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Of 7792 refugees resettled to the United States, 44% are infected with tuberculosis (43% latent tuberculosis and <1% active); 7% are infected with chronic viral hepatitis, and 4% with parasitic infections (strongyloides 2%, schistosomes 1%, miscellaneous 1%). No refugees had malaria.Background. Many nations are struggling to develop structured systems and guidelines to optimize the health of new arrivals, but there is currently no international consensus about the best approach.Methods. Data on 7792 migrants who crossed international borders for the purpose of resettlement and underwent a protocol-based health assessment were collected from the GeoSentinel Surveillance network. Demographic and health characteristics of a subgroup of these migrants seen at 2 US-based GeoSentinel clinics for protocol-based health assessments are described.Results. There was significant variation over time in screened migrant populations and in their demographic characteristics. Significant diagnoses identified in all migrant groups included latent tuberculosis, found in 43% of migrants, eosinophilia in 15%, and hepatitis B infection in 6%. Variation by region occurred for select diagnoses such as parasitic infections. Notably absent were infectious tuberculosis, soil-transmitted helminths, and malaria. Although some conditions would be unfamiliar to clinicians in receiving countries, universal health problems such as dental caries, anemia, ophthalmologic conditions, and hypertension were found in 32%, 11%, 10%, and 5%, respectively, of screened migrants.Conclusions. Data from postarrival health assessments can inform clinicians about screening tests to perform in new immigrants and help communities prepare for health problems expected in specific migrant populations. These data support recommendations developed in some countries to screen all newly arriving migrants for some specific diseases (such as tuberculosis) and can be used to help in the process of developing additional screening recommendations that might be applied broadly or focused on specific at-risk populations. [ABSTRACT FROM PUBLISHER]

Of 7629 migrants, one third were infected with tuberculosis (22% active, 10% latent), one quarter with a variety of parasites (malaria 7%, schistosomes 6%, Strongyloides 5%, miscellaneous 5%), and 17% with chronic viral hepatitis (12% hepatitis B, 5% hepatitis C).Background. Increasing international migration may challenge healthcare providers unfamiliar with acute and long latency infections and diseases common in this population. This study defines health conditions encountered in a large heterogenous group of migrants.Methods. Migrants seen at GeoSentinel clinics for any reason, other than those seen at clinics only providing comprehensive protocol-based health screening soon after arrival, were included. Proportionate morbidity for syndromes and diagnoses by country or region of origin were determined and compared.Results. A total of 7629 migrants from 153 countries were seen at 41 GeoSentinel clinics in 19 countries. Most (59%) were adults aged 19–39 years; 11% were children. Most (58%) were seen >1 year after arrival; 27% were seen after >5 years. The most common diagnoses were latent tuberculosis (22%), viral hepatitis (17%), active tuberculosis (10%), human immunodeficiency virus (HIV)/AIDS (7%), malaria (7%), schistosomiasis (6%), and strongyloidiasis (5%); 5% were reported healthy. Twenty percent were hospitalized (24% for active tuberculosis and 21% for febrile illness [83% due to malaria]), and 13 died. Tuberculosis diagnoses and HIV/AIDS were reported from all regions, strongyloidiasis from most regions, and chronic hepatitis B virus (HBV) particularly in Asian immigrants. Regional diagnoses included schistosomiasis (Africa) and Chagas disease (Americas).Conclusions. Eliciting a migration history is important at every encounter; migrant patients may have acute illness or chronic conditions related to exposure in their country of origin. Early detection and treatment, particularly for diagnoses related to tuberculosis, HBV, Strongyloides, and schistosomiasis, may improve outcomes. Policy makers should consider expansion of refugee screening programs to include all migrants. [ABSTRACT FROM PUBLISHER]

Measles remains a risk for travelers, with 94 measles diagnoses reported to the GeoSentinel network from 2000 to 2014, twothirds since 2010. Asia was the most common exposure region, then Africa and Europe. Efforts to reduce travel-associated measles should target all vaccine-eligible travelers, including catchup vaccination of susceptible adults. [ABSTRACT FROM AUTHOR]

Human mobility has always been associated with the spread of infection, and mobility of nonimmigrant visitors and temporary residents to the United States is increasing, from ≈12 million in 1987 to ≈37 million in 2007. Lack of information about the health status of these populations upon arrival and their need for and use of medical services in the United States hinders development of public health policy, education, and provision of adequate clinical care. After these issues and needs are clarifi ed, intervention programs should be developed to increase access and decrease the disparities of care experienced by these populations. [ABSTRACT FROM AUTHOR]

