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Infectious Diseases in Refugee Children: To Screen or Not to Screen

  • Infectious Diseases (B Marais, Section Editor)
  • Published:
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Abstract

Purpose of Review

To review the evidence on cost-effectiveness of screening refugee children for latent tuberculosis infection, soil-associated helminths, malaria, chronic hepatitis B infection and human immunodeficiency virus infection.

Recent Findings

There is strong epidemiologic evidence that it is likely to be cost-effective to screen refugee children from endemic areas for tuberculosis, hepatitis B, HIV infection and schistosomiasis. The evidence to support cost-effectiveness of screening for strongyloides infection is weak and for malaria is unknown.

Summary

Screening of refugee children for infections should be based on best available evidence of cost-effectiveness.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barnett ED. Infectious disease screening for refugees resettled in the United States. Clin Infect Dis. 2004;39(6):833–41.

    Article  PubMed  Google Scholar 

  2. Dang K, Tribble AC. Strategies in infectious disease prevention and management among US-bound refugee children. Curr Probl Pediatr Adolesc Health Care. 2014;44(7):196–207.

    Article  PubMed  Google Scholar 

  3. Martin JA, Mak DB. Changing faces: a review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and 2004. Med J Aust. 2006;185(11–12):607–10.

    PubMed  Google Scholar 

  4. Shingadia D, Novelli V. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis. 2003;3(10):624–32.

    Article  PubMed  Google Scholar 

  5. World Malaria Report. World Health Organization. Copyright (c). Geneva: World Health Organization; 2015.

    Google Scholar 

  6. Shepard CW, Finelli L, Fiore AE, Bell B. Epidemiology of hepatitis B and hepatitis B virus infection in United States children. Pediatr Infect Dis J. 2005;24(9):755–60.

    Article  PubMed  Google Scholar 

  7. Greenawa C, Sandoe A, Vissandjee B, Kitai I, Gruner D, Wobsetr W, et al. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ. 2011;183(12):E939–51.

    Article  Google Scholar 

  8. Zammarchi L, Casadei G, Strohmeyer M, Bartalesi F, Liendo C, Matteelli A, et al. A scoping review of cost-effectiveness of screening and treatment for latent tubercolosis infection in migrants from high-incidence countries. BMC Health Serv Res. 2015;15:412.

    Article  PubMed  PubMed Central  Google Scholar 

  9. •• WHO Guidelines. Approved by the Guidelines Review Committee, in guidelines on the management of latent tuberculosis infection. Geneva: World Health Organization Copyright (c) World Health Organization; 2015. A collection of sentinel studies on the treatment of LTBI.

  10. Smieja MJ, Marchetti CA, Cook DJ, Smaill FM. Isoniazid for preventing tuberculosis in non-HIV infected persons. Cochrane Database Syst Rev. 2000;2:Cd001363.

    PubMed  Google Scholar 

  11. Global Tuberculosis Report. World Health Organization. 20th ed. Geneva: WHO Press; 2015.

    Google Scholar 

  12. Guzman Herrador BR, Rønning K, Borgen K, Mannsåker T, Dahle UR. Description of the largest cluster of tuberculosis notified in Norway 1997–2011: is the Norwegian tuberculosis control programme serving its purpose for high risk groups? BMC Public Health. 2015;15:367.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ritz N, Brinkmann F, Santiago Garcia B, Tebruegge M, Kampmann B. Tuberculosis in young refugees. Lancet. 2015;386(10012):2475–6.

    Article  PubMed  Google Scholar 

  14. Evans TB, Mador MJ, Glick M, Ahmad I. Tuberculosis misclassification among resettled refugees in Buffalo, New York, USA. Int J Tuberc Lung Dis. 2015;19(2):231–6.

    Article  CAS  PubMed  Google Scholar 

  15. Subedi P, Drezner KA, Dogbey MC, Newbern EC, Yun K, Scott KC, et al. Evaluation of latent tuberculous infection and treatment completion for refugees in Philadelphia, PA, 2010–2012. Int J Tuberc Lung Dis. 2015;19(5):565–9.

    Article  CAS  PubMed  Google Scholar 

  16. Liu Y, Weinberg MS, Ortega LS, Painter JA, Maloney SA. Overseas screening for tuberculosis in U.S.-bound immigrants and refugees. N Engl J Med. 2009;360(23):2406–15.

    Article  CAS  PubMed  Google Scholar 

  17. Posey DL, Naughton MP, Willacy EA, Russell M, Olson CK, Godwin CM, et al. Implementation of new TB screening requirements for U.S.-bound immigrants and refugees—2007–2014. MMWR Morb Mortal Wkly Rep. 2014;63(11):234–6.

