Quick Summary: Screening and Vaccination Guide for Refugee and Immigrant Health

Publication Summary

In 2011, the Canadian Medical Association Journal published detailed evidence-based clinical guidelines for immigrants and refugees as a gold standard for clinical and public health practitioners in Canada. NCCID has designed a summarized version as a quick review tool for clinicians.

Reproduced with permission from CMAJ

Published: 2016

Subject Area(s):

Author(s):

Project No. 295

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.
Varicella
  • 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.
Hepatitis B
  • 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).
Tuberculosis
  • 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.
HIV
  • 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.
Hepatitis C
  • 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.
Intestinal parasites

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.

Malaria
  • 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.
Oral Health
  • 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.
Women’s Health

Contraception

  • 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.

Cervical cytology

  • 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.