Refugee+Health

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Below are recommended vaccines and screening lab tests for refugees who have recently arrived in the US. Most refugees are required to these tests are part of the official US refugee program.

What do providers need to know when they see a patient in their clinic for a refugee health screening?  Our public health division has taken multiple steps to make this process easier for providers: 1. The provider will usually get an inbasket message at the time the appointment is scheduled alerting them that they have an upcoming refugee health screening. This inbasket message will spell out specifically what vaccines and lab tests the patient needs. Many providers cut and paste this list into a note or the problem list in advance, or simply order the tests and vaccines at that time, to be administered when the patient arrives for the appointment. 2. The lists of required labs and vaccines for refugees will be scanned into the patient's chart under the media tab. This list is now also on iSite and the ccrmc wiki (ccrmc.wikispaces.com, search "refugee"). 3. Most of these patients are healthy. Focus on obtaining the required vaccines and labs and a brief health assessment. If all the required labs and vaccines are not done you likely will get a message from public health asking you to order what's missing. If needed the patient can be brought back for further assessments. 4. One common omission is ordering a CBC instead of a CBC w/diff. The differential is needed to check for eosinophilia, a marker for parasitic disease. Another is ordering a chronic hep panel but not a Hep B SAb as well. The Hep B Sab is not part of the chronic hep panel but is required. See the attached lists. Maggie Nguyen in the public health division is a resource to contact if you have further questions  Hepatitis B surface Antigen (HBsAg) Hepatitis B surface antibody (anti-HBs) and Hepatitis B core antibody (anti-HBc) And Hepatitis C Antibody Screen (anti-HCV) || All Refugees ||
 * ** REFUGEE HEALTH ASSESSMENT PROGRAM (RHAP) **
 * REQUIRED LABORATORY TESTS ** ||
 * **TESTS** || **FEFUGEES** ||
 * QuantiFeron TB test || All Refugees ||
 * Complete Blood Count (CBC) and evaluation of eosinophilia || All Refugees ||
 * Complete Hepatitis panel, including:
 * HIV Antibody || All Refugees ||
 * Syphilis Screening RPR (if RPR reactive, perform TPPA/FTA-ABS/TP-MHA) || All Refugees ≥ 15yrs ||
 * Stool O+P (2 samples) || All Refugees ||
 * Random Serum Glucose || All Refugees ||
 * Random Lipid Panel || Men ≥ 35yrs, Women ≥ 45 yrs, or if Diabetes, Obese, history of Cardiovascular Disease, Hypertension or familial risk factors ||
 * Antistrongyloides Antibody Serology || All Refugees ||
 * Chlamydia Screen || Women >15 - ≤ 25 years or if risk factors are present ||
 * Lead || All Refugees 6 mos old to ≤ 16 years ||
 * Pregnancy test || Sexually active, 13-55 years ||
 * Fecal Occult Blood || ≥ 50 years – 75 ||

**M ****o ****nths ** ||||||  **12 ** **M ****o ****nths-6 ** **<span style="font-family: Georgia,serif; font-size: 12pt;">Years ** || **<span style="font-family: Georgia,serif; font-size: 12pt;">7 ****<span style="font-family: Georgia,serif; font-size: 12pt;">-10 ** **<span style="font-family: Georgia,serif; font-size: 12pt;">Years ** || <span style="font-family: Georgia,serif; font-size: 12pt;">1957  || <span style="font-family: Georgia,serif; font-size: 12pt;">8 months  ||||||||||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   || <span style="font-family: Georgia,serif; font-size: 12pt;">(MCV4)  ||||||||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 11 years through18 years   ||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   || <span style="font-family: Georgia,serif; font-size: 9pt;">DTP=diphtheriaandtetanustoxoidsandpertussisvaccine; DTaP=diphtheriaandtetanustoxoidsandacellular pertussis vaccine;DT=pediatricformulationdiphtheriaandtetanustoxoids; Td=adultformulationtetanusand diphtheriatoxoids;Tdap=adolescentand adult formulationtetanusanddiphtheriatoxoidsandacellularpertussis vaccine(Boostrixforpersons10-64yearsold;Adacelforpersons11-64yearsold); IPV=inactivatedpoliovirusvaccine (killed);MMR=combinedmeasles,mumps, andrubellavaccine;Hib=Haemophilusinfluenzaetypeb conjugate vaccine;MCV=meningococcalconjugate vaccine;PCV=pneumococcalconjugate vaccine;PPV=pneumococcal polysaccharidevaccine.AdaptedfromACIPrecommendations.
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Table:Requirementsforroutinevaccinationofadjustmentofstatusapplicantswho are not fullyvaccinatedor lack documentation. ||
 * **<span style="font-family: Georgia,serif; font-size: 12pt;">Vaccine ** |||||||||||||||||||||||||||| **<span style="font-family: Georgia,serif; font-size: 12pt;">Age **  ||
 * ^  || **<span style="font-family: Georgia,serif; font-size: 12pt;">Birth-1 **
 * <span style="font-family: Georgia,serif; font-size: 12pt;">M ****<span style="font-family: Georgia,serif; font-size: 12pt;">o ****<span style="font-family: Georgia,serif; font-size: 12pt;">nth ** |||||||| **<span style="font-family: Georgia,serif; font-size: 12pt;">2 ****<span style="font-family: Georgia,serif; font-size: 12pt;">-11 **
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Years ** || **<span style="font-family: Georgia,serif; font-size: 12pt;">11-17 **
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Years ** |||||| **<span style="font-family: Georgia,serif; font-size: 12pt;">18-64 **
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Years ** || **<span style="font-family: Georgia,serif; font-size: 12pt;">≥ ****<span style="font-family: Georgia,serif; font-size: 12pt;">65 **
 * <span style="font-family: Georgia,serif; font-size: 12pt;">DTP/DTaP/DT || <span style="font-family: Georgia,serif; font-size: 12pt;">NO |||||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">YES   ||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Td/Tdap |||||||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 7yearsandolder(forTd); if 10yearsthrough64years(for Tdap-seeACIPschedule);if 65 yearsandolder(forTd)   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">IPV  || <span style="font-family: Georgia,serif; font-size: 12pt;">NO ||||||||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES   ||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">MMR |||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   |||||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if bornin1957orlater ||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO,if born before
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Rotavirus |||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 6 weeksto
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Hib  || <span style="font-family: Georgia,serif; font-size: 12pt;">NO ||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 2months through59 months   ||||||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">HepatitisA |||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 12 months through23 months   ||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">HepatitisB |||||||||||||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">YES,birththrough18years |||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Meningococcal
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Varicella |||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||||||||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Pneumococcal || <span style="font-family: Georgia,serif; font-size: 12pt;">NO |||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">YES, if 2months through59months (forPCV)   ||||||||||||  <span style="font-family: Georgia,serif; font-size: 12pt;">NO   ||  <span style="font-family: Georgia,serif; font-size: 12pt;">YES (for PPV)   ||
 * <span style="font-family: Georgia,serif; font-size: 12pt;">Influenza |||||| <span style="font-family: Georgia,serif; font-size: 12pt;">NO   |||||||||||||||||||||| <span style="font-family: Georgia,serif; font-size: 12pt;">YES,6months andolder(annuallyeachfluseason) ||

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<span style="font-family: Arial,sans-serif;">California Refugee Health Program Policyand Procedure Manual September2013