Infectious Disease Screening Research Articles

Health Consequences of Long-Term Injection Heroin Use Among Aging Mexican American Men

Research on the health consequences of long-term injection drug use (IDU) is limited. This article examines these consequences among aging, male Mexican American injecting heroin users. Concern for this group is crucial, given its health disparities and the association of IDU with disease transmission. Aging, male Mexican American IDUs (N = 227) were recruited through intensive outreach. Participants self-reported health status, medical and substance use history, and completed behavioral and psychometric health scales. Results: Participants had significantly poorer self-rated health and negative health conditions. Selected medical conditions not associated with the heroin-use lifestyle (i.e., hypertension, diabetes, arthritis) were lower relative to the comparison samples. This population has a complex profile of health consequences linked to a heroin-using lifestyle. The study concludes that routine screening of infectious diseases and medical and behavioral conditions among aging substance using populations may contribute to reducing Hispanic health disparities.

How I treat: the selection and acquisition of unrelated cord blood grafts

AbstractUse of unrelated donor cord blood (CB) as an alternative stem cell source is increasing, and yet there is little information to guide transplant centers in the unique aspects of the search and selection of CB grafts. There is no mechanism to easily access the global inventory of CB units, nor is the product information provided by all banks standardized. To address these challenges, this manuscript reviews the logistics of the search, selection process, and acquisition of CB grafts as practiced by our center. Topics include who should be considered for a CB search, how to access the global CB inventory, and how to balance total nucleated cell dose and human leukocyte antigen match in unit selection. We discuss aspects of unit quality and other graft characteristics (processing methods, unit age, availability of attached segments, infectious disease, and hemoglobinopathy screening) to be considered. We incorporate these considerations into a unit selection algorithm, including how to select double-unit grafts. We also describe how we plan for unit shipment and the role of backup grafts. This review aims to provide a framework for CB unit selection and help transplantation centers perform efficient CB searches.

Approaches to Minimize Infection Risk in Blood Banking and Transfusion Practice

The use of blood donor history and state-of-the-art FDA-licensed serological and nucleic acid testing (NAT) assays have greatly reduced the "infectious window" for several transfusion-transmitted pathogens. Currently transmission of human immunodeficiency virus (HIV), Human T-cell Lymphotropic Virus (HTLV), hepatitis viruses and West Nile Virus are rare events. The seroprevalence of cytomegalovirus in the donor population is high and cytomegalovirus infection can cause significant complications for immunocompromised recipients of blood transfusion. Careful use of CMV seronegative blood resources and leukoreduction of blood products are able to prevent most CMV infections in these patients. Currently, bacterial contamination of platelet concentrates is the greatest remaining infectious disease risk in blood transfusion. Specialized donor collection procedures reduce the risk of bacterial contamination of blood products; blood culture and surrogate testing procedures are used to detect potential bacterially contaminated platelet products prior to transfusion. A rapid quantitative immunoassay is now available to test for the presence of lipotechoic acid and lipopolysaccharide bacterial products prior to platelet transfusion. Attention has now turned to emerging infectious diseases including variant Creutzfeldt-Jakob disease, dengue, babesiosis, Chagas' disease and malaria. Challenges are presented to identify and prevent transmission of these agents. Several methods are being used or in development to reduce infectivity of blood products, including solvent-detergent processing of plasma and nucleic acid cross-linking via photochemical reactions with methylene blue, riboflavin, psoralen and alkylating agents. Several opportunities exist to further improve blood safety through advances in infectious disease screening and pathogen inactivation methods.

Testing for HIV, Sexually Transmitted Infections, and Viral Hepatitis in Jails: Still a Missed Opportunity for Public Health and HIV Prevention

Jails provide an underutilized public health opportunity for screening for HIV, sexually transmitted infections (STIs), and viral hepatitis, and for such other infectious diseases as tuberculosis. Incarcerated individuals are more likely to be men, poor, persons of color, and at high risk for HIV. The vast majority of jails in the United States do not screen routinely for HIV or STIs, thereby missing an opportunity for HIV and STI diagnosis, treatment, and prevention. Nesting HIV testing within STI testing and treatment in conjunction with testing and treatment for other infectious diseases, as appropriate based on community prevalence, provides a public health opportunity and will enhance HIV prevention. HIV testing and linkage to care, both within corrections and in the community, comprise an important component of the "seek and treat" strategy to further prevent HIV infection. Jail-based screening of infectious diseases, especially for HIV and STIs, in conjunction with treatment and linkage to community care has thus far been a neglected component of HIV prevention among high-risk communities.

