years prehistoric that are sexually active
  • Leucoesterase (LE) positive on a urine sample
  • Women or children with a history of or at risk for sexual assault
  • Any refugee with symptoms
  • Gonorrhea
    • Carry out a urine nucleic amplification test for the following:
      • Women or children with a history of or at risk for sexual assault
      • Leucoesterase (LE) positive on a urine sample
      • Any refugee with symptoms
    • HIV

As of January 4, 2010, refugees are no longer screened for HIV infection.

  • All refugees should be screened unless they are opt-out. Refugees should be informed orally or in writing when/if they will be screened for HIV. A refugee’s choice to refuse an HIV test should be documented in the medical record.
    • Screening should be repeated 3-6 months after resettlement for refugees who are at risk or had exposure.
  • Provide culturally sensitive and appropriate counseling for most HIV-infected refugees in their primary spoken language and ensure the competence of bilingual staff and interpreters to offer patients language assistance to patients with limited English proficiency.
  • Refer all refugees verified to be HIV-infected for treatment, care, and preventative services.
  • Special considerations for kids:
    • Screen children <12 years old unless the mother’s HIV status could be confirmed as negative and the child is otherwise believed to be at reduced risk of disease (no history of high-risk exposures like blood product transfusions, early sex, or sexual abuse). In most situations, complete risk information won’t be available; consequently, most kids <12 years of age should be screened.
    • For kids <18 months of age, who test positive for HIV antibodies, the test with DNA or RNA assays. Results of antibody tests in this age group may be unreliable; they may detect persistent maternal antibodies.
    • Offer chemoprophylactic sulfamethoxazole/trimethoprim for all children born to or breastfed by an HIV-infected mother, beginning at six weeks of age and proceeding until they are confirmed to be uninfected.
  • Special considerations for pregnant women:
    • Test all pregnant refugee women as part of prenatal and the post-arrival screening and care.

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