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Global Refugees Checklist
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Clinical Resources

See http://ccirhken.ca/ for more resources.

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Tuberculosis Screening: Tuberculin skin test (TST)

Indications for TST: persons at high risk for disease

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INH Treatment of Latent Tuberculosis Infection (active disease ruled out)

Isoniazid 300mg OD (children 5mg/kg); consider pyridoxine 25-50mg OD to prevent neuropathy in malnourished states

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Canadian criteria for a positive TST

High risk people: 5mm

HIV, Contact with active TB, signs of inactive TB on CXR, organ transplant steroids >15mg/day

High risk conditions: 10 mm

Silicosis, DM, Chronic Renal Failure, Leukemia, lymphoma, Malnutrition, child<5 years of age

High Prevalence Population: 10 mm

Foreign Born (high prevalence countries- see Greenaway et al. TB in CMAJ 2011) arrived <5 years, health care worker, aboriginal, prisons, homeless, urban poor

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*Risk of INH hepatotoxicity (AST> 5 times normal)

Age Risk
25-34 4/1000
35-49 8/1000
50+ 19/1000

Monitoring (i.e. AST at 3 weeks and Q 3months) is required for those over 50 years of age and those with pre-existing liver disease, alcoholism or concomitant use of hepatotoxic drugs.

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Immunizations

Immunizations needed for primary prevention- particularly for travel to country of origin. If status unknown, serology: Hepatitis B, Varicella and offer a primary series: MMR, TdPP.

Consider

Also consider Hepatitis A for all immigrants and refugees and Pneumococcal and H influenza for sickle cell disease

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Visiting Friends and Relatives (VFR) Travel- preparation for future travel home

(see travel health website: www.TravelHealth.gc.ca)

Consider

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Laboratory Investigations

*Basic Tenets of Screening: suitable test and facilities to diagnose available, accepted treatment available, recognized latent or asymptomatic disease stage, diagnosis and treatment should be cost effective.

*Consider periodic screening for infectious disease and chronic illness tailored to history of travel and lifestyle

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Special Laboratory Investigations to Consider

*Malaria

Rapid Diagnostic Test (RDT), thick & thin smears when fever within 3 months of travel to Malaria zone.

Note: Many cases of Malaria occur in immigrants from developing countries, both on migration or after traveling home

*Vitamin D

25-Hydroxycholecalciferol: bone and muscle aches in women who use body veils.

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Working with an interpreter

Pre-interview

Discuss with the interpreter the goal of the interview, emphasize confidentiality, and seating arrangements

Interview

Speak to patient not to the interpreter- ensures patient faces physician when interpreter speaks, explain the interpreter’s role, and frequently repeat back to patient what you hear.

End of the interview

Repeat important concepts, review treatment plan
carefully, have patient repeat back general diagnosis and plan

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Global Health Risks

Tuberculosis, Malaria, HIV-AIDS, Hepatitis A, B,C, Typhoid, Measles, Intestinal Parasites, Rheumatic Heart Disease, undiagnosed chronic conditions; Trauma and Violence: Rape, Torture

Malnutrition and Micronutrient deficiency: iron, folate, iodine (some regions), Thalasemias (Africa, Middle East) Sickle cell (Africa, Caribbean); microcytic anemia, replace iron and then do Hgb electrophoresis

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Treatment of common asymptomatic intestinal worms and parasites

* Doses are same for children unless noted by asterisk. ** not available in Canada

Intestinal worm or parasite Primary treatment Alternative treatment
Entamoeba histolytica Paramomycin 500 mg po tid×7d* Metronidazole 750 tid x 10d
(positive serology or stool antigen) Iodoquinol 650 mg po tid×20d*  
Giardia lamblia Metronidazole 250 mg po tid×5d* Tinidazole
Ascaris lumbercoides Albendazole 400 mg po×1 dose6 Mebendazole 100mg bidx3d
Enterobius vermicularis Albendazole 400 mg po×1 dose
(repeat in 2wks)6
Mebendazole 100mg once then repeat in 2wks
Strongyloides stercoralis Thiabendazole 50 mg/kgdivided bid×2d
(max dose 3 g/d) **
Albendazole/Ivermectin
Schistomsoma mansoni, haematobium Praziquatel 40mg/kg po divided bid x 1d  
Trichuris trichiura Albendazole 400 mg po×1 dose Mebendazole 100mg tid x3d
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Resources

  1. Online eligibility check for IFHP for refugee claimant patients
  2. Children and Youth to Canada: A Health Care Guide, Canadian Pediatric Society, 2000
  3. Canadian Guide to Immunizations, Health Canada, 2002
  4. Travel and Tropical Medicine, Public Health Agency of Canada
  5. Life expectancy calculator, PHIRN, 2012
  6. Health Canada’s Special Access Programme: Drugs and health products [database] Ottawa (ON):
    Health Canada; 2008 Available
  7. Additional resources and information for clinicians, Bridge Refugee Clinic, Vancouver Coastal Health

Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the CCIRH preventative checklist is meant as a guide only.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa

Fair Use Authorization: See http://ccirhken.ca

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