Evaluating screening tests for infectious diseases among immigrants

Background: Screening strategies for immigrants and refugees are not well studied and strategies are not universally accepted or implemented. Some have suggested empirical treatments for parasitic diseases among all immigrants.

Methods: As a pilot project in our inner city clinic which provides care to many immigrants and refugees, we requested our providers to follow general recommendations for laboratory analysis in immigrants to look for chronic viral and parasitic diseases. We reviewed charts to evaluate result of laboratory analysis among 80 of recent immigrants (less than 5 years in the U.S.).

Results: Patients were mostly from central and south America and Africa. Majority was young. 46% of patients were exposed to hepatitis B with positive HBc antibody, 32 % had positive HBS antibody (immune to Hepatitis B after exposure), and one had HBS antigen positive (infecting subject). 15% had eosinophilia in their blood.

14% of patients had some forms of ova & parasite detected in their stool but only 3% had of those had eosinophilia. 7% had abnormal liver tests. 14% exposed to TB but 3 % had abnormal chest x-ray findings consistent with old TB. Of those who had HIV tests only one had a positive HIV test result.

Conclusion: Significant rate of Hepatitis B exposure may suggest evaluation for chronic infectious diseases among recent immigrants. The relationship between eosinophilia, a marker of parasitic infections, and stool ova & parasites needs further research.