Debilitating Clinical Disease in a Wild-Born Captive Western Lowland Gorilla (Gorilla gorilla gorilla) Co-Infected with Varicella Zoster Virus (VZV) and Simian T-Lymphotropic Virus (STLV)

A wild-born, 34-yr-old female western lowland gorilla (Gorilla gorilla gorilla) was transferred between zoologic collections in the United Kingdom. Adjustment to its new environment was difficult and a series of health problems ensued. Progressive severe illness of multiple etiologies, and a failure to respond to multiple therapies, led to its euthanasia 5 mo later. Disease processes included severe thoracic and axillary cutaneous ulceration of T2-3 dermatome distribution, gastroenteritis, ulcerative stomatitis, emaciation, hind limb weakness or paresis, and decubitus ulcers of the ankles and elbows. Ante- and postmortem infectious disease screening revealed that this animal was not infected with Mycobacterium tuberculosis, simian varicella virus (SVV), simian immunodeficiency virus (SIV), or hepatitis B virus; but was infected with varicella-zoster virus (VZV) and simian T-lymphotropic virus (STLV). It is hypothesized that recrudescence of VZV and other disease processes described were associated with chronic STLV infection and the end of a characteristically long incubation period.

Needlestick injuries

I read the editorial by Hartle [1] and the survey by Burrows and Padkin [2] with insight and overwhelming frustration. I recently experienced the unwanted, embarrassing and stressful experience of a needlestick injury from an unconscious, high-risk patient. I was advised to start post exposure prophylaxis (PEP), but the added complication of possible pregnancy made it an incredibly difficult decision. I dutifully (and with hindsight possibly naively) followed the hospital protocol. It was made abundantly clear to me that unless testing for infectious diseases was in the patient’s best interests, no tests would be carried out. Throughout this experience, it was apparent that my best interests were not a relevant consideration. Discussions with colleagues made me question my decision to follow standard protocol. It seems many needlestick injuries go unreported, therefore avoiding occupational health involvement and enabling prompt (possibly unlawful) testing of patients. In many circumstances, a reason can be ‘invented’ to justify patient testing. If staff felt protected in these circumstances, more incidents would be reported and the real scale of the problem would become evident. It seems that as employees we have no protection. The Mental Capacity Act (2005) is clear that any investigation or treatment carried out on a patient lacking capacity may only be performed in the patient’s best interests [3]. The General Medical Council (GMC) withdrew its advice about testing patients for serious communicable diseases in exceptional circumstances. Currently, the GMC states that the law does not permit testing the infection status of an incapacitated patient solely for the benefit of a healthcare worker [4]. Health and safety are an obligation for all employers, but it seems to be disregarded in this context. I can testify that the physical side effects of PEP are extremely unpleasant, but the psychological impact is altogether more terrifying. As much as you tell yourself everything will be fine, your mind runs through all the most negative scenarios and there are feelings of guilt for exposing your family to the situation. Hartle comments that ‘testing without consent risks undermining public and political confidence in the healthcare profession’, and I agree. It’s therefore imperative to approach this problem from a different perspective, whilst lobbying to change the law. The Mental Capacity Act began in 1989 with a Law Commission investigation and did not gain royal assent until 2005 [5]. Changing the law will not happen quickly! Rather than argue about what is in the patients’ best interests and addressing the problem after the event, we need to review our approach to testing for infectious diseases in all hospital patients. Expectant mothers are routinely asked if they agree to human immunodeficiency virus (HIV) testing and no counselling is offered. I believe that screening for infectious diseases should be carried out on all patients admitted to intensive care. The rate of HIV infection in the UK continues to rise with an estimated 83 000 infected at the end of 2008, with 27% unaware of their infection [6]. Prompt recognition and treatment of this illness would fundamentally be in the patient’s best interests. Should we consider asking for informed consent to screen blood for infectious diseases routinely in all elective and emergency surgical patients? This approach could ensure the prompt management of healthcare workers exposed to potentially infective body fluids, avoiding inordinate levels of stress and the unnecessary use of PEP. Department of Health guidelines recommend PEP be started within the first hour whenever possible [7]. Prior knowledge of a patient’s infective status would enable an individual to make an informed and timely decision about commencing treatment. I think the majority of the public would support these ideas and would be surprised at the current situation. More importantly, is a healthcare professional going to be functioning safely in view of the constant fear and anxiety he/she would be experiencing? Patients must be treated by someone who is concentrating on the here and now, and not on what a blood test will show in six months. This letter is undoubtedly influenced by my own experience, but I am determined not to ignore this issue, as it is an all too frequent occurrence. We need a balanced approach to this problem; the position in which we find ourselves at present is unfair. We need to identify a solution that protects all parties concerned and demonstrates common sense. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.

