Refugee Health Exam

1. Indications
   1. Last examination prior to immigration
2. Preparation
   1. Obtain Prior Exam records from Public Health Department
3. General Exam
   1. Complete Medical Examination
   2. Vital signs
      1. Height
      2. Weight
      3. Blood Pressure
   3. Visual Acuity
   4. Hearing Testing
   5. Evaluate for Hansen's Disease
   6. Assess mental health needs
   7. Complete Dental Examination
4. Evaluation: Common presenting concerns in refugees
   1. Psychiatric
      1. Major Depression
      2. Anxiety Disorder
      3. Post-Traumatic Stress Disorder
   2. Pain concerns
      1. Headache
      2. Abdominal Pain or Pelvic Pain
      3. Neck Pain or Back pain
   3. Chronic conditions
      1. Anemia
      2. Asthma or COPD
      3. Diabetes Mellitus
      4. Hypertension
      5. Hyperlipidemia
      6. Vitamin D Deficiency
5. Evaluation: High risk conditions screened on immigration
   1. Tuberculosis
   2. Sypilis
   3. Chancroid
   4. Gonorrhea
   5. Granuloma Inguinale
   6. Lymphogranuloma venereum
   7. Hansen Disease
   8. Malaria
   9. Stool Parasites
   10. Chemical Dependency or Substance Abuse
   11. Serious psychiatric disorder with risk of institutionalization or harm to others
6. Labs: Typically completed by immigration officials prior to entry, however re-screen as indicated
   1. Complete Blood Count (CBC) with differential
      1. Evaluate for Anemia
      2. Evaluate for Eosinophilia (parasitic infection)
   2. Consider Serum Chemistry Panel if indicated
   3. Consider Urinalysis and Urine Culture if indicated
   4. Consider Urine Pregnancy Test (urine HCG) if indicated
   5. Urine or cervical swab for Gonorrhea and Chlamydia PCR
   6. Human Immunodeficiency Virus (HIV Testing)
   7. Tuberculin Skin Testing (PPD) or quantiferon-G
      1. All patients age >6 months regardless of BCG vaccine
   8. Hepatitis B Serology
      1. xHBsAg
      2. xHBsAb
      3. Consider xHBcAb
      4. Treat carriers and evaluate and immunize contacts
      5. See Viral Hepatitis Screening
   9. Syphilis Serology (Rapid Plasma Reagin or VDRL)
      1. Indicated for age over 14 years
      2. Differentiate from Yaws
   10. Three stool specimens for Ova and Parasites
   11. Malaria if symptomatic or suspicious history
       1. Three thick and thin smears for Malaria parasites
7. Immunizations
   1. If no record, begin Primary Series for age appropriate
   2. Vaccinations mandated by CDC for refugees requesting adjustment status for U.S permanent residence (typically at 1 year)
      1. http://www.cdc.gov/immigrantrefugeehealth/laws-regs/vaccination-immigration/revised-vaccination-criteria-immigration.html
8. Resources
   1. Minnesota Department of Health Refugee Health Program
      1. http://www.health.state.mn.us/refugee
9. References
   1. Barnett (2004) Clin Infect Dis 39(6): 833-41
   2. Eckstein (2011) Am Fam Physician 83(4): 429-36
   3. Stauffer (2009) Curr Opin Infect Dis 22(5): 436-43