Table 2. Domestic health screening results among adults and children who resettled to the US with Special Immigrant Visas (SIV), 2014–2016a,b,c.
| Health Screening Results | Adults ≥18 years old | Children <18 years old | ||||||
|---|---|---|---|---|---|---|---|---|
| All | Iraq | Afghanistan | p-value | All | Iraq | Afghanistan | p-value | |
| n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |||
| Total | 6,124 | 1,112 (18.2) | 5,012 (81.8) | 4,816 | 851 (17.7) | 3,965 (82.3) | ||
| Time of domestic medical examination | n = 6063 | n = 1,104 | n = 4,959 | 0.54 | n = 4,774 | n = 843 | n = 3,931 | 0.08 |
| <30 days | 3,281 (54.1) | 580 (52.5) | 2,701 (54.5) | 2,764 (57.9) | 466 (55.3) | 2,298 (58.5) | ||
| 30–90 days | 2,665 (44.6) | 503 (45.6) | 2,162 (43.6) | 1,940 (40.6) | 370 (43.9) | 1,570 (39.9) | ||
| >90 days | 117 (1.9) | 21 (1.9) | 96 (1.9) | 70 (1.5) | 7 (0.8) | 63 (1.6) | ||
| TBd | n = 3471 | n = 451 | n = 3,020 | 0.01 | n = 2,673 | n = 320 | n = 2,353 | 0.95 |
| No evidence of TB | 2,963 (85.4) | 408 (90.7) | 2,555 (84.6) | 2,591 (96.9) | 310 (96.9) | 2,281 (96.9) | ||
| Clinically active | 2 (0.1) | 0 (0) | 2 (0.1) | 0 (0) | 0 (0) | 0 (0) | ||
| Not clinically active | 8 (0.2) | 1 (0.2) | 7 (0.2) | 0 (0) | 0 (0) | 0 (0) | ||
| LTBI | 498 (14.4) | 42 (9.3) | 456 (15.1) | 82 (3.1) | 10 (3.1) | 72 (3.2) | ||
| Hepatitis Be | n = 5777 | n = 1,069 | n = 4,708 | <0.0001 | n = 3,988 | n = 741 | n = 3,247 | <0.0001 |
| Susceptible | 3,669 (63.5) | 772 (72.2) | 2,897 (61.5) | 1,064 (26.7) | 223 (30.1) | 841 (25.9) | ||
| Uninfected, susceptibility unknown | 616 (10.7) | 166 (15.5) | 450 (9.6) | 1,340 (33.6) | 199 (26.9) | 1,141 (35.1) | ||
| Infected | 106 (1.8) | 6 (0.6) | 100 (2.1) | 23 (0.6) | 1 (0.1) | 22 (0.7) | ||
| Immune | ||||||||
| Natural infection | 331 (5.7) | 15 (1.4) | 316 (6.7) | 33 (0.8) | 3 (0.4) | 30 (0.9) | ||
| Hepatitis B vaccination | 978 (16.9) | 104 (9.7) | 874 (18.6) | 1,487 (37.3) | 311 (42.0) | 1,176 (36.2) | ||
| Not specified | 77 (1.3) | 6 (0.6) | 71 (1.5) | 41 (1) | 4 (0.5) | 37 (1.1) | ||
| Hepatitis Cf | n = 4,007 | n = 598 | n = 3,409 | N/A | n = 2,554 | n = 342 | n = 2,212 | N/A |
| Screened, positive | 31 (0.8) | 4 (0.7) | 27 (0.8) | 8 (0.3) | 2 (0.6) | 6 (0.3) | ||
| Malariag | n = 1,572 | n = 136 | n = 1,436 | n = 1,219 | n = 83 | n = 1,136 | ||
| Screened, positive | 2 (0.1) | 0 (0) | 2 (0.1) | 5 (0.4) | 0 (0) | 5 (0.4) | ||