Impact of the May 12, 2008, earthquake on blood donations across five Chinese blood centers

On May 12, 2008, a severe earthquake struck China's Sichuan Province. The nationwide outpouring of charity resulted in a surge of subsequent blood donations. The quantity and quality of these donations were examined in comparison with routine donations. Whole blood and apheresis donations from five geographically different blood centers collected within 1 week postearthquake were compared with those collected during the rest of the year. Regional differences, demographic characteristics, first-time and repeat donor status, and infectious disease screening markers associated with these donations were compared by earthquake status using chi-square statistics. Poisson regression analysis examined the number of daily donations by earthquake status after adjusting for center, day of week, and seasonal variations. The number of daily donations across five blood centers increased from 685 on a typical day to 1151 in the postearthquake week. The surge was observed in both sexes and across different education levels, age, and ethnicity groups and three blood centers and was significant after adjusting for confounding covariates. The influx of first-time donors (89.5%) was higher than that of repeat donors (34%). There was a significant change in the overall screening reactive marker rates excluding alanine aminotransferase (2.06% vs. 1.72%% vs. 4.96%). However, when the individual screening test was analyzed separately, no significant differences were found. Timely donations in response to a disaster are crucial to ensure emergency blood transfusion. The dramatically increased postearthquake donations suggest that Chinese blood centers are capable of handling emergency blood needs. Measures to maintain blood safety should be taken in times of emergency.

Expanded infectious diseases screening program for Hispanic transplant candidates

Most guidelines for pre-transplant screening recommend enhanced screening among patients with potential exposure to such pathogens as Strongyloides stercoralis and Trypanosoma cruzi, the cause of Chagas disease. The incidence of these diseases in the Hispanic immigrant population has not been extensively studied. Transplant candidates who were evaluated by our program's Hispanic Transplant Program were referred for expanded infectious disease screening including Mycobacterium tuberculosis, S. stercoralis, Leishmania, and T. cruzi. Between December 2006 and December 2008, 83 patients were screened. Most were from Mexico but we also screened patients from Ecuador, Puerto Rico, and Peru. Most patients lived in urban locations before moving to the United States. Latent tuberculosis infection (LTBI) was found in 20%, and 6.7% had serologic evidence of S. stercoralis infection. These patients underwent treatment of latent infection without difficulty. To date, 14 patients have undergone living-donor kidney transplantation. Two of these patients had positive Leishmania titers and are being followed clinically, 1 was treated for S. stercoralis, and 2 were treated for LTBI pre-transplant. All have done well without evidence of screened pathogens an average of 348 days (range 65-766 days) post transplant. Expanded screening identifies endemic infections in the Hispanic immigrant population that can be treated before transplant, thereby minimizing post-transplant infectious complications.

Fetal Right Ventricular Diverticulum With Pericardial Effusion: Report of a New Case Treated by In Utero Pericardiocentesis

Right ventricular diverticulum associated with pericardial effusion was diagnosed in a male fetus at 13 weeks of gestation. Screening for infectious, chromosomal, or structural disease was negative. Because there was concern about pulmonary hypoplasia, fetal pericardiocentesis was performed at 17 weeks of gestation. The pericardial fluid did not reaccumulate, and the diverticulum decreased and finally disappeared before the third trimester. The diverticulum could not be seen on the neonatal echocardiography scan performed on the full-term live baby, who was delivered vaginally. The child is doing well at 11 months of age. Given the good outcome of this case, in utero drainage should be considered in similar cases.

Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan

ObjectiveThe objective of this study was to evaluate the burden of sexual- and injection drug use-related infections in male prisoners in Karachi, Pakistan. MethodsWe administered a structured questionnaire in a cross-sectional survey of 365 randomly selected imprisoned men. We analyzed blood for the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) by ELISA, and for syphilis by rapid plasma reagin with Treponema pallidum hemagglutination assay confirmation. Subjects with possible tuberculosis (World Health Organization criteria) provided sputum samples for an acid-fast bacillus smear and culture. ResultsThe prevalence of tuberculosis was 2.2% (95% CI 0.71–3.8%). Of 357 of the randomly selected prisoners (eight refused to give blood), 2.0% (95% CI 0.6–3.4) were HIV-infected; syphilis was confirmed in 8.9% (95% CI 6.0–11.8%), HBV in 5.9% (95% CI 3.5–8.3%), and HCV in 15.2% (95% CI 11.7–18.8). By self-report, 59.2% had used any illicit drugs, among whom 11.8% (95% CI 8.5–15.0) had injected drugs. The median length of stay in the prison had been 3.2 (range 1–72) months. ConclusionsAll four infections were prevalent among the prisoners in Pakistan. Prisons are excellent venues for infectious disease screening and intervention given the conditions of poverty and drug addiction. Collaboration with community-based health providers is vital for post-discharge planning.

Lot release testing of serological infectious disease assays used for donor and donation screening

Monitoring of the ongoing performance of infectious disease screening assays is a critical part of any donation screening programme. Although assay sensitivity is formally evaluated prior to implementation, it is essential that this level of performance is maintained from lot-to-lot. In 2002, National Health Service Blood and Transplant developed and implemented a formal system for the lot release testing of serology infectious disease screening assays. Lot release panels were prepared for each of the serological screening markers. They each comprise 10-15 members and include both genuine low-titre and diluted high-titre materials. For each panel member, a minimum reactivity is expected, based upon the formal sensitivity evaluation of each assay. All new lots of the screening assays used are assessed prior to supply of the lot to the organization. Since 2002, a total of 887 different lots of the serology screening assays used have been supplied. Of these, 876 (98.8%) passed lot release and were authorized for supply to the organization. Eleven lots (1.2%) were failed because the lots did not meet the release criteria or were unsuitable for some other reason. The lot release system has proved to be effective in objectively assessing assay performance to ensure that there is no significant lot-to-lot variation such that the performance of the assay may fall below that originally determined at evaluation. The few assays that have failed lot release did have proven performance issues that were subsequently accepted by the manufacturers. CONTENTS SUMMARY: Description of the Lot Release Testing system for serology infectious disease screening assays in use within NHSBT with a critical analysis and review of the data generated in the 7 years that the system has been in use.

Seroprevalence of HIV, hepatitis b, and hepatitis c among opioid drug users on methadone treatment in the netherlands

BackgroundInjecting drug users (IDU) remain an important population at risk for blood-borne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). In the Netherlands, a program is being implemented to offer annual voluntary screening for these infections to opioid drug users (ODUs) screened in methadone care. At two care sites where the program is now operating, our study aimed to estimate the seroprevalence among ODUs screened for HIV, HBV and HCV; to evaluate HBV vaccination coverage; and to assess the feasibility of monitoring seroprevalence trends by using routine annual screening data.MethodsOpioid drug users on methadone treatment are routinely offered voluntary screening for infectious diseases such as HIV, HBV and HCV. Data on uptake and outcome of anti-HIV, anti-HBc, and anti-HCV screening among ODUs receiving methadone were obtained from two regions: Amsterdam from 2004 to 2008 and Heerlen from 2003 to 2009.FindingsAnnual screening uptake for HIV, HBV and HCV varied from 34 to 69%, depending on disease and screening site. Of users screened, 2.5% were HIV-positive in Amsterdam and 11% in Heerlen; 26% were HCV-positive in Amsterdam and 61% in Heerlen. Of those screened for HBV, evidence of current or previous infection (anti-HBc) was found among 33% in Amsterdam and 48% in Heerlen. In Amsterdam, 92% were fully vaccinated for HBV versus 45% in Heerlen.ConclusionAnnual screening for infectious diseases in all ODUs in methadone care is not fully implemented in the Netherlands. On average, more than half of the ODUs in methadone care in Heerlen and Amsterdam were screened for HIV, HBV and HCV. In addition, screening data indicate that HBV vaccination uptake was rather high. While the HIV prevalence among these ODUs was relatively low compared to other drug-using populations, the high HCV prevalence among this group underscores the need to expand annual screening and interventions to monitor HIV, HBV and HCV in the opioid drug-using population.

