Infectious diseases are frequently considered when evaluating refugees but pose variable risks to the patients, their close contacts, and the community.
Malaria, for example, is less likely to be a concern at this time due to presumptive pre-departure therapy provided to most refugees from endemic countries. Tuberculosis, if not diagnosed and treated, is associated with longer term risk for disease. Intestinal parasites such as strongyloidiasis and schistosoma are common infections in refugee populations from sub-Saharan Africa and South Asia and can lead to anemia as well as liver and urological complications. Vaccine-preventable diseases such as measles and polio require different approaches based on the age of the refugee. Children with unclear immunization histories will need vaccination while adults may already have immunity to measles, mumps, rubella, and other diseases, yet need other vaccinations such as pneumococcal, influenza, diphtheria, tetanus, and pertussis. Hepatitis B is the leading world-wide cause of hepatocarcinoma; evaluation for carrier status and vaccination of high risk susceptible individuals are important. STDs, filariasis, and other infections also need to be considered depending on risk factors and symptoms.
1. Eckstein, B. Primary Care for Refugees. American Family Physician, Feb 2011. 83 (4): 429-436.
2. Immigrant and Refugee Health, CDC website. Available at http://www.cdc.gov/immigrantrefugeehealth/guidelines/general-guidelines.html#cancer_screening
3. Stauffer, W, Weinberg, M. Emerging clinical issues in refugees. Current Opinion in Infectious Diseases, 2009. 22: 436-442.