TABLE 19.2.

Examples of Medical Screening of Migrants by Region, Population, Condition, and Intervention

Region	Population	Infectious Disease Conditions	Noninfectious Conditions	Intervention
Latin America	Migrant workers, agricultural	STD, TB, intestinal parasites, Trypanosoma cruzi	Substance use/abuse: alcohol, tobacco, others	Assessment and counseling, safer sex practices, HBV serology (HBsAg) and immunization of at-risk individuals; TST for children. Immunization: routine, hepatitis B; perinatal care and screening for maternal-child health (all at-risk populations); preventative Rx for existing conditions (e.g., syphilis, HIV, hypothyroidism, diabetes, hypertension)
	Migrant workers, domestic	TB, intestinal tapeworm (Taenia solium and other parasites) Hansen disease, T. cruzi	Diet: caloric balance, micronutrient deficiencies; occupational risks: physical violence, psychological abuse, toxins, or dangerous environmental exposures
	Children of migrant laborers	TB	Physical and mental developmental milestones, educational participation and attainment
Europe	Women smuggled or trafficked, particularly from Eastern Europe (also Asia and Africa)	Acquired risk environments and behaviors for STDs	Occupational risks: forced labor and commercial sex workers, physical and psychological abuse, violence, substance abuse	Assessment and referral to justice and immigration protection services Local standards of clinical practice need to be observed with a heightened suspicion of imported disease conditions that are of low or zero prevalence in the USA or Europe.
	The elderly	TB, tertiary syphilis, Strongyloides (southern Europe)	Common diseases of advancing age: renal failure, malignancies, diabetes, hypertension
	Other workers		Previous occupational exposures: asbestos, radiation, trauma
Asia	Migrants from rural environments	Intestinal parasites, including Strongyloides; tuberculosis, Hansen disease, chronic HBV carriage (most populations of Asia, sub-Saharan Africa, parts of Oceania) Note: Pulmonary paragonimiasis can mimic TB. Liver flukes can lead to chronic hepatic scarring.	Dietary deficiencies, acculturation effects on mental status Occupational and environmental health risks	Stools for parasites; serology for Strongyloides, HBV (HBsAg) and immunization of at-risk individuals. TST (children) Clinical assessment for cultural norms: body mass, hematological and biochemical parameters
Africa	Refugees	Note: immigration medical waivers may have been given for screened Class A conditions (e.g., tuberculosis)	Victims of forced relocation, torture, rape, physical and psychological trauma Posttraumatic stress disorders Nutritional deficiencies, particularly in children and women of childbearing potential Negative effects of acculturation	Intestinal, blood, and tissue parasites including Strongyloides (serology), schistosomiasis (urine), malaria TST (children) Iron status HBV serology (HBsAg) and immunization of at-risk individuals
Oceania	Immigrants	Hepatitis B, tuberculosis, Hansen disease		Serological screening: HBV (HBsAg) and immunization of at-risk individuals Skin examination. Heightened clinical suspicion
North America	Long-term expatriates (humanitarian/relief workers, business travelers, “overlanders” or backpackers) Sex tourists VFR: migrant return travel, with or without local-born children or next-generation travel	Communicable diseases endemic in the population and area of work or travel Consider exposures in those VFR, immune status, local access and use of healthcare services	Culture shock and other psychological adaptation disorders; acquired behavioral risks Cultural components of foreign exposures; VFR: female circumcision, scarification, tattooing, or piercing	Clinical assessment and management of post-exposure risks based on geographic environment and activities: tuberculosis, intestinal parasites, serology for Strongyloides. TST for long-term exposure in high-prevalence countries Note: eosinophilia correlates poorly to the presence or absence of invasive helminthic infections

HBV, Hepatitis B virus; HIV, human immunodeficiency virus; Rx, prescription; STD, sexually transmitted disease; TB, tuberculosis; TST, tuberculin skin test; VFR, visiting friends and/or relatives.