O3236: Routine Laboratory Screening of Foreign-Born Children in the US to Understand Disease Burden

Background: Evidence-based guidelines for health screening in refugee children exist, but there are little data on testing strategies for non-refugee immigrants as well as regional sub-groups within the general population of foreign-born children. Additional evidence of the prevalence of recommended conditions by region of origin is necessary to develop more specific guidelines, especially for use when resources for testing are limited. The objective of this study is to determine the prevalence of positive screening tests in immigrant children at one large pediatric health system in the US, including an assessment of trends present in the results based on region of origin.

Methods: An electronic medical record (EMR) order set for routine screening of immigrant children was implemented. Order set data were analyzed through a single-site, retrospective cross-sectional approach and stratified by language and screening test. Frequency and percent values were reported for categorical variables.

Results: From July 2020 through December 2023, 405 foreign-born children were tested using the EMR order set and had results recorded. Two regional populations accounted for nearly three-fourths of all children in the data set, with 23.5% (95/405) from Afghanistan (Dari/Pashto-speaking) and 50.4% (204/405) from Latin America (Spanish-speaking). Of the Latin American children, 69.4% (25/36) were anemic, 2.4% (1/42) had elevated lead levels, 1.9% (3/157) had hepatitis C, 5.1% (3/59) had a positive tuberculosis test, 0% (0/68) had strongyloidiasis, and 33.3% (12/36) had eosinophilia. Of the Afghan children, 30.8% (24/78) were anemic, 40.8% (31/76) had high lead levels, 4.5% (2/44) had strongyloidiasis, 26.9% (21/78) had eosinophilia, and 2.4% (2/82) had HIV. Of all patients tested, 34.7 % (66/190) were anemic, 20.2% (39/193) had elevated lead levels, 0.9% (3/349) had hepatitis C, 3.4% (7/205) had a positive tuberculosis test, 3.6% (5/138) had strongyloidiasis, 24.7% (47/190) had eosinophilia, 0.6% (2/311) were positive for HIV and 3.2% (1/31) were positive for chlamydia. No individual in the data set tested positive for pregnancy, gonorrhea, hepatitis B, or syphilis. None of the Afghan or Latin American children had chlamydia, none of the Afghans had hepatitis C, and none of the Latin Americans had HIV.

Conclusion: These data support the strong current evidence that routine screening can identify asymptomatic conditions in immigrant children. Furthermore, they contribute to the limited body of evidence on regional variations among Afghans and Latin Americans in prevalence of abnormal results for recommended laboratory tests. Additional prevalence data for these and other immigrant sub-populations are needed to better tailor guidelines to children’s region of origin.