Paeds · infectious-diseases
International adoption, immigration and refugee infection screening
Also known as Post-arrival health screen for migrant children · Refugee and asylum-seeker screening · Internationally adopted child screening · Immigrant child infection screen · Newcomer paediatric health assessment
Fellowship topic on the comprehensive infection screen for the three populations of migrant children — internationally adopted, immigrant, and refugee or asylum-seeking — anchored on the must-not-miss five (tuberculosis, HIV, hepatitis B, hepatitis C, parasitic and intestinal disease); the principle that a documented record is never trusted without re-verification in your own laboratory; the Australasian ASID/RHeANA framework and the United States CDC domestic examination guidance; the silent natural history of latent, chronic and vaccine-gap infections that makes screening the only route to early detection; the IGRA-versus-TST debate; the strongyloidiasis and schistosomiasis serology that is too often missed; the catch-up immunisation that follows on serological evidence; and the trauma-informed, interpreter-mediated, equity-grounded framing that turns a checklist into a medical home.
On this page & tools
Your progress
Saved locally on this device.
Practise this topic
Target exams
Red flags
Life stages
Care settings
Clinical exam formats
Board mappings
Two stances toward the same newly arrived child
Record-trusting stance
Re-verification stance
S.C.R.E.E.N. — the six acts of the post-arrival assessment
Set the relationship — welcome, trained interpreter, trauma-informed · Core panel — TB, HIV, hepatitis B, hepatitis C, syphilis, stool and parasite serology · Re-verify — never trust the overseas record, repeat every serology yourself · Exclude malaria if febrile within months of arrival from an endemic area · Every immunity re-checked and catch-up immunisation on serological evidence · Navigate the medical home — growth, development, mental health, dental, vision and an explicit follow-up plan [9] [4]
Overview & Definition
Picture a four-year-old girl who has just arrived from an orphanage in a resource-limited country to join her adoptive family, sitting in your clinic looking well, with a thin folder of pre-adoption records in a language you do not read. The easy assumption is that she is healthy — and on the surface she is. The fellowship-level skill is to know that this is exactly the child in whom tuberculosis, chronic hepatitis B, HIV, and Strongyloides can sit silently for years, and that the single visit is the best — and sometimes only — chance to find them. The post-arrival infection screen is the structured, comprehensive assessment of a migrant child that targets these silent infections before they declare themselves. [1] [2]
The three populations share a logic but differ in detail. Internationally adopted children carry a higher burden of chronic viral hepatitis, tuberculosis and intestinal parasites than any routinely screened paediatric group, and their pre-adoption records are often sparse, untranslated, or unreliable. Immigrant children are often healthy but may have incomplete or undocumented vaccination and region-specific exposures. Refugee and asylum-seeking children are the most comprehensively screened group, because many high-income resettlement programmes run an overseas pre-departure examination followed by a domestic post-arrival assessment — yet even here the record is re-verified, never assumed. [3] [8]
What makes this a fellowship-level topic is that the dangerous infections are silent at the time of screening. Latent tuberculosis, chronic hepatitis B and C, and HIV produce no symptoms for years; Strongyloides can persist for decades; and a vaccine record can record doses that were never given or never took. The clinician is therefore screening not for illness but for future risk, and the discipline is to act on laboratory evidence rather than on the child's appearance or the paper in the folder. The reward is that almost everything found is treatable today, and the assessment opens a relationship that delivers the medical home. [7] [9]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
References12Show ledgerHide ledger
- [1]Hostetter MK; Iverson S; Thomas W; et al Medical evaluation of internationally adopted children. N Engl J Med, 1991.PMID 1649404
- [2]Miller LC Caring for internationally adopted children. N Engl J Med, 1999.PMID 10559456
- [3]Stauffer WM; Kamat D; Walker PF Screening of international immigrants, refugees, and adoptees. Prim Care, 2002.PMID 12687898
- [4]Barnett ED Immunizations and infectious disease screening for internationally adopted children. Pediatr Clin North Am, 2005.PMID 16154464
- [5]Eckerle JK; Howard CR; John CC Infections in internationally adopted children. Pediatr Clin North Am, 2013.PMID 23481113
- [6]Nielsen AV; Kjaergaard J; Pedersen TM; et al Infectious diseases detected by screening after arrival to Denmark in internationally adopted children. Acta Paediatr, 2020.PMID 31580515
- [7]Shetty AK Infectious Diseases among Refugee Children. Children (Basel), 2019.PMID 31783605
- [8]Abu-Shamsieh A; Maw S Pediatric Care for Immigrant, Refugee, and Internationally Adopted Children. Pediatr Clin North Am, 2022.PMID 34794672
- [9]Chaves NJ; Paxton GA; Biggs BA; et al The Australasian Society for Infectious Diseases and Refugee Health Network of Australia recommendations for health assessment for people from refugee-like backgrounds: an abridged outline. Med J Aust, 2017.PMID 28403765
- [10]Cinardo P; Farrant O; Gunn K; et al Screening for neglected tropical diseases and other infections in refugee and asylum-seeker populations in the United Kingdom. Ther Adv Infect Dis, 2022.PMID 35958977
- [11]Wang Z; Posey DL; Brostrom RJ; et al US Postarrival Evaluation of Immigrant and Refugee Children with Latent Tuberculosis Infection Diagnosed Overseas, 2007-2019. J Pediatr, 2022.PMID 35120982
- [12]Mitchell T; Lee D; Weinberg M; et al Impact of Enhanced Health Interventions for United States-Bound Refugees: Evaluating Best Practices in Migration Health. Am J Trop Med Hyg, 2018.PMID 29260657