Measles, Mumps and Rubella (MMR)
- Vaccinate all adult immigrants without immunization records using one dose of measles–mumps–rubella vaccine.
- Vaccinate all immigrant children with missing or uncertain vaccination records using age-appropriate vaccination for measles, mumps and rubella.
Diphtheria, Pertussis, Tetanus and Polio
- Vaccinate all adult immigrants without immunization records using a primary series of tetanus, diphtheria and inactivated polio vaccine (three doses), the first of which should include acellular pertussis vaccine.
- Vaccinate all immigrant children with missing or uncertain vaccination records using age-appropriate vaccination for diphtheria, pertussis, tetanus and polio.
- Vaccinate all immigrant children < 13 years of age with varicella vaccine without prior serologic testing.
- Screen all immigrants and refugees from tropical countries ≥ 13 years of age for serum varicella antibodies, and vaccinate those found to be susceptible.
- Screen adults and children from countries where the seroprevalence of chronic hepatitis B virus infection is moderate or high (i.e., ≥ 2% positive for hepatitis B surface antigen), such as Africa, Asia and Eastern Europe, for hepatitis B surface antigen, anti-hepatitis B core antibody and antihepatitis B surface antibody.
- Refer to a specialist if positive for hepatitis B surface antigen (chronic infection).
- Vaccinate those who are susceptible (negative for all three markers).
- Screen children, adolescents < 20 years of age and refugees between 20 and 50 years of age from countries with a high incidence of tuberculosis as soon as possible after their arrival in Canada with a tuberculin skin test.
- If test results are positive, rule out active tuberculosis and then treat latent tuberculosis infection. Carefully monitor for hepatotoxicity when isoniazid is used.
- Screen for HIV, with informed consent, all adolescents and adults from countries where HIV prevalence is greater than 1% (sub-Saharan Africa, parts of the Caribbean and Thailand).
- Link HIV-positive individuals to HIV treatment programs and post-test counselling.
- Screen for antibody to hepatitis C virus in all immigrants and refugees from regions with prevalence of disease ≥ 3% (this excludes South Asia, Western Europe, North America, Central America and South America).
- Refer to a hepatologist if test result is positive.
Strongyloides: Screen refugees newly arriving from Southeast Asia and Africa with serologic tests for Strongyloides, and treat, if positive, with ivermectin.
Schistosoma: Screen refugees newly arriving from Africa with serologic tests for Schistosoma, and treat, if positive, with praziquantel.
- Do not conduct routine screening for malaria. Be alert for symptomatic malaria in migrants who have lived or travelled in malaria-endemic regions within the previous three months (suspect malaria if fever is present or person migrated from sub-Saharan Africa). Perform rapid diagnostic testing and thick and thin malaria smears.
- Screen all immigrants for dental pain (asking, “Do you have any problems or pain with your mouth, teeth or dentures?”). Treat dental pain with nonsteroidal anti-inflammatory drugs (NSAIDs) and refer patients to a dentist.
- Screen all immigrant children and adults for obvious dental caries and oral disease (examine mouth with penlight and tongue depressor). Refer patients with obvious dental disease to a dentist or oral health specialist.
- Screen immigrant women of reproductive age for unmet contraceptive needs soon after arrival to Canada.
- Provide culturally sensitive, patient-centered contraceptive counselling (giving women their method of choice, having contraception on site and fostering a good interpersonal relationship).
Vaccination against human papillomavirus
- Vaccinate 9 to 26 year old female patients against human papillomavirus.
- Screen sexually active women for cervical abnormalities by Papanicolaou (Pap) test.
- Information, rapport and access to a female practitioner can improve uptake of screening and follow-up.