Program Characteristics Associated With Testing for HIV and Hepatitis C in Veterans Substance Use Disorder Clinics

This study examined whether organizational characteristics and quality improvement initiatives were related to HIV and hepatitis C (HCV) testing rates in veterans' substance use disorders programs. Data were collected by surveying 232 program directors at all U.S. Department of Veterans Affairs (VA) substance use disorder programs. Program directors (N=223) reported that, on average, 35% of their patients were tested for HIV (median=10%) and 57% were tested for HCV (median=80%). Of the quality improvement initiatives examined, computerized reminders to clinicians (p=.02) and a designated clinician for screening (p=.01) were positively associated with HCV testing, and computerized templates that guide clinicians through ordering of testing were positively associated with HIV testing (p=.06). Despite national emphasis on HIV testing, rates of testing were lower for HIV than for HCV in programs serving veterans with substance use disorders and at risk of both illnesses. System-level quality improvement initiatives may be effective at increasing rates of infectious disease screening.

Group Testing Regression Models with Fixed and Random Effects

Group testing, where subjects are tested in pools rather than individually, has a long history of successful application in infectious disease screening. In this article, we develop group testing regression models to include covariate effects that are best regarded as random. We present approaches to fit mixed effects models using maximum likelihood, investigate likelihood ratio and score tests for variance components, and evaluate small sample performance using simulation. We illustrate our methods using chlamydia and gonorrhea data collected by the state of Nebraska as part of the Infertility Prevention Project.

Malaria Diagnosis by a Polymerase Chain Reaction–Based Assay Using a Pooling Strategy

Pooling clinical specimens reduces the number of assays needed when screening for infectious diseases. Polymerase chain reaction (PCR)-based assays are the most sensitive tests to diagnose malaria, but its high cost limits its use. We adapted a pooling platform that could reduce the number of assays needed to detect malaria infection. To evaluate this platform, two sets of 100 serum samples, with 1% and 5% malaria prevalence, were tested. DNA, extracted from pooled samples, was amplified by malaria-specific PCR. Additional validation was performed by determining the level of PCR detection based on 1:10 and 1:100 dilution. The platform correctly detected all malaria samples in the two test matrices. The use of stored serum samples also has important implications for studies investigating malaria prevalence rates retrospectively. Field studies, using serum and whole blood specimens, are needed to validate this technique for the adaptation of these methods for clinical utility.

Management of varicella contacts in pregnancy: VZIG or vaccination?

Background Varicella infection during pregnancy poses a serious risk for both foetus and mother. It has been suggested that it would be more cost-effective to screen antenatally with post-partum vaccination, which occurs in the US, than the current policy of checking immune status post varicella exposure, with VZIG administration where necessary. Additionally, it is doubtful whether the current policy provides best patient care, when a vaccine is available. Objectives The study aims to retrospectively compare the cost of the current policy with a cost estimate for antenatal screening with post-partum vaccination in NI. Study design A cost estimate of antenatal screening of primigravidas, with post-partum vaccination, was calculated for two models: (1) verbal screening, with serological testing of those with no history of varicella infection and (2) serological screening of all primigravidas. Results The cost of VZIG issued to pregnant women in 2006 was £100,800; 43% of births were to primigravidas therefore the estimated cost of VZIG issued to multigravidas was £58,100. The cost of verbal screening with post-partum vaccination is estimated at £23,750 p.a., saving £34,350 over current policy. The estimated cost of screening all primigravidas with post-partum vaccination is £43,000, saving £15,100. Conclusions This retrospective study suggests that in NI either of the proposed antenatal screening strategies would be less costly than current practice. This finding supports the suggestion that varicella immunity testing should be included in the Antenatal Infectious Diseases Screening Programme, either as part of the universal vaccination programme or solely as an antenatal programme.

