Abstract
.With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States–bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2–6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand–Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5–89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B–infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.
Highlights
Since 1975, the United States has resettled more than three million refugees, with 85,000 arriving in 2016.2 United States–bound refugees have three organized health encounters during resettlement: 1) required initial overseas examination, performed 2–6 months before travel to detect and treat “inadmissible” public health conditions
During the initial overseas medical examination, we offered voluntary testing and management for anemia, hepatitis B virus (HBV) infection, and intestinal parasites to a convenience sample of U.S.-bound refugees aged 3 6 months living in three camps on the Thailand–Burma border
Eosinophilia was associated with positive Strongyloides multiplex bead array (MBA) (Fisher’s P < 0.001; OR: 1.94 95% CI: 1.31, 2.87) and with positive Strongyloides quantitative polymerase chain reaction (qPCR) (Fisher’s P = 0.0077; OR: 2.1, 95% CI: 1.2, 3.6), 33% (43/132) of MBApositive and 27% (18/66) of qPCR-positive participants were not eosinophilic
Summary
An unprecedented 65 million people— approximately 1% of the world’s population—are forcibly displaced. Since 1975, the United States has resettled more than three million refugees, with 85,000 arriving in 2016.2 United States–bound refugees have three organized health encounters during resettlement: 1) required initial overseas examination, performed 2–6 months before travel to detect and treat “inadmissible” public health conditions (primarily tuberculosis [TB]). CDC, the U.S Department of State, and IOM have developed supplemental overseas health programs, including vaccination and presumptive STH treatment to improve and protect public and individual migrant health.. CDC, the U.S Department of State, and IOM have developed supplemental overseas health programs, including vaccination and presumptive STH treatment to improve and protect public and individual migrant health.4 These costsaving interventions harmonize health services for refugees originating from the same areas and reduce burden on domestic providers.. In 2012, we implemented a program evaluation, assessing the feasibility and impact of overseas identification and management of selected, common medical conditions beyond the scope of the required examination To our knowledge, this is the first large-scale prospective evaluation of medical and preventive health interventions in a migrating population
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