Healthcare for adult immigrants and refugees
- Patricia F Walker, MD, DTM&H, FASTMH
Patricia F Walker, MD, DTM&H, FASTMH
- Professor of Medicine
- University of Minnesota
- Elizabeth D Barnett, MD
Elizabeth D Barnett, MD
- Professor of Pediatrics
- Boston University School of Medicine
- William Stauffer, MD, MSPH, CTropMed, FASTMH
William Stauffer, MD, MSPH, CTropMed, FASTMH
- University of Minnesota
Components of the health assessment for immigrants and refugees include addressing patient health concerns, screening for diseases associated with the country of origin and migration history, initiating age-appropriate immunizations, and routine healthcare maintenance. Guidance on a broad range of topics related to immigrant and refugee health in the United States is available from the United States Centers for Disease Control and Prevention . (See "Preventive care in adults: Recommendations".)
Issues related to healthcare for adult immigrants and refugees will be reviewed here; issues related to international adoption are discussed separately. (See "International adoption: Immunization considerations" and "International adoption: Infectious disease aspects".)
Migrants refer to individuals who come to resettle in a new country. Types of migrants include:
●Refugee – Someone who, "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country" . Refugees seek to establish their status as a refugee having fled their country of origin and while residing in a country of first asylum.
●Asylum seeker – An individual who has submitted a claim to a government for refugee status and is waiting for the claim to be accepted or rejected. Asylum seekers seek to establish their refugee status after fleeing to a country where they hope to be granted asylum.
- Centers for Disease Control and Prevention: Immigrant and Refugee Health www.cdc.gov/immigrantrefugeehealth (Accessed on January 30, 2014).
- United Nations High Commissioner for Refugees. 1951 United Nations Refugee Convention. http://www.unhcr.org/pages/49da0e466.html (Accessed on January 30, 2014).
- Centers for Disease Control and Prevention. Immigrant and Refugee Health: Overseas Interventions. http://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/interventions/index.html (Accessed on August 27, 2014).
- Centers for Disease Control and Prevention: Immigrant and Refugee Health—Guidelines for the US Domestic Examination for Newly Arriving Refugees www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/domestic-guidelines.html (Accessed on January 30, 2014).
- Pottie K, Greenaway C, Feightner J, et al. Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183:E824.
- Figueira M, Christiansen D, Barnett ED. Cost-effectiveness of serotesting compared with universal immunization for varicella in refugee children from six geographic regions. J Travel Med 2003; 10:203.
- Van Doorslaer E, Tormans G, Van Damme P. Cost-effectiveness analysis of vaccination against hepatitis A in travellers. J Med Virol 1994; 44:463.
- Cohen AL, Veenstra D. Economic analysis of prevaccination serotesting compared with presumptive immunization for polio, diphtheria, and tetanus in internationally adopted and immigrant infants. Pediatrics 2006; 117:1650.
- Centers for Disease Control and Prevention: Immigrant and Refugee Health— Guidelines for Screening for Tuberculosis Infection and Disease during the Domestic Medical Examination for Newly Arrived Refugees www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/tuberculosis-guidelines.html (Accessed on January 30, 2014).
- Walter ND, Painter J, Parker M, et al. Persistent latent tuberculosis reactivation risk in United States immigrants. Am J Respir Crit Care Med 2014; 189:88.
- Centers for Disease Control and Prevention: Tuberculosis (TB) www.cdc.gov/tb/statistics/surv/surv2012/slides/surv20.htm (Accessed on January 30, 2014).
- Centers for Disease Control and Prevention. Screening for hepatitis during the domestic medical examination for newly arrived refugees. http://www.cdc.gov/immigrantrefugeehealth/pdf/domestic-hepatitis-screening-guidelines.pdf (Accessed on April 04, 2014).
- Weinbaum CM, Williams I, Mast EE, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep 2008; 57:1.
- Eckman MH, Kaiser TE, Sherman KE. The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis 2011; 52:1294.
- Hurie MB, Mast EE, Davis JP. Horizontal transmission of hepatitis B virus infection to United States-born children of Hmong refugees. Pediatrics 1992; 89:269.
- Fishbain JT, Eckart RE, Harner KC, Hospenthal DR. Empiric immunization versus serologic screening: developing a cost-effective strategy for the use of hepatitis A immunization in travelers. J Travel Med 2002; 9:71.
- Plans-Rubió P. Critical prevalence of antibodies minimizing vaccination costs for hepatitis A, hepatitis B, varicella, measles and tetanus in adults and adolescents in Catalonia, Spain. Vaccine 2004; 22:4002.
- Schwartz E, Raveh D. The prevalence of hepatitis A antibodies among Israeli travellers and the economic feasibility of screening before vaccination. Int J Epidemiol 1998; 27:118.
- Eckman MH, Talal AH, Gordon SC, et al. Cost-effectiveness of screening for chronic hepatitis C infection in the United States. Clin Infect Dis 2013; 56:1382.
