大研究总结了新的儿童难民对美国的健康问题

对于刚到美国的难民儿童，乙肝、肺结核、寄生虫感染、高血铅水平和贫血是由筛查项目所覆盖的公共健康问题之一。在这个国家有史以来规模最大的难民儿童的流行病学研究，公共卫生研究人员描述了在过去的十年中，作为他们的家庭逃离迫害儿童的健康状况。

在费城儿童医院的研究人员从policylab（CHOP）创建了第一个多国家，大规模数据集的难民儿童抵达美国2006和2012之间。孩子们从六个国家、三个亚洲和三个非洲国家到达。

“了解孩子们的健康档案，来自不同的国家，让我们为父母提供更好的咨询，安排具体的测试，确保我们提供给孩子一个健康的开始在美国，”主要作者凯瑟琳云，MD，MHS说，在policylab和切碎的难民健康计划的儿科医生。这项研究出现在11月12日美国公共卫生杂志。

The study team analyzed medical data from 8,148 refugees, all under age 19, from Bhutan, Myanmar, the Democratic Republic of the Congo, Ethiopia, Iraq and Somalia。 The data were collected in medical screening visits completed shortly after children arrived in four states: Colorado, Minnesota, Pennsylvania and Washington。

The office visits followed the domestic refugee health guidelines issued by the U。S。 Centers for Disease Control and Prevention (CDC)。 Accordingly, clinicians measured blood lead levels, anemia, hepatitis B virus infection, tuberculosis (TB) infection or disease, and markers of infection by 粪 (parasitic worms)。

About 20 percent of the children in the sample had blood levels at or above 5 micrograms per deciliter, the current U。S。 threshold for elevated blood lead, but fewer than 2 percent had levels above 10 mcg/dL。 Hepatitis B virus infection was rare in children younger than age 5。 TB prevalence estimates varied by the test used, but were much lower (about 10 percent) when a blood test was used, compared to results from a tuberculin skin test (about 20 percent)。

The disease prevalences varied by national groups。 In general, the prevalences were higher among children from the Democratic Republic of the Congo, Ethiopia and Somalia, and lower for Iraqi children。 Among children from Myanmar, diseases were more common among those who came to the U。S。 from Thailand compared to those who came to the U。S。 from Malaysia。

The authors drew several policy implications from their study。 “Our data suggest that the existing CDC medical screening guidelines remain relevant and hold great value,” said Yun。 “We also recommend that multi-state public health collaborations monitor the health of newly arrived refugee children, along with resources available to them。 Public health officials should pool and analyze these data in a timely manner, because refugee populations change significantly over time。”

In addition, public health officials performing refugee health surveillance in each national group should assess differences between children from different countries of departure, because many children are born in host countries rather than in their parents’ country of origin。 Finally, added Yun, in the future it may be more cost-effective to perform health screening overseas, before refugees leave their countries, because this may provide more timely, actionable information。

Partial support for some co-authors of this study came from a cooperative agreement with the Centers for Disease Control and Prevention。 Co-authors with Yun and her colleagues from CHOP were from Thomas Jefferson University, the Colorado Department of Public Health and Environment, the University of Colorado School of Medicine, the Minnesota Department of Health, the University of Minnesota, and the Washington State Department of Health。

“健康档案，新来的难民儿童在美国，2006-2012年，”美国公共卫生杂志, published Nov。 12, 2015。

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