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