New Patient Visit
One of the first questions for all new patients, regardless of background, should be this.
What is Where was the child born?
(discuss immigrant health paradox)
Countries with high TB burden include Latin America, the countries of the former Soviet Union, this continent, and the countries that comprise these two world regions.
What is Africa, the Middle East, and Asia?
Children younger than 3 years of age who did not have screening in the newborn period should receive a referral to this.
What is Audiology?
When children are uninsured, vaccines can be given without charge through this program.
What is Vaccines for Children (VFC)?
For a new immigrant family, the provider should inform them of resources for which they might be eligible that can alleviate health risks caused by social circumstances. Assistance for food insecurity might be found through these 2 social safety nets.
What are WIC and SNAP?
When the provider is not fluent in the preferred language of a caregiver or child, this is the recommendation.
What is Use of a certified medical interpreter?
Not a family member, friend, or child.
Induration at the site of the TST or PPD test for TB can be attributable to one of these three causes, which leads to the migration of mononuclear cells to the area with resulting inflammation.
What is Infection with M. tuberculosis, exposure to NTM, and receipt of BCG vaccine?
One of your patients who has a BMI in the 99th%tile needs to start the 3HP Treatment Regimen. You will order this test prior to therapy, and then ID will order it monthly during therapy.
What is Liver Function Testing?
They recommend ALT and AST if a patient is obese, has nonalcoholic steatohepatitis, is on hepatotoxic meds, has underlying liver disease, or pregnant in the first 12 weeks.
BCG vaccines are administered in countries with high TB burden because they reduce the risk of these 2 types of TB.
What are miliary TB (disseminated) and CNS disease (meningitis)?
This model is the gold standard for any pediatric primary care practice and it includes providing comprehensive services, community connection, care coordination, and referral support.
What is a medical home?
Your patient who just immigrated here from an area with an increased burden of endemic TB needs these 2 assessments after their history is taken to assess for TB before you could start treatment.
What is A thorough physical examination and a high quality CXR (PA and lateral)?
Risk factors for developing TB disease include contacts of people with confirmed radiographic or clinical evidence of TB, children immigrating from countries with high TB burden, children with significant travel to these countries, and these 2 other groups of children.
What are Children with HIV infection and Children with immune suppression due to other diseases (diabetes, CRF, malnutrition, immunodeficiencies, children on TNF alpha antagonists like Humira)?
In addition to baseline testing, all adolescent females who are new immigrants should be tested for these.
What is pregnancy (B-HCG) and STIs (gonorrhea and chlamydia)?
If an immigrant child does not have an attainable immunization record or the record is not acceptable, these are the 2 options for care.
What is: perform serum testing looking for immunity OR vaccination can be administered as if the child has not had any previous vaccinations?
Always screen children for SDOHs, including these 5 things.
What are housing, environmental exposures, interpersonal violence, food insecurity, and caregiver employment.
A family recently immigrated from Africa, where they were living in a refugee camp for a year. The grandfather died of a "cough" before they left. The children are ages 6, 10, and 13, but you are most concerned about this one's progression from latent TB to TB disease.
What is The 13 year old?
Children younger than 4, adolescents, and immunocompromised individuals are at a higher relative risk for TBI to active TB.
For children older than 12 months, presumptive treatment for soil-transmitted helminths should be given using one of these 2 agents.
What is Albendazole or Pyrantel Pamoate?
The QFT assay and the T-spot are both tests of this type; they are blood tests which are more specific than the TST, yielding fewer false positive results but still failing to distinguish between TBI and TB disease.
What is IGRA (Interferon gamma release assay)?
Vaccinations given in other countries can be accepted if these three criteria are met. Name them.
What are: Vaccines are written in ink or typed on an official immunization form, the timing of administration and vaccine type are acceptable per CDC guidelines, and the patient's correct name and DOB are on the record?
These are 4 reasons that immigrant children might come to the US, according to the article.
What are economic opportunity, educational attainment, family reunification, and a safe haven from violence?
These 2 techniques make a caregiver and patient feel more comfortable at a physical exam.
What are Normalizing and framing?
An immigrant child who came from Latin America and received a blood transfusion or organ transplant while there, are pregnant, are immunosuppressed, or whose mother also is infected may have this.
What is Chagas Disease (Trypanosoma cruzi)?
These 7 items are considered baseline testing for all asymptomatic immigrant children.
What is: CBC with diff, lead, TB, HIV, syphilis, Hep B surface antigen, Hep C antibody?
An 18 month old boy recently immigrated from India with his family. The family reports that he had received vaccines before and they do have the child's medical records at home but they forgot to bring them to the clinic today. This is the most appropriate plan.
What is: follow-up in 4-6 weeks for record review and immunizations?
Based on some research evidence and expert opinion, pediatric practitioners working with immigrant children are at high risk for burnout and can mitigate that risk by building resilience through this.
What is advocacy?