CDC Interim Recommendations for Initial Domestic Medical Screening of Haitian Orphans

Updated with CDC link (February 1)


CDC released Interim Recommendations for Initial Domestic Medical Screening of Haitian Orphan on January 25, 2010.

These recommendations are targeted for US medical providers evaluating orphaned children being evacuated from Haiti because Haitian orphans entering the United States under parole status have been allowed to bypass the normal overseas medical screening examination. The full text of the CDC Recommendations is 6 pages in length.

Here are two excerpts:

“This medical screening should be performed as soon as possible after arrival and consist of a general medical screening, as well as screening for tuberculosis (TB), vaccination status, intestinal parasites, malaria, malnutrition, and HIV. A subsequent more comprehensive medical evaluation is recommended in accordance with the American Academy of Pediatrics guidelines on the Medical Evaluation of 2 Internationally Adopted Children for Infectious Diseases. (Red Book®: 2009 Report of the Committee on Infectious Diseases - 28th Ed. (2009) Although these examinations may be performed together, the immediate screening described in this document should not be delayed to accommodate the comprehensive examination.

*INITIAL MEDICAL SCREEING*

All orphans should have a medical history (if known) and physical examination. Components of the medical history should include:

• History of trauma;
• Symptoms of communicable disease (i.e. fever, coryza, cough, rash, diarrhea, vomiting);
• Past medical and surgical history including any known chronic diseases;
• Specific history of TB and HIV should be solicited;
• Medication history.

Components of the physical examination should include:

• Vital signs and assessment of hydration status
• Height, weight, head circumference (if age appropriate)
• Obvious injuries that may have resulted from trauma
• A full physical examination with particular attention paid to signs that may indicate underlying medical problems such as heart disease, asthma, chronic malaria (e.g. tachycardia, heart murmurs, labored respirations, abdominal tenderness) or undetected but subtle injury from trauma (e.g. splenic rupture).
• Assessment of nutritional status (looking for signs of malnutrition)
• If fever is present, there should be a high clinical suspicion of malaria, dengue fever, and typhoid. Consideration should also be given to detecting clinical conditions requiring isolation (i.e. typhoid, tuberculosis, measles or chickenpox). Optimally, evaluation should be performed in consultation with an expert in infectious diseases or tropical medicine.

Orphans with known chronic medical conditions (e.g. asthma, congenital cardiac conditions, seizure disorders) should be carefully evaluated and treated, particularly since previous therapy may have been disrupted. Orphans with known chronic cardiac and respiratory disease should have vital signs assessed including oxygen saturation (portable oximeter) as soon as possible. Orphans with diabetes should have a glucose measurement as soon as possible.”

“…it is strongly recommended to have a comprehensive medical history and physical examination once they arrive at their final destination to evaluate other medical and developmental issues in the child, including hearing and vision assessment, evaluation of growth and development, blood lead concentration, complete blood cell count with red blood cell indices, newborn screening and/or measurement of thyroid-stimulating hormone concentration, and examination for congenital anomalies (including fetal alcohol syndrome). (Red Book®: 2009 Report of the Committee on Infectious Diseases - 28th Ed. (2009)."

Specifically PTSD is common after surviving natural disasters. The National Center for PTSD aims to help U.S. Veterans and others through research, education, and training on trauma and PTSD. They have prepared helpful resources for survivors (including children). Please consult http://www.ptsd.va.gov/professional/pages/helping-survivors-after-disaster.asp

PEAR recommends handing the provider summary on PTSD http://www.ptsd.va.gov/professional/pages/handouts-pdf/Reactions.pdf to your health care providers during the screening of your child as well as the full CDC letter found here: http://www.cdc.gov/immigrantrefugeehealth/exams/recommendations-domestic-medical-screening-haitian-orphan.html

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