In this section
In general, health screening in refugee and asylum seeker children should be performed in the outpatient setting. In Victoria, refugee health assessments are often completed in primary care. See initial assessment; a list of suggested initial investigations is included. Children aged < 5 years from malaria endemic areas in Australia < 3 months should have opportunistic malaria screening if they have not had previous screening.
No-one arriving as a refugee or asylum seeker will be vaccinated and up to date according to the Australian immunisation schedule, due to differences in country of origin immunisation schedules.
Australian data suggest the prevalence of anaemia is 10 - 30% in refugee children, with similar prevalence in children from Africa, Middle East or Asia. Iron deficiency affects a similar proportion. Low B12 and/or folate have recently been reported in refugees from Afghanistan and Sri Lanka; and lead toxicity has been reported in up to 7 - 13% of refugee children from Africa, South Asia and Burma, especially in children < 6 years.
Current humanitarian source countries have either intermediate (2 - 7%) or high (>=8%) prevalence of HBsAg. The prevalence of HBsAg in refugee cohorts reflects area of origin prevalence. Both vertical and horizontal modes of transmission are important in the epidemiology of hepatitis B in children, and immunisation of non-immune household contacts is a priority. Household composition may be fluid in the early settlement period, and it is probably safer to assume household contact is the norm, rather than the exception.
In children diagnosed with hepatitis B infection it is important to:
The key challenge in management of refugee children/young people with chronic hepatitis B is that they need follow-up/monitoring for years, with transition to adult services. Coordinated care is essential.
Parasites are common in refugee children/young people and are also seen in asylum seeker children. Australian data suggest the prevalence of pathogenic faecal parasites in post arrival refugee health screening is 14 - 42%, Giardia was the most common parasite identified in African cohorts. The prevalence of Schistosoma infection is 12 - 38% in African refugees and 7% in Karen refugees, the prevalence of Strongyloides is 1 - 9% in African refugees and 21% in Karen refugees. Parasite infections may last for years and have sequelae for nutrition, growth and function. In general, treatment is usually short course (often single dose) and well tolerated.
All refugee and asylum seeker children and adolescents should be screened for TB infection. The Mantoux test (Tuberculin Skin Test -TST) is the preferred first line screening test in children aged <5 years, and can be used at all ages. Interferon-gamma release assays (IGRA) such as QFN-GIT® and T-SPOT-TB® can be used in those age >=5 years but are not suitable as first line screening tests in younger children. The prevalence of a positive TST (10 mm or more) in refugees from Africa, Europe and the Middle East is 25 - 55%. Latent TB infection (LTBI) is evidence of TB infection without evidence of active TB disease (based on history examination and a chest x-ray). Children diagnosed with LTBI are not infectious; although their lifetime risk of developing TB disease is around 10%, and may be higher, especially in those aged < 5 years.
Up to 90% of African-Australians in Melbourne will have low Vitamin D during the winter months. Low vitamin D is also seen in other refugee groups, especially people who have reduced sun exposure, including women who wear covering clothing. Most vitamin D is made in the skin through the action of sunlight, diet is a poor source of vitamin D. Risk factors for low vitamin D include limited sunlight exposure, dark skin, conditions/medications affecting vitamin D metabolism (obesity, liver or renal disease, anticonvulsant, TB medications), and for babies: low maternal vitamin D and breastfeeding with other risk factors.
Immigrant health clinic resources Updated April 2016 Contact: firstname.lastname@example.org