Immigrant & Refugee Health - Medical examination for ...
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Immigrant & Refugee Health - Medical examination for newly arrived refugees and immigrants

Vaccinations:

 • Age-appropriate vaccines as indicated (see Health Screening & Maintenance section)

 • If no vaccine documentation, check titers (including childhood vaccines such as MMR) or assume pt not vaccinated.

Screening:

 • General screening: CBC w/ differential (eos, anemia), UA (hematuria), glucose, gen chem, pregnancy test if appropriate; hepatitis, lead, micronutrient, chronic disease

 • Tuberculosis: eval sxs, h/o sick contacts, PE; send T-spot (preferred with prior exposure to BCG vaccine) or ✓PPD

 • STIs: Syphilis (TrepAb at MGH, VDRL/RPR elsewhere); HIV; GC/CT (urine NAAT) if ♀ < 25 & sexually active or ♀ > 25 + risk (h/o sexual assault, LE ⊕ on UA, sxs, new or >1 partner, partner w/ STI)

 • Malaria (PCR most sensitive, blood films less sensitive if ∅sxs)

     o Test pts from Sub-Saharan Africa (SSA) who did not receive pre-departure presumptive Rx w/ artesunate-combination (e.g. pregnant ♀ when Rx was C/I)

     o Any pt from malaria-endemic country w/ sxs infection

 • Intestinal/Tissue Invasive Parasites: Test if no pre-departure Rx (albendazole, ivermectin) or incomplete: ≥2 stool O&P, Strongy serologies. If SSA: schisto serologies.

     o Absolute eos: not specific or sensitive but if persistently elevated do work-up and consider empiric Strongy Rx.



#Immigrant #Refugee #screening #primarycare #diagnosis 
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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