This article provides a framework for understanding how Muslim identity, and the current social and political contexts in which it is shaped, affects the health of Muslims in the UK and the US, and the quality of health care they receive. Key medical and public health literature that addresses health concerns related to Muslim communities in the UK and the US is reviewed. Few data exist specific to health disparities for Muslim minorities. However, the article focuses on emerging studies concerning the consequences of –Islamophobia– for the physical and mental health and health care of Muslim families and children. We argue that, despite substantive structural differences in the health care systems of the UK and the US, social structural and political forces play similar roles in the health of Muslim children in both countries. Finally, we call for significant cultural and institutional adjustments in health care settings and further research studies to provide specific data to address health disparities for these growing and diverse populations. [ABSTRACT FROM AUTHOR]

Yellow fever continues to occur in regions of Africa and South America, despite the availability of effective vaccines. Recently, some cases of severe neurologic disease and multiorgan system disease have been described in individuals who received yellow fever vaccine. These events have focused attention on the need to define criteria for judicious use of yellow fever vaccine and to describe the spectrum of adverse events that may be associated with yellow fever vaccine. Describing host factors that would increase risk of these events and identifying potential treatment modalities for yellow fever and yellow fever vaccine-associated adverse events are subjects of intense investigation. [ABSTRACT FROM AUTHOR]

Background. Refugees may arrive for resettlement with asymptomatic parasitic infections, and eosinophilia may be the only clue to the presence of infection. Our aim was to determine the prevalence of eosinophilia and develop a standardized approach to the evaluation of asymptomatic refugees with eosinophilia. Methods. We reviewed the medical records of refugees seen from October 1998 through May 2002 at Boston Medical Center. Data examined included age, country of origin, absolute eosinophil count, results of stool ova and parasite testing, and results of serological testing for Strongyloides stercoralis, Schistosoma species, and filaria. Results. Eosinophilia—defined as an absolute eosinophil count of ⩾450 cells/μL—was present in 266 (12%) of 2224 refugees. Patients with eosinophilia ranged in age from 2 months to 81 years and had arrived from Africa, Eastern Europe, Southeast Asia, South America, the Caribbean, and the Middle East. Absolute eosinophil counts ranged from 450 to 3224 cells/μL. Pathogens were identified in stool samples of 76 (29%) of 265 patients. Serological testing for S. stercoralis, Schistosoma species, and/or filaria was done for 120 (45%) of 266 patients. Results of serological testing were positive for S. stercoralis in 45 (39%) of 115 patients, for Schistosoma species in 15 (22%) of 67 patients, and for filaria in 18 (51%) of 35 patients. Serological evidence of parasitic infection was seen at all levels of eosinophilia and in patients with and without pathogens identified in their stool samples. Conclusions. Systematic evaluation for parasites in asymptomatic, newly arrived refugees with eosinophilia should include stool ova and parasite examination, serological examination for S. stercoralis for all patients, and serological examination for Schistosoma species and filaria in patients from regions where these organisms are endemic. [ABSTRACT FROM AUTHOR]

Refugees resettling in the United States carry a significant burden of infectious diseases as a result of exposures in their countries of origin and the circumstances of their migration. Overseas screening is required before entry, but it incompletely assesses infectious diseases in refugees. Domestic health assessment has the potential to provide more comprehensive assessment for infectious diseases. Screening protocols ideally should test for tuberculosis, hepatitis B, and intestinal and other parasites and should include mechanisms for providing or updating immunizations. Testing for other infectious diseases, including malaria, hepatitis C, human immunodeficiency virus, and sexually transmitted diseases, can be performed on the basis of clinical signs and symptoms. This article reviews the current status of overseas and domestic health screening for refugees, infectious disease burdens, and future goals for health assessment of refugees and other immigrants. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether it is more cost-effective to test for varicella antibody or to immunize without testing in immigrant populations. The reliability of history of varicella disease is also unclear.Methods: The prevalences of varicella antibody in immigrant children from six regions of the world were used in a cost-effectiveness model to calculate the antibody prevalence above which it is more cost-effective to test rather than to immunize. History of varicella disease was obtained from chart review. We calculated the positive and negative predictive values of varicella history by age group and region.Results: The prevalence of varicella antibody above which it is more cost-effective to test than to immunize was 34% for children less than 13 years old and 17% for those aged 13 years and older. Overall, the positive predictive value of varicella history was 93-100% and the negative predictive value of varicella history was 28-66% among the six geographic regions.Conclusion: Immunization without serotesting was cost-effective in children <5 years of age. Testing prior to immunization was cost-effective in children 5 years of age and older. History of varicella was a good predictor of the presence of antibody to varicella, whereas a negative history was a poor predictor of the absence of antibody to varicella. [ABSTRACT FROM AUTHOR]