| Strongyloidiasish | n = 2,578 | n = 201 | n = 2,377 | 0.6 | n = 2,018 | n = 131 | n = 1,887 | 0.9 |
| Screened, positive | 75 (2.9) | 7 (3.5) | 68 (2.9) | 50 (2.5) | 3 (2.3) | 47 (2.5) | ||
| Schistosomiasish | n = 130 | n = 42 | n = 88 | n = 96 | n = 17 | n = 79 | ||
| Screened, positive | 2 (1.5) | 0 (0) | 2 (2.3) | 2 (2.1) | 0 (0) | 2 (2.5) | ||
| Other intestinal parasitesi | n = 3,982 | n = 555 | n = 3,427 | 0.3 | n = 3,341 | n = 451 | n = 2,890 | 0.4 |
| One or more intestinal parasites | 1,235 (31.0) | 183 (33.0) | 1,052 (30.7) | 737 (22.1) | 93 (20.6) | 644 (22.3) | ||
| Blastocystis | 435 (10.9) | 46 (8.3) | 389 (11.4) | 233 (7.0) | 22 (4.9) | 211 (7.3) | ||
| Giardia | 111 (2.8) | 10 (1.8) | 101 (3.0) | 272 (8.1) | 17 (3.8) | 255 (8.8) | ||
| Dientamoeba | 108 (2.7) | 6 (1.1) | 102 (3.0) | 76 (2.3) | 12 (2.7) | 64 (2.2) | ||
| Ascaris | 60 (1.5) | 0 (0) | 60 (1.8) | 45 (1.4) | 0 (0) | 45 (1.6) | ||
| Entamoeba histolytica | 74 (1.9) | 9 (1.6) | 65 (1.9) | 25 (0.8) | 2 (0.4) | 23 (0.8) | ||
| Hymenolepsis | 3 (0.1) | 0 (0) | 3 (0.1) | 17 (0.5) | 0 (0) | 17 (0.6) | ||
| Others | 2 (0.05) | 0 (0) | 2 (0.06) | 5 (0.1) | 0 (0) | 5 (0.2) | ||
| Syphilisj | n = 5,304 | n = 928 | n = 4,376 | N/A | n = 723 | n = 105 | n = 618 | N/A |
| Screened, positive | 9 (0.2) | 2 (0.2) | 7 (0.2) | 1 (0) | 0 (0) | 1 (0.2) | ||
| Gonorrheak | n = 18 | n = 4 | n = 14 | N/A | n = 4 | n = 2 | n = 2 | N/A |
| Screened, positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | ||
| Chlamydiak | n = 1,573 | n = 121 | n = 1,452 | N/A | n = 166 | n = 15 | n = 151 | N/A |
| Screened, positive | 14 (0.9) | 2 (1.7) | 12 (0.8) | 2 (1.2) | 0 (0) | 2 (1.3) | ||
| HIVk | n = 5,782 | n = 1,027 | n = 4,755 | N/A | n = 3,924 | n = 662 | n = 3,262 | N/A |
| Positive, screened/unscreened (type 1, type 2, or unknown) | 4 (0.07) | 1 (0.1) | 3 (0.06) | 1 (0.03) | 1 (0.2) | 0 (0) | ||
| Blood lead level l | N/A | n = 2,368 | n = 543 | n = 1,825 | <0.0001 | |||
| <5 mcg/dL | N/A | N/A | N/A | 1,181 (49.9) | 470 (86.6) | 711 (39) | ||
| 5–9 mcg/dL | N/A | N/A | N/A | 944 (39.9) | 71 (13.1) | 873 (47.8) | ||
| 10–19 mcg/dL | N/A | N/A | N/A | 201 (8.5) | 2 (0.4) | 199 (10.9) | ||
| 20–44 mcg/dL | N/A | N/A | N/A | 36 (1.5) | 0 (0) | 36 (2) | ||
| 45–69 mcg/dL | N/A | N/A | N/A | 2 (0.1) | 0 (0) | 2 (0.1) | ||
| 70+ mcg/dL | N/A | N/A | N/A | 4 (0.2) | 0 (0) | 4 (0.2) | ||
aPercentages may not add up to 100% because of rounding.
