Screening of international immigrants, refugees, and adoptees

Frequently clinicians are faced with screening and providing preventive care to immigrants, refugees, and international adoptees. Evidence-based medicine on which to base screening protocols for these populations is lacking. It is important to review all health and vaccination records of the patient. In addition to acute symptoms, one should inquire about the symptoms of diseases prevalent in the country of origin or transit (e.g., hematuria). Many unexpected pathologic conditions may be detected by a thorough physical examination. If a reliable immunization record is presented, one need not repeat the vaccines or check titers. Remaining vaccines should be administered according to ACIP guidelines, except for certain populations (e.g., adoptees). Routine laboratory screening tests should include CBC with differential, stool for ova and parasites, urinalysis, general chemistry profile, serology for hepatitis B, and tests for HIV and syphilis. A tuberculin skin test should be performed on all immigrants, and a chest radiograph should be obtained for any patient with symptoms or a positive PPD. Lead level, hepatitis C, and TSH should be obtained for all children and most adoptees. In addition, special screening tests (e.g., for malaria, hepatitis C, and STIs) may be indicated in high-risk populations. A more organized screening system that emphasizes evidence-based and population-specific screening protocols and better communication between international, federal, state, and local levels is needed in the United States.