Hepatitis A is the most common vaccine-preventable disease in international travelers. Many individuals born and raised in hepatitis A endemic areas are likely to be immune to hepatitis A. Unnecessary hepatitis A immunization could be avoided by taking into account prior exposure to hepatitis A and judicious use of serotesting prior to immunization. Methods: Patients born and raised in countries of high prevalence of hepatitis A who were seen for pretravel consultation and who had hepatitis antibody measured were eligible. Data were collected about country of birth and length of residence there before emigration, length of time till departure on current trip, current age, and hepatitis A antibody result. Results: Patients ranged from 12 to 74 years of age and were from 27 countries. Their pretravel visit occurred from 4 to more than 90 days prior to departure. Ninety-five percent (122 of 129) of patients were immune to hepatitis A, including 100% (83 of 83) of those who resided in their country of origin until at least aged 20. Most patients were seen for pretravel consultation less than 28 days prior to departure. Conclusion: Individuals born and raised until aged 20 in hepatitis A endemic countries are likely to be immune to hepatitis A. Serotesting is most helpful in assessing immunity to hepatitis A in those under 20 years of age. [ABSTRACT FROM AUTHOR]

Immigrant children who enter the United States without immunization records may be required to receive vaccines for diseases to which they are already immune or for which they have previously received immunization. We tested 669 newly arrived refugees (age range, 0-20 years) for antibody to measles, rubella, and varicella, to determine the seroprevalence of antibodies to these diseases in this group of immigrants. Five hundred forty-nine (82%) of 669 patients had antibody to measles, 545 (82%) of 668 had antibody to rubella, and 430 (64%) of 668 had antibody to varicella. Antibody to all 3 diseases increased with increasing age. No clinically significant differences in presence of antibody were noted by region of origin. [ABSTRACT FROM AUTHOR]

Background With the future epidemiology and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uncertain, the use of safe and effective coronavirus disease 2019 (COVID-19) vaccines in pediatric populations remains important. Methods We report data from two open-label substudies of an ongoing phase 1/2/3 master study (NCT05543616) investigating the safety and immunogenicity of a variant-adapted bivalent COVID-19 vaccine encoding ancestral and Omicron BA.4/BA.5 spike proteins (bivalent BNT162b2). The open-label groups presented here evaluate dose 4 with bivalent BNT162b2 in 6-month- to <12-year-olds who previously received three original (monovalent) BNT162b2 doses. In 6-month- to <5-year-olds, primary immunogenicity objectives were to demonstrate superiority (neutralizing titer) and noninferiority (seroresponse rate) to Omicron BA.4/BA.5 and noninferiority (neutralizing titer and seroresponse rate) to SARS-CoV-2 ancestral strains in participants who received bivalent BNT162b2 dose 4 compared with a matched group who received three doses of original BNT162b2 in the pivotal pediatric study (NCT04816643). In 5- to <12-year-olds, primary immunogenicity comparisons were descriptive. Reactogenicity and safety following vaccination were evaluated. Results In 6-month- to <5-year-olds, dose 4 with bivalent BNT162b2 met predefined immunogenicity superiority and noninferiority criteria against Omicron BA.4/BA.5 and ancestral strains when compared with dose 3 of original BNT162b2. In 5- to <12-year-olds, bivalent BNT162b2 induced robust Omicron BA.4/BA.5 and ancestral strain neutralizing titers comparable with dose 3 of original BNT162b2. The safety profile for dose 4 of bivalent BNT162b2 given as dose 4 was consistent with that of original BNT162b2 in 6-month- to <12-year-olds. Reactogenicity events were generally mild to moderate. No adverse events led to discontinuation. Conclusions These safety and immunogenicity data support a favorable benefit-risk profile for a variant-adapted BNT162b2 in children <12 years old. [ABSTRACT FROM AUTHOR]