bProportion of all SIVH who were not screened for a particular medical condition: latent TB (14.3%; 3% for Iraqi and Afghan adults, 35% for Iraqi children, and 27% for Afghan children); HBV (6.5%; 3% for Iraqi adults, 2% for Afghan adults, and 12% for Iraqi and Afghan children); hepatitis C virus (40.0%); malaria (74.4%); Strongyloides (57.9%); Schistosoma (97.9%), intestinal parasites (33.1%); syphilis (44.9%); gonorrhea (99.8%); chlamydia (84.1%); EBLL (77.5%); and HIV (17.6%).
cWe used χ2 tests to compare characteristic or disease condition by nationality (Iraqi or Afghan). p-Values were reported if frequency per cell was ≥5. Statistical significance was noted at a p-value <0.05.
dFor TB, information on diagnosis was reported and categorized as no evidence of TB, clinically active, not clinically active, and LTBI [15]. TB disease diagnosis was made by a positive smear, culture, or clinical diagnosis of pulmonary TB. A classification of not clinically active TB was made when a person had a history of previous episode(s) of TB or abnormal stable radiographic findings and had a positive reaction to TST, negative cultures, and no clinical and/or radiographic evidence of current disease. Diagnosis of LTBI was made by a positive interferon gamma release assay (IGRA) or TST and negative diagnostic workup for TB. The majority of adults (95%) were tested using IGRA. Among children tested for LTBI, 87% were tested using IGRA and 17% were tested using TST. Data were included if states provided information about TB diagnosis for an individual.
eHBV status was categorized as susceptible (HBsAg, anti-HBc, and anti-HBs all negative), uninfected/susceptibility unknown (HBsAg negative, anti-HBc and anti-HBs unknown), infected (HBsAg positive), immune through natural infection (HBsAg negative, anti-HBc positive, and anti-HBs positive), immune through hepatitis B vaccination (HBsAg negative, anti-HBc negative, and anti-HBs positive) and immune but not specified (HBsAg negative, anti-HBs positive, and anti-HBc unknown) [16]. About 3.5% of all SIV adults and 6% of all SIV children had HBV results where the interpretation was unknown or unclear.
fHepatitis C was diagnosed by any of the following: detection of antibody to hepatitis C virus (anti-HCV), a positive recombinant immunoblot assay (RIBA) result, or a positive HCV RNA polymerase chain reaction (PCR) result.
gMalaria diagnosis was laboratory confirmed using either microscopy or by a rapid diagnostic test.
hStrongyloides and Schistosoma diagnoses were laboratory confirmed using either microscopy or by serology testing.
iIntestinal parasite infection diagnoses were laboratory confirmed using stool ova and parasite testing. Reported p-value compares Iraqi and Afghan SIVH with any intestinal parasite reported (pathogenic and nonpathogenic) to Iraqi and Afghan SIVH with no intestinal parasite reported.
jSyphilis diagnosis was made via a positive non-treponemal test (venereal disease research laboratory [VDRL] or rapid plasma reagin [RPR]) followed by a positive confirmatory treponemal test (e.g., Treponema pallidum-particle agglutination [TP-PA], microhemagglutination assay for T. pallidum [MHA-TP]). Syphilis testing is recommended in all persons ≥15 years of age if no overseas testing results are available, and in persons <15 years of age if sexually active.
kGonorrhea, chlamydia, and HIV diagnoses were made via laboratory-confirmed testing.
lBlood lead level screening applies to children from 6 months up to 16 years of age only.
Abbreviations: anti-HBc, antibody to hepatitis B core antigen; anti-HBs, antibody to hepatitis B surface antigen; EBLL, elevated blood lead levels; HBsAg, hepatitis B virus surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; LTBI, latent tuberculosis infection; SIV, Special Immigrant Visa; SIVH, SIV holder; TB, tuberculosis; TST, tuberculin skin test