| December 2012 · Vol. 61, No. 12: E1-E10 ONLINE EXCLUSIVE
The refugee medical exam: What you need to do
Refugees arrive in this country with complex medical needs. Here’s how best to care for these patients during the initial medical examination, and beyond.
Douglas
Bishop,
MDZufall Health Center, Morristown, NJ Marc
Altshuler,
MDDepartment of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia
marc.altshuler@jefferson.edu Kevin
Scott,
MDDepartment of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia Jeffrey
Panzer,
MDFamily and Community Medicine, Northwestern University, Erie Family Health Center, Chicago Geoffrey
Mills,
MD, PhDDepartment of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia Patrick
McManus,
MDDepartment of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia
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PRACTICE RECOMMENDATIONS
• Use tuberculin skin testing alone or in conjunction with interferon-gamma release assay to screen children younger than 5 years for tuberculosis. A
• Include 2 evaluations for ova and parasites plus a complete blood count with differential when screening refugees for parasitic infections. B
• Screen all adolescent and adult refugees for human immunodeficiency virus infection. A
• Check blood lead levels in all children 6 months to 16 years of age on arrival in the United States B and 6 months later. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
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The authors reported no potential conflict of interest relevant to this article.
In 2011, 56,384 refugees fleeing persecution in their native countries were admitted to the United States. The largest numbers came from Burma (30.1%), Bhutan (26.6%), and Iraq (16.7%).1 They joined the more than 3 million refugees from all over the world who have resettled in this country since 1975. 1
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