OCULAR TOXOPLASMOSIS DURING NATALIZUMAB TREATMENT

Natalizumab (Tysabri®, Biogen-Dompe, Cambridge, MA) is the first selective adhesion-molecule inhibitor approved for the treatment of multiple sclerosis (MS). Although undoubtedly efficacious in clinical and radiologic control of MS, its use raised some concerns regarding the potential occurrence of opportunistic infection in the exposed population, referring in particular to progressive multifocal leukoencephalopathy (PML).1 Toxoplasma gondii (TG) is a protozoan parasite that infects up to a third of the world's immunocompetent population with usually mild or no symptoms. On the contrary, its reactivation is a threatening condition that affects immunocompromised subjects, namely persons with HIV, organ transplant recipients, people with neoplastic disease, or people on a prolonged steroid treatment.2,3 Here we discuss the reactivation of ocular toxoplasmosis (OT) during natalizumab treatment. ### Case report. The patient is a 28-year-old man with relapsing-remitting MS. His previous medical history includes alcohol abuse and no malignancies, signs of immunodeficiency, or temporary stays abroad. He first visited our center in 2004 due to a right subacute sensory-motor syndrome. We performed brain MRI and CSF analysis along with screening for autoimmune, infectious, dysmetabolic, and thrombophilic diseases. All of them proved to be compatible with the diagnosis of clinically isolated syndrome suggestive for MS. After a high-dose steroid course followed by symptoms remission, he was treated with interferon beta 1b …

IGF-I during primiparous pregnancy and maternal risk of breast cancer

Previously, we reported that insulin-like growth factor (IGF)-I during early pregnancy is positively associated with maternal risk of breast cancer. To further explore this association, we designed a new study limited to women who donated a blood sample during their first pregnancy ending with childbirth. A case-control study was nested within the Northern Sweden Maternity Cohort in which repository since 1975, serum specimens remaining after early pregnancy screening for infectious diseases had been preserved. Study subjects were selected among women who donated a blood sample during the full-term pregnancy that led to the birth of their first child. Two hundred and forty-four women with invasive breast cancer were eligible. Two controls, matching the index case for age and date at blood donation were selected (n = 453). IGF-I was measured in serum samples on an Immulite 2000 analyzer. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A significant positive association of breast cancer with IGF-I was observed, with OR of 1.73 (95% CI: 1.14-2.63) for the top tertile, P < 0.009. Subgroup analyses did not indicate statistical heterogeneity of the association by ages at sampling and diagnosis or by lag time to cancer diagnosis, although somewhat stronger associations with risk were observed in women < or = age 25 at index pregnancy and for cases diagnosed within 15 years of blood donation. The results of the study add further evidence for an adverse effect of elevated IGF-I concentrations during early reproductive life on risk of breast cancer.

The epidemiology of health conditions of newly arrived refugee children: A review of patients attending a specialist health clinic in Sydney

To determine the prevalence of common diseases in newly arrived refugee children, resettled in Sydney, by region of birth. To identify health needs of refugee children in Australia. We prospectively screened for common diseases in refugee children attending a specialist paediatric refugee clinic, the Children's Hospital, Westmead, between May 2005 and December 2006. Screening tests included full blood count, Mantoux, vitamin D level, hepatitis B serology, syphilis serology, Schistosomiasis serology and malarial antigens. There were 239 patients, the majority (75%) from Africa, with 127 girls and 112 boys. Thirty-six percent were 0-7 years old, 45% were 8-12 years old and 19% were 13-17 years old. Of those tested, 16% had Schistosomiasis, 5% had malaria and 4% were hepatitis B carriers. Of 216 children who had Mantoux tests, 33% were > or =10 mm and 24% were > or =15 mm, including four children with active disease (2 lymphadenitis, 1 pulmonary and 1 gastric). Vitamin D deficiency was the most common diagnosis: 61% had serum 25(OH)D3 <50 nmol/L. Anaemia was present in 15%. Disease prevalence was higher in children from Africa than Asia or the Middle East, and most of the children were asymptomatic. Given that we have only seen about 10% of the refugee children resettled in New South Wales, our results may not be generalisable to all refugees. Our findings suggest that screening refugee children for common treatable conditions, even if they are asymptomatic, is paramount. In addition to infectious diseases screening, nutritional deficiencies should routinely be screened for.

Teaching transfusion medicine research methods in the developing world

Teaching transfusion medicine research methods in the developing world