    PubMed  Google Scholar 

  18. • Sharma SK, Sharma A, Kadhiravan T, Tharyan P. Rifamycins (rifampicin, rifabutin and rifapentine) compared to isoniazid for preventing tuberculosis in HIV-negative people at risk of active TB. Cochrane Database Syst Rev. 2013;9:169–294. A review of the efficacy of various LTBI treatment regimens.

  19. Fraser A,  Paul M, Attamna A, Leibovici L. Drugs for preventing tuberculosis in people at risk of multiple-drug-resistant pulmonary tuberculosis. Cochrane Database Syst Rev. 2006;2:CD005435.

    PubMed  Google Scholar 

  20. WHO Guidelines. Approved by the Guidelines Review Committee. Rapid advice: treatment of tuberculosis in children. Geneva: World Health OrganizationCopyright (c) World Health Organization; 2010.

  21. Libman MD, MacLean JD, Gyorkos TW. Screening for schistosomiasis, filariasis, and strongyloidiasis among expatriates returning from the tropics. Clin Infect Dis. 1993;17(3):353–9.

    Article  CAS  PubMed  Google Scholar 

  22. Dawson-Hahn EE, Greenberg SL, Domachowske JB, Olson BG. Eosinophilia and the seroprevalence of schistosomiasis and strongyloidiasis in newly arrived pediatric refugees: an examination of Centers for Disease Control and Prevention screening guidelines. J Pediatr. 2010;156(6):1016–8.

    Article  PubMed  Google Scholar 

  23. Sato Y, Kobayashi J, Toma H, Shiroma Y. Efficacy of stool examination for detection of Strongyloides infection. Am J Trop Med Hyg. 1995;53(3):248–50.

    CAS  PubMed  Google Scholar 

  24. Bisoffi Z, Buonfrate D, Sequi M, Mejia R, Cimino RO, Krolewiecki AJ, et al. Diagnostic accuracy of five serologic tests for Strongyloides stercoralis infection. PLoS Negl Trop Dis. 2014;8(1):e2640.

    Article  PubMed  PubMed Central  Google Scholar 

  25. de Silva S, Saykao P, Kelly H, MacIntyre CR, Ryan N, Leydon J, et al. Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7–20 years after resettlement in Australia. Epidemiol Infect. 2002;128(3):439–44.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Goswami ND, Shah JJ, Corey GR, Stout JE. Persistent eosinophilia and Strongyloides infection in Montagnard refugees after presumptive albendazole therapy. Am J Trop Med Hyg. 2009;81(2):302–4.

    PubMed  Google Scholar 

  27. Seybolt LM, Christiansen D, Barnett ED. Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia. Clin Infect Dis. 2006;42(3):363–7.

    Article  PubMed  Google Scholar 

  28. Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha JL, Seet RC, Summer AP, et al. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med. 2007;120(6):545.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Naidu P, Yanow SK, Kowalewska-Grochowska KT. Eosinophilia: a poor predictor of Strongyloides infection in refugees. Can J Infect Dis Med Microbiol. 2013;24(2):93–6.

    PubMed  PubMed Central  Google Scholar 

  30. Muennig P, Pallin D, Challah C, Khan K. The cost-effectiveness of ivermectin versus albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States. Epidemiol Infect. 2004;132(6):1055–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Buonfrate D, Sequi M, Mejia R, Cimino RO, Krolewiecki AJ, Albonico M, et al. Accuracy of five serologic tests for the follow up of Strongyloides stercoralis infection. PLoS Negl Trop Dis. 2015;9(2):e0003491.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Geltman PL, Cochran J, Hedgecock C. Intestinal parasites among African refugees resettled in Massachusetts and the impact of an overseas pre-departure treatment program. Am J Trop Med Hyg. 2003;69(6):657–62.

    PubMed  Google Scholar 

  33. Gyorkos TW, MacLean JD, Viens P, Chheang C, Kokoskin-Nelson E. Intestinal parasite infection in the Kampuchean refugee population 6 years after resettlement in Canada. J Infect Dis. 1992;166(2):413–7.

    Article  CAS  PubMed  Google Scholar 

  34. • Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC Jr, Terashima A, Samalvides F, Pérez-Molina JA, Plana MN. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016;18:CD007745. An important study assessing the efficacy of various antihelminthics in eliminating Strongyloides carriage.

  35. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824–925.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kamgno J, Boussinesq M, Labrousse F, Nkegoum B, Thylefors BI, Mackenzie CD. Encephalopathy after ivermectin treatment in a patient infected with Loa loa and Plasmodium spp. Am J Trop Med Hyg. 2008;78(4):546–51.

