Immigrant, Refugee, and Migrant Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America.
PLoS Med. 2020 Mar 17;17(3):e1003069. doi: 10.1371/journal.pmed.1003069. eCollection 2020 Mar.
The United States has admitted over 80,000 Special Immigrant Visa holders (SIVH), which include children. Despite the increase in the proportion of SIVH admissions to the US over recent years, little is known about health conditions in SIV children. We report the frequency of selected diseases identified overseas and assess differences in selected conditions between SIV children from Iraq and Afghanistan.
We analyzed 15,729 overseas medical exam data in Centers for Disease Control and Prevention's Electronic Disease Notification system (EDN) for children less than 18 years of age from Iraq (29.1%) and Afghanistan (70.9%) who were admitted to the US from April 2009 through December 2017 in a cross-sectional analysis. Variables included age, sex, native language, measured height and weight, and results of the overseas medical examination. From our analysis, less than 1% of SIV children (Iraqi: 0.1%; Afghan: 0.12%) were reported to have abnormal tuberculosis test findings, less than 1% (Iraqi: 0.3%; Afghan: 0.7%) had hearing abnormalities, and about 4% (Iraqi: 6.0% Afghan: 2.9%) had vision abnormalities, with a greater prevalence of vision abnormalities noted in Iraqis (OR: 1.9, 95% CI 1.6-2.2, p <0.001). Seizure disorders were noted in 46 (0.3%) children, with Iraqis more likely to have a seizure disorder (OR: 7.6, 95% CI 3.8-15.0, p < 0.001). On average, children from Afghanistan had a lower mean height-for-age z-score (Iraqi: -0.28; Afghan: -0.68). Only the data quality assessment for height for age for children ≥5 years fell within WHO recommendations. Limitations included the inability to obtain all SIVH records and self-reported medical history of noncommunicable diseases.
In this investigation, we found that less than 1% of SIV children were reported to have abnormal tuberculosis test findings and 4% of SIV children had reported vision abnormalities. Domestic providers caring for SIVH should follow the US Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees, including an evaluation for malnutrition. Measurement techniques and anthropometric equipment used in panel site clinics should be assessed, and additional training in measurement techniques should be considered. Future analyses could further explore the health of SIV children after resettlement in the US.
美国已接收超过 80,000 名特殊移民签证持有者（SIVH），其中包括儿童。尽管近年来 SIVH 在美国的录取比例有所增加，但对于 SIV 儿童的健康状况知之甚少。我们报告了在海外发现的某些疾病的频率，并评估了来自伊拉克和阿富汗的 SIV 儿童之间某些疾病的差异。
我们在一项横断面分析中，分析了 2009 年 4 月至 2017 年 12 月期间，年龄在 18 岁以下从伊拉克（29.1%）和阿富汗（70.9%）进入美国的儿童在疾病预防控制中心电子疾病报告系统（EDN）中，15729 名海外医疗检查数据。变量包括年龄、性别、母语、测量身高和体重，以及海外体检结果。从我们的分析中发现，不到 1%的 SIV 儿童（伊拉克：0.1%；阿富汗：0.12%）报告有异常的结核菌素试验结果，不到 1%（伊拉克：0.3%；阿富汗：0.7%）有听力异常，约 4%（伊拉克：6.0%；阿富汗：2.9%）有视力异常，伊拉克人视力异常更为普遍（比值比：1.9，95%置信区间：1.6-2.2，p<0.001）。46 名儿童（0.3%）有癫痫发作障碍，伊拉克人更有可能患有癫痫发作障碍（比值比：7.6，95%置信区间：3.8-15.0，p<0.001）。平均而言，来自阿富汗的儿童身高年龄 z 评分较低（伊拉克：-0.28；阿富汗：-0.68）。只有≥5 岁儿童的身高年龄数据质量评估符合世卫组织的建议。限制包括无法获得所有 SIVH 记录和自我报告的非传染性疾病病史。
在这项调查中，我们发现不到 1%的 SIV 儿童有异常的结核菌素试验结果，4%的 SIV 儿童有视力异常报告。照顾 SIVH 的国内服务提供者应遵循美国疾病预防控制中心（CDC）关于新到达难民的美国国内体检指南，包括对营养不良的评估。应评估面板现场诊所使用的测量技术和人体测量设备，并考虑额外的测量技术培训。未来的分析可以进一步探讨 SIV 儿童在美国重新安置后的健康状况。
