Review article

Screening of international immigrants, refugees, and adoptees

Who should be screened?

The U.S. Public Health Service requires screening of all immigrants and refugees before departure from their country of origin or first asylum; undocumented individuals do not undergo screening. Refugees undergo the most thorough screening, with the authority administering the program (U.S. government, United Nations, or other refugee organization) determining the exact evaluation. Most refugees undergo evaluation by the International Office of Migration (IOM). The IOM employs healthcare

What is screening?

The clinician should perform the screening examination with a focus on the traditional tenets of screening:

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  The condition sought should be an important health problem.

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  There should be an accepted treatment for patients with recognized disease.

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  Facilities to diagnose and treat should be available to the patient.

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  There should be a recognized latent or asymptomatic disease stage.

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  There should be a suitable test or examination (acceptable sensitivity, specificity, reliability, and positive and negative

Summary

Frequently clinicians are faced with screening and providing preventive care to immigrants, refugees, and international adoptees. Evidence-based medicine on which to base screening protocols for these populations is lacking. It is important to review all health and vaccination records of the patient. In addition to acute symptoms, one should inquire about the symptoms of diseases prevalent in the country of origin or transit (eg, hematuria). Many unexpected pathologic conditions may be detected

Acknowledgements

We would like to thank the following for their valuable input: Ann O'Fallon and colleagues, Minnesota Department of Health; Julie Hauer, MD, and Dana Johnson, MD, University of Minnesota International Adoption Clinic; John Toso, MD; Phil Fischer, MD; and Robert D. Newman, MD, and colleagues, Center for Disease Control and Prevention.