    CAS  PubMed  Google Scholar 

  37. Greaves D, Coggle S, Pollard C, Aliyu SH, Moore EM. Strongyloides stercoralis infection. BMJ. 2013;347:f4610.

    Article  PubMed  Google Scholar 

  38. Kramer CV,  Zhang F,  Sinclair D,  Olliaro PL.  Drugs for treating urinary schistosomiasis.  Cochrane Database Syst Rev. 2014;8:CD000053.

    PubMed  Google Scholar 

  39. Ross AG, Bartley PB, Sleigh AC, Olds GR, Li Y, Williams GM, et al. Schistosomiasis. N Engl J Med. 2002;346(16):1212–20.

    Article  PubMed  Google Scholar 

  40. Barsoum IS, Kamal KA, Bassily S, Deelder AM, Colley DG. Diagnosis of human schistosomiasis by detection of circulating cathodic antigen with a monoclonal antibody. J Infect Dis. 1991;164(5):1010–3.

    Article  CAS  PubMed  Google Scholar 

  41. Danso-Appiah A, Olliaro PL, Donegan S, Sinclair D, Utzinger J. Drugs for treating Schistosoma mansoni infection. Cochrane Database Syst Rev. 2013;2:CD000528.

    PubMed  Google Scholar 

  42. Clerinx J, Van Gompel A. Schistosomiasis in travellers and migrants. Travel Med Infect Dis. 2011;9(1):6–24.

    Article  PubMed  Google Scholar 

  43. Whitty CJ, Carroll B, Armstrong M, Dow C, Snashall D, Marshall T, et al. Utility of history, examination and laboratory tests in screening those returning to Europe from the tropics for parasitic infection. Trop Med Int Health. 2000;5(11):818–23.

    Article  CAS  PubMed  Google Scholar 

  44. Jaureguiberry S, Paris L, Caumes E. Acute schistosomiasis, a diagnostic and therapeutic challenge. Clin Microbiol Infect. 2010;16(3):225–31.

    Article  CAS  PubMed  Google Scholar 

  45. Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, et al. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis. 2007;45(10):1310–5.

    Article  PubMed  Google Scholar 

  46. Young MK, McCall BJ, Heel K. The impact of pre-departure screening and treatment on notifications of malaria in refugees in south-east Queensland. Commun Dis Intell Q Rep. 2010;34(1):37–40.

    PubMed  Google Scholar 

  47. Hutton DW, Tan D, So SK, Brandeau ML. Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B. Ann Intern Med. 2007;147(7):460–9.

    Article  PubMed  Google Scholar 

  48. Veldhuijzen IK, Toy M, Hahne SJ, De Wit GA, Schalm SW, de Man RA, et al. Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology. 2010;138(2):522–30.

    Article  PubMed  Google Scholar 

  49. Wong WW, Woo G, Jenny Heathcote E, Krahn M. Cost effectiveness of screening immigrants for hepatitis B. Liver Int. 2011;31(8):1179–90.

    Article  PubMed  Google Scholar 

  50. Rossi C, Schwartzman K, Oxlade O, Klein MB, Greenaway C. Hepatitis B screening and vaccination strategies for newly arrived adult Canadian immigrants and refugees: a cost-effectiveness analysis. PLoS One. 2013;8(10):e78548.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Sheikh M, Pal A, Wang S, MacIntyre CR, Wood NJ, Isaacs D, et al. The epidemiology of health conditions of newly arrived refugee children: a review of patients attending a specialist health clinic in Sydney. J Paediatr Child Health. 2009;45(9):509–13.

    Article  PubMed  Google Scholar 

  52. Moreno A, Crosby S, Labelle C, Sullivan M, Samet JH. Health assessment of HIV-infected refugees. J Acquir Immune Defic Syndr. 2003;34(2):251–4.

    Article  PubMed  Google Scholar 

  53. Moreno A, Labelle C, Samet JH. Recurrence of post-traumatic stress disorder symptoms after initiation of antiretrovirals including efavirenz: a report of two cases. HIV Med. 2003;4(3):302–4.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Benjamin Smith & David Isaacs

  2. Discipline of Child Health, University of Sydney, Sydney, NSW, 2006, Australia

    David Isaacs

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  1. Benjamin Smith
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Correspondence to David Isaacs.

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Benjamin Smith and David Isaacs declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Infectious Diseases.

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Smith, B., Isaacs, D. Infectious Diseases in Refugee Children: To Screen or Not to Screen. Curr Pediatr Rep 4, 84–89 (2016). https://doi.org/10.1007/s40124-016-0103-6

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  • DOI: https://doi.org/10.1007/s40124-016-0103-6

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