Strengthening the Prevention, Detection, and Treatment of Diseases affecting US-bound Refugees and Other Globally Mobile Populations

整体项目总结 在技术指导下，疾病控制和预防中心，移民健康司 国际移民组织(IOM)为前往美国的人进行必要的出发前活动 难民和移民，以确保他们适合旅行，确保他们获得具有成本效益的公共卫生 干预措施，并确定、管理和管理具有公共卫生意义的传染病 据报道。这些活动包括健康评估，其中包括筛查和治疗 结核病(TB)和其他传染病，对那些有重要医学意义的人进行额外评估 条件、疫苗接种和推定治疗、登机前检查和疫情应对。AS 全球流动性继续加速，提高了对 影响这类人群的疾病对个人和社区的健康越来越重要。 我们建议开展三项活动，总体目标是加强出发前程序和疾病 预防和控制(摘要见附录)：(A)疟疾的诊断和后续行动 在前往美国的难民中感染疟疾，为推定治疗建议提供信息。推定 建议将青蒿素为基础的联合疗法(ACT)用于撒哈拉以南地区所有前往美国的难民 启程前前往非洲。尽管被认为对疟疾有效，但最近的数据表明，它可能是 不够充分。我们将在前往美国的乌干达难民中确定ACT治疗马来支原体的成功率， 和其他考虑因素，以告知出发前的指导方针。(B)潜伏性结核病感染测试 为坦桑尼亚的赴美难民和越南的赴美移民提供自愿待遇。一个 大量抵达美国的移民和难民可能患有未经诊断和治疗的LTBI 一些人会继续患上活动性结核病。鉴于LTBI治疗的开始和完成率 抵达美国后的难民和移民是次优的，需要新的战略。我们将评估 在健康评估期间在国外提供长期脑损伤检测和治疗的可接受性和可行性。(C) 一种快速护理点检测策略，以增加对前往美国的推定类圆线虫的治疗 撒哈拉以南非洲的难民。LOA LOA感染的标准诊断需要实验室测试，即 不容易得到的。许多前往美国的难民不能进行脑溢血检测，因此必须被排除在 推定治疗弓形虫病，使他们面临严重的长期后遗症的风险。我们会 研究智能手机显微镜的使用情况，将其作为一种治疗黄褐斑的点检方法。 总之，这些活动将有助于保护和改善前往美国的难民和 移民，确定最佳做法并提供以证据为基础的疾病预防和战略 控制，并降低传染病输入美国的风险。

OVERALL PROJECT SUMMARY Under technical guidance the Centers for Disease Control and Prevention, the Migration Health Division of the International Organization for Migration (IOM) performs essential pre-departure activities for U.S.-bound refugees and immigrants to ensure they are fit to travel, that they receive cost-effective public health interventions, and that communicable diseases of public health significance are identified, managed, and reported. These activities comprise health assessments, which include screening and treatment for tuberculosis (TB) and other infectious diseases, additional evaluations for those with significant medical conditions, vaccinations and presumptive treatment, pre-embarkation checks, and outbreak response. As global mobility continues to accelerate, improved understanding, prevention, detection, and treatment of diseases affecting such populations is increasingly important for the health of individuals and communities. We propose to three activities with the overall goal of strengthening pre-departure procedures and disease prevention and control (see appendix attachment for summaries): (A) Diagnosis and Follow-up of Plasmodium malariae Infections in U.S.-bound Refugees to Inform Presumptive Treatment Recommendations. Presumptive artemisinin-based combination therapy (ACT) is recommended for all U.S.-bound refugees from Sub-Saharan Africa prior to departure. Although thought to be effective against P. malariae, recent data suggest it may be inadequate. We will determine rates of ACT success against P. malaraiae in U.S.-bound refugees in Uganda, and other considerations to inform pre-departure guidelines. (B) Latent Tuberculosis Infection (LTBI) Testing and Voluntary Treatment for U.S.-Bound Refugees in Tanzania and U.S.-Bound Immigrants in Vietnam. A substantial number of immigrants and refugees arriving in the U.S. may have undiagnosed and untreated LTBI and some will go on to develop active TB disease. Given that LTBI treatment initiation and completion rates for refugees and immigrants after arrival in the U.S. are suboptimal, new strategies are wanted. We will assess the acceptability and feasibility of offering LTBI testing and treatment overseas during the health assessment. (C) A Rapid Point-of-Care Testing Strategy to Increase Presumptive Strongyloides Treatment of U.S.-bound Refugees in Sub-Saharan Africa. Standard diagnostics for Loa loa infection require laboratory testing that is not readily available. Many U.S.-bound refugees cannot be tested for loaisis and thus must be excluded from presumptive treatment for strongyloidiasis, putting them at risk for serious long-term sequelae. We will investigate the use of a smart phone-based microscope as a point-of-care test for loaisis. Together, these activities will contribute to protecting and improving the health of U.S.-bound refugees and immigrants, identifying best practices and provide evidence-based strategies for disease prevention and control, and reducing the risk of infectious disease importation into the U.S.