- Chen W, Dinner K, Wong T, et al. Hepatitis C Screening among Immigrants in Canada: A Cost-Effectiveness Analysis. Presented at: Toronto Health Economics and Technology Assessment Collaborative 2013. www.ispor.org/awards/13meet/presentations/CA3.pdf (Accessed on January 29, 2014).
- Centers for Disease Control and Prevention: Immigrant and Refugee Health—Screening for Sexually Transmitted Diseases during the Domestic Medical Examination for Newly Arrived Refugees www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/sexually-transmitted-diseases.html (Accessed on January 30, 2014).
- Centers for Disease Control and Prevention. Intestinal parasite guidelines for domestic medical examination for newly arrived refugees. http://www.cdc.gov/immigrantrefugeehealth/pdf/intestinal-parasites-domestic.pdf (Accessed on April 04, 2014).
- Centers for Disease Control and Prevention. Guidelines for overseas presumptive treatment of strongyloidiasis, schistosomiasis, and soil-transmitted helminth infections for refugees resettling to the United States. http://www.cdc.gov/immigrantrefugeehealth/pdf/intestinal-parasites-overseas.pdf (Accessed on April 04, 2014).
- Geltman PL, Cochran J, Hedgecock C. Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas pre-departure treatment program. Am J Trop Med Hyg 2003; 69:657.
- Swanson SJ, Phares CR, Mamo B, et al. Albendazole therapy and enteric parasites in United States-bound refugees. N Engl J Med 2012; 366:1498.
- http://www.cdc.gov/immigrantrefugeehealth/pdf/malaria-domestic.pdf (Accessed on April 08, 2014).
- Centers for Disease Control and Prevention, Filler SJ, MacArthur JR, et al. Locally acquired mosquito-transmitted malaria: a guide for investigations in the United States. MMWR Recomm Rep 2006; 55:1.
- Seybolt LM, Christiansen D, Barnett ED. Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis 2006; 42:363.
- Centers for Disease Control and Prevention: Immigrant and Refugee Health--Screening for Lead during the Domestic Medical Examination for Newly Arrived Refugees http://www.cdc.gov/immigrantrefugeehealth/guidelines/lead-guidelines.html (Accessed on January 30, 2014).
- Penrose K, Hunter Adams J, Nguyen T, et al. Vitamin D deficiency among newly resettled refugees in Massachusetts. J Immigr Minor Health 2012; 14:941.
- Aucoin M, Weaver R, Thomas R, Jones L. Vitamin D status of refugees arriving in Canada: findings from the Calgary Refugee Health Program. Can Fam Physician 2013; 59:e188.
- Centers for Disease Control and Prevention (CDC). Vitamin B12 deficiency in resettled Bhutanese refugees--United States, 2008-2011. MMWR Morb Mortal Wkly Rep 2011; 60:343.
- Benson J, Phillips C, Kay M, et al. Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS One 2013; 8:e57998.
- Campagna AM, Settgast AM, Walker PF, et al. Effect of country of origin, age, and body mass index on prevalence of vitamin D deficiency in a US immigrant and refugee population. Mayo Clin Proc 2013; 88:31.
- Jaranson JM, Ekblad S, Kroupin GV, Eisenman DP. Mental Health and Illness in Immigrants: Epidemiology and Risk Factors. In: Immigrant Medicine, Walker PF, Barnett ED. (Eds), Elsevier, Philadelphia 2007. p.627.
- Hollifield M, Verbillis-Kolp S, Farmer B, et al. The Refugee Health Screener-15 (RHS-15): development and validation of an instrument for anxiety, depression, and PTSD in refugees. Gen Hosp Psychiatry 2013; 35:202.
- Minnesota Department of Health. Minnesota Refugee Health Provider Guide. http://www.health.state.mn.us/divs/idepc/refugee/guide/10mentalhealth.html (Accessed on June 02, 2016).
- Watts C, Zimmerman C. Violence against women: global scope and magnitude. Lancet 2002; 359:1232.
- Ekblad S, Kastrup MC, Eisenman DP, Arcel LT. Interpersonal Violence towards Women. In: Immigrant Medicine, Walker PF, Barnett ED. (Eds), Elsevier, Philadelphia 2007. p.665.
- American Cancer Society. Global Cancer Facts & Figures, 2nd ed. American Cancer Society, Atlanta 2011. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf (Accessed on June 02, 2016).
- Baum S, Greenberger S, Pavlotsky F, et al. Late-onset onchocercal skin disease among Ethiopian immigrants. Br J Dermatol 2014; 171:1078.
- PRELIMINARY SCREENING
- CLINICAL APPROACH
- Health assessment
- - Establishing rapport
- - Health history
- - Physical examination
- Infectious disease screening
- - Tuberculosis
- - Human immunodeficiency virus
- - Hepatitis
- Hepatitis B
- Hepatitis A and C
- - Sexually transmitted diseases
- - Parasitic infections
- General screening
- - Blood count
- - Lead screening
- - Micronutrient screening
- - Mental health screening
- - Cancer screening
- - Chronic disease screening
- Additional pearls