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Refugee and Immigrant Health

Refugee and Immigrant Health. May 1, 2013. The American Melting Pot. Natural-born citizens Naturalized citizens Permanent legal residents Non-immigrant visitors Refugees Asylees Undocumented immigrants. The American Melting Pot. Refugees

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Refugee and Immigrant Health

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  1. Refugee and Immigrant Health May 1, 2013

  2. The American Melting Pot • Natural-born citizens • Naturalized citizens • Permanent legal residents • Non-immigrant visitors • Refugees • Asylees • Undocumented immigrants

  3. The American Melting Pot Refugees • Displaced by war, famine, civil or political unrest • Unwilling or unable to return because of persecution or well-founded fear of persecution • 2009: 74,602 refugees (2581 in Washington) • WA: Burma, Bhutan, Ukraine, Iraq, Moldova

  4. The American Melting Pot Asylees • Must meet same conditions as refugees • Applies for asylum after arrival • 2009: 22,119 granted asylum (354 in WA) • China, Ethiopia, Haiti

  5. The American Melting Pot Legal Permanent Residents (Green card holders) • Family-sponsored • Job-based • “alien of extraordinary ability” • Refugee or asylee status • Green card lottery (50,000/yr) • Misc. other pathways

  6. The American Melting Pot Naturalization • ≥18 years old • Permanent resident for ≥5 years* • Good moral character • Basic knowledge of US history and government * • Read/write/speak basic English* • Period of permanent residence in US • $680 *some exceptions

  7. The American Melting Pot Non-immigrant visitors • Visitor visas: more than 40 categories • Visa waiver program

  8. The American Melting Pot Medical Screening • Required: Hx and PE, evaluation for active TB, syphilis serology, ACIP recommended immunizations (immigrants) • HIV testing stopped 1/2010 • Screening before entry for refugees, immigrants • Screening after arrival for refugees • Screening in US for “status adjusters”

  9. The American Melting Pot Refugee pre-treatment • Empiric treatment for parasites with albendazole and ivermectin (Asia, Africa, Middle East) • Empiric treatment for schistosomiasis with praziquantel (Africa) • Empiric treatment for falciparum malaria (sub-Saharan Africa)

  10. Hepatitis B Prevalence

  11. Hepatitis C Prevalence

  12. Schistosomiasis Prevalence

  13. Zwerling A, Behr MA, Verma A, Brewer TF, et al. (2011) The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices. PLoS Med 8(3): e1001012. doi:10.1371/journal.pmed.100101 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001012

  14. Figure 2. Map displaying BCG vaccination policy by country. Zwerling A, Behr MA, Verma A, Brewer TF, et al. (2011) The BCG World Atlas: A Database of Global BCG Vaccination Policies and Practices. PLoS Med 8(3): e1001012. doi:10.1371/journal.pmed.1001012 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001012

  15. Thalassemia distribution

  16. Resources • Cultural Orientation Resource Center: http:/www.culturalorientation.net/ • Ethnomed: http://ethnomed.org/ • CDC Immigrant and Refugee Health: http://www.cdc.gov/immigrantrefugeehealth/guidelines/refugee-guidelines.html • Evidence-based Clinical Guidelines for Refugees and Immigrants: http://www.cmaj.ca/content/early/2011/07/27/cmaj.090313.full.pdf • TB risk calculator: http://www.tstin3d.com/

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