Screening Recommendations

Our recommended refugee-specific initial screening tests for both adults and children:

All patients

  • Complete blood count, iron studies
     
  • G6PD levels
    - males only
    - if born in Africa, Asia or the Middle East (see Map)
     
  • Hemoglobinopathy screen
    - if born in Africa, Asia, the Middle East, the Caribbean or Mediterranean countries
     
  • ​Hepatitis B surface antigen, anti-HBs, anti-HBc
     
  • Hepatitis C serology
     
  • HIV serology
    - with patient consent
     
  • Latent TB screening
    - with a tuberculin skin test (TST), or interferon-gamma release assay (IGRA) if available
    - age 6 months to 50 years* (age >2 if IGRA) and from a country with a high TB incidence (see Table)
     
  • Schistosoma serology
    - if from an endemic country (see Map)​
     
  • Strongyloides serology
    - if from an endemic country (see Map)
    ​
  • Varicella IgG immune status
    - age >13 only

Adults only

  • Hemoglobin A1c
    - age >35 or earlier if positive family history
     
  • Syphilis serology
     
  • Urine chlamydia/gonorrhea NAAT
* Screening up to age 65 can be considered if the patient has a medical condition that increases the risk of TB reactivation, such as diabetes or end-stage renal disease. Patients with a history of previously treated tuberculosis should not be offered latent TB screening.

 

ABOUT OUR SCREENING RECOMMENDATIONS

While most of our screening recommendations for refugees are based on the CMAJ Evidence-based clinical guidelines for immigrants and refugees (Pottie et al., 2011), we also recommend broader screening tests based on our clinical experience. For example, while the CMAJ guidelines only recommend screening for HIV and hepatitis B/C in patients from countries with disease prevalence above a certain threshold, we have decided to recommend these screening tests for all newly arrived refugees. This is mainly to simplify our recommendations, especially considering the low cost of these serologic tests.

We also reviewed the screening recommendations by the Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and the Caring for Kids New to Canada website.

As for any other Canadian patient, refugee patients should also be offered age-appropriate screening (cancer, dyslipidemia, etc.).