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Refugee Health 101 with focus on Syrian Refugees
- 1. January 27, 2016 Dr. Bhooma Bhayana Dr. Natalie Lovesey Joanne Veldhorst, NP REFUGEE HEALTH 101
- 2. Mission Statement Chronic Diseases Infectious Diseases Women’s Health Mental Health CCIRH Preventative Care Forms PRESENTATION OVERVIEW
- 3. MISSION STATEMENT Transition/ welcome “altruism” the caring of “the other” Global health, our boundaries are beyond “sea to sea” Early detection Evidence based- informed by evidence and not xenophobia Not an immigration medical exam
- 4. CHRONIC DISEASE IN SYRIAN NEWCOMERS Diabetes Iron Deficiency Anemia Dental Health Vision Health
- 5. Varicella – most adolescents and young adults will be immune CHILDREN: Catch-up childhood vaccine if absent or uncertain vaccination records. Offer varicella vaccine to children <13 yo. ADULTS: If no records, give 1 dose of MMR and a primary series of tetanus, diphtheria and polio, with 1st dose being Tdap. Varicella serology & vaccinate if susceptible. INFECTIOUS DISEASES
- 6. Do not offer testing for latent TB Screen all children and adults for chronic Hep B infection and vaccinate if susceptible Consider screening for Hepatitis C Shoulder consider Strongyloides serology, but should not collect stool samples unless the patient has abdominal symptoms. INFECTIOUS DISEASES RECOMMENDATIONS
- 7. Hep B sAg, sAb, cAb Hep C serology Varicella serology (esp women of childbearing age) Rubella serology (women of childbearing age) Strongyloides serology Stool O&P only if GI symptoms ID SUMMARY – WHAT TO ORDER
- 8. Childbearing years - Rubella and varicella serology Anemia Confirming or ruling out pregnancy Discussing contraception needs Preconception considerations (folic acid) Follow up visit – gyne exam/Pap smear, STI screening, screening for IPV Adjustment stress/social isolation WOMEN’S HEALTH
- 9. Immunization catch-up Growth and development (WHO growth charts) Anemia Resource: www.kidsnewtocanada.ca PEDIATRICS
- 10. CCIRH: Remain alert for possible PTSD but do not routinely screen for history of trauma CCIRH: Screen for depression (as usual for primary care) MENTAL HEALTH
- 15. Paper/e-Package of Resources Caring for Kids New to Canada (CPS) – kidsnewtocanada.ca Sick Kids – aboutkidshealth.ca – multilingual patient handouts CCIRH: www.ccihrken.ca Online London Refugee Health Network List RESOURCES
Hinweis der Redaktion
- IME includes CXR in those >11 yo to rule out active TB, and syphilis & HIV tests in those 15 yo and over. Europe has received ~600 000 Syrian refugees in the past year and no serious public health concerns have been noted In crowded enviro’ts – scabies and head lice Vaccine coverage was >90% in Syria prior to the war WHO & UNICEF estimate that only ~40-50% of Syrian children have received the primary series of Tdp and polio vaccines. Studies have shown most adolescents 83-97% are immune to varicella. Varicella vax is not part of the routine imm schedule in Syria. Give vaccines without prior serologic testing (with possible exception of varicella). More research may change this.
- TB – WHO 2014 – incidence in Syria was low, 17 in 100 000. Active cases of TB in Turkey and Lebanon – low in 2014 - <20/100 000. Syrian refugees in Jordan in 2015 – 12 per 100 000. (CCIRH g/l advise screening when incidence is >30 per 100 000. Rate of chronic Hep B infection 5.6% Hep C: – prevalence in Syrian refugees is uncertain; war may have increased the prevalence Strongy – relatively low prevalence (<5%) in limited community based studies, but the prevalence appears highest in refugee populations. Potential increased exposure to it in unsanitary conditions in refugee camps– potential high benefit of preventing fatal disseminated strongy//low risk of therapy. *More research could change this recommendation. Recommend AGAINST stool stamples for O&P if asymptomatic.