G274(P) Infection screening in unaccompanied asylum-seeking children

Abstract

Background In 2016, 3175 unaccompanied asylum-seeking children (UASC) entered the United Kingdom. Many originate from countries with high rates of infections which are often treatable in the asymptomatic stages preventing progression to severe disease. Following statutory Initial Health Assessments (IHA), referral to specialist clinics is encouraged, where testing for latent infections may be tailored appropriately. Aims To evaluate the service provided by two infection clinics to determine if UASC infection screening was offered as recommended by Royal College Paediatrics and Child Health guidance Methods A clinical audit was registered at both sites. Data were anonymously and retrospectively extracted from patient records into a Microsoft Excel database for UASC seen between January 1 st 2016 and 30th August 2017. Results 77 UASC were seen in clinic, 91% were male, median age was 16 years (range 11–18). They came from 14 different countries; 31 were from Afghanistan, 15 from Eritrea and 10 from Albania. All were tested for TB. 51 were tested for hepatitis B, of whom four (8%) were positive. 51 UASC tested negative for HIV and hepatitis C. Of 24 children tested for schistosomiasis four (16.6%) were positive. Of 74 asymptomatic UASC, 17 (23%) had LTBI. Three UASC with active tuberculosis were referred following presentation at emergency departments, all originally from Afghanistan. Two had been symptomatic for over four months. The median length of time between arriving in the UK and infection screening was 10 months (range 1–60 months; data available on 37 children). Conclusion We demonstrate clinically important rates of detection of treatable infections. Patients were offered testing as recommended by RCPCH guidance but there was significant delay due to high non- attendance and delays in IHA Intensive liaison work by specialist Table 1: Outcomes within each domain for the Core Outcome Set (COS) during each Delphi round nurses is ongoing to improve the time to testing, with promising results. We recommend that timely and tailored infection screening be offered to all UASC, by informed consent following expert counselling about their individual risk More data are needed to inform best practice and develop consistent guidance.