Guidelines for evaluating and updating immunizations during the domestic medical examination for newly arrived refugees
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Guidelines for evaluating and updating immunizations during the domestic medical examination for newly arrived refugees

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      • Immunizations administered outside the United States can be accepted as valid if the schedule (minimum ages and intervals) was similar to that recommended in the United States.

      • Written records are more likely to predict protection if the vaccines, dates of administration, intervals between doses, and the person’s age at the time of vaccination are comparable to U.S. recommendations.

      • All refugees originating from intermediate or highly endemic countries (hepatitis B prevalence >2%), as well as those who are at risk for hepatitis B infection ( should be tested for hepatitis B virus infection and existing immunity.1-3 Refugees who are chronically infected with hepatitis B should receive further evaluation and monitoring. Refugees who are not immune and not chronically infected should be offered vaccination.

      • Checking for laboratory evidence of immunity (i.e., antibody levels) is an acceptable alternative for certain antigens when previous vaccination or exposure is likely.

      • Most refugees will understand the need for follow-up care for immunizations; this follow-up visit offers an opportunity to establish and assure primary care.

      Refugees, unlike most immigrant populations, are not required to have any vaccinations before arrival in the United States. In addition, many vaccines have limited or no availability in some developing countries or in specific refugee settings. Therefore, most refugees, including adults, will not have had complete Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations when they arrive in the United States. However, depending on health-care access, organized vaccination programs and initiatives, and availability of vaccines, refugees may have some documented vaccinations. During the medical screening visit for new arrivals, the provider must review any written vaccination records presented by the refugee, assess reported vaccinations for adherence to acceptable U.S. recommendations, and subsequently, initiate necessary immunizations. Each of these tasks presents challenges to the clinical practitioner.

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