Refugee Health

Refugee Health : Refugee Health Care Guide


Medication Dosing

Attitudes towards rx:

#. Try very very hard to decrease Cost and Pill burden.
#. Manage expectations of care.
#. Keep regular frequent visits. Often have a lot of questions, concerns.
#. Give yourself time to work. It takes time for you to learn what their baseline is. It takes time for trust develop also.

Initial Health Screening @ Maricopa County Health Dept.
• IOM screening at country of origin
• Repeat screening at entry within ?1-2 months
• Pt to bring all these records with them to PCP.
• Contact person #? - to request records?

Adults (>19 yo): HIV, RPR, Hep B / LFTs, CBC, VZV, QFT
Peds (<18 yo): HIV, RPR, Hep B / LFTs, CBC, Lead, QFT

Xpress Pharmacy
Address: 2007 W Bethany Home Rd, Phoenix, AZ 85015
Phone:(480) 447-7434

Peds Dental group that provides free transportation for our refugees. 
They'll pick up whole families of kids and take them all for appts on the same day. 

  • Village Eye Care :
    • Jalynn (Office Manager)
    • # 623.931.2943 - 13945 W. Grand Ave, Surprise AZ 85374
    • Possible to organize rides, pro-bono assistance.

- Refugee Health Guidelines

Low Cost Options
• 4 dollar rx list
• Mammograms
• STD checks: $20 county STD clinic


OB Care

Adult Health

#. WCC
#. Vaccinations
- get records from public health department


Vaccines For Adult Refugees
FMC Schedule Vaccines For Adult Refugees
Dr. PJ Parmar Schedule : Needed for green card (permanent resident status) at 1 year.
Day 0: MMR + var* + tdap (+hep B*) ----- Day 0 is typically given at Dept Health.
At Day 0 + 1 mo : MMR + var + Td (+hep B*)
At Day 0 + 7 mo : Td +/- flu (+hep B*)
* Td #3 should be 6mo after Td#2.
*All refugees need at least 1x polio vaccine within 12 mo arrival or documented polio vaccine prior to arrival.
*Refugees are tested for hepatitis B virus infection (HBsAg) prior to vaccination, and are vaccinated only if negative (and if a dose is due). If Dept Health started Hep B series, then we will continue per above.
*Varicella : given if varicella non-immune – typically tested by Dept Health on Day 0.
Pediatric Vaccines : per routine catch-up guidelines.
Maricopa Dept Health Protocol for Adult.
Day 0: Tdap, MMR, Varicella, Hepatitis B #1. 
  - Flu vaccine during flu season. 
  - We perform Varicella and Hepatitis B titer so we will only give if patient is non-immune to Varicella and Hepatitis B.
-  If patient is immune to Hepatitis B and has vaccine record shows Vaccine series has not completed, will provide vaccine to complete its series.
- We also provide Hepatitis A vaccine if patient is chronically infected with Hepatitis B.
4 to 6 weeks:  TD, MMR, Varicella, Hepatitis B #2.
6 to 7 months: TD (last dose), Hepatitis B#3, Hepatitis A#2 (if #1 dose was given).
Re Polio vaccine: As far as polio vaccine, we do not routinely provide.  We will only provide when we get a notification from refugee health. They notify us if refugees came from polio outbreak areas or  received non-effective polio vaccine (i.e expired or damaged vaccine). 
è We only give initial dose during Initial Refugee Screening.  Follow-up dose will be refer to PCP.  Patient can return to us with referral if PCP’s office do not have above vaccines.
Hep A:
  • Peds: 2 doses by 2 yo
  • Adults: anybody who wants it, sexual high risk, IV drug use, hepatitis patients.
Hep B:
  • Peds: 3 doses by month 18.
  • Adults: anybody who wants it. Medical indications: ESRD/DM2, sexual high risk, IV drug use, tattoo.
  • Note: test Hb Sab before giving vaccine; remember that refugees can get #1 hep B vacc before they leave, falsely giving high hep B s Ab, may still need the whole thing.
  • Schedule: #1: Day 0 --> #2: at least 1 mo later --> #3: at least 2 mo after #2, 4mo after #1.
  • Peds: 4 doses by 4-6 yo
  • Most adults don't need it since vaccinated as child. However, if never been vaccinated, and are in groups (traveling to endemic/high risk area, polio lab, healthcare workers w/ contact), can get the vaccine:
  • Schedule: #1: day 0 --> #2: 1-2 mo --> #3: 6-12 mo after 2nd dose. Can catch up #2, #3 any time no matter how long since previous
  • Peds: 3-4 doses by 15 mo
  • Adults: if asplenic (no hx HIB vacc), give 1 dose
  • not indicated for >5 yo, adults; exception: sickle cell, maybe HIV.
  • Peds: 2 doses by 4-6 yo
  • Adult: 1x dose when >60 yo
  • Schedule: 1x dose
MMR: c/I in pregnancy!
  • Peds: 2 doses before 4-6 yo
  • Adult: any unvaccinated >18 yo & born after 1956
  • Schedule: Day 0 #1 --> #2  1mo
  • Peds: typically get 5 doses up to 5-6 yo.
  • Tdap in every pregnancy 3rd trimester
  • Td booster q10 years; can give as Tdap if never had Tdap before.
  • Schedule: for unvaccinated adults : Tdap day 0 --> #2 (Td): 4mo later --> #3 (Td): 6-12 mo after #2.
  • Peds: 1st at 11-12 yo, then booster at 16-18 yo
  • Adults: asplenic pts --> 2 doses MenACWY at least 2 mo apart, then q5years. Plus Men B series.
  • Adults: college students w/o booster --> 1 dose MenACWY
  • Peds: at 11-12 yo 3 doses ; schedule Day 0 --> 1-2 mo --> 6mo
  • Adults: up to 26 yo. Same schedule as Peds above.
  • Peds: 2 doses before 4-6 mo
  • Peds: 4 dose before 15 mo


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