Appendix and References

Appendix A1

Dental, Optometry, and Physiotherapy Clinics in Calgary Accepting IFHP Coverage

Appendix A2

Initial Screening Serology Requisitions

Physicians in Alberta can use the pre-filled requisitions linked below, which are based off our recommended initial screening tests (see Our Screening Recommendations section). These requisitions can be used for both adults and children with the specificities listed below:

Serology and Molecular Testing Requisition

Remember to fill out the "Clinical History" section.
  • Check off "Syphilis" serology for adults
  • Check off "Varicella zoster IgG" for patients >13 years old
  • Add "Schistosoma serology" under "Specify Other Serology and Molecular Tests" for patients from an endemic country (see Appendix A3)

Community General Requisition

  • Check off "Hemoglobin A1c" for adults age >35 or earlier if positive family history
  • Add "G6PD levels" under "Other Tests Not Listed" for male patients only

Microbiology Requisition

  • For adults only.

Appendix A3

G6PD Deficiency Map, List of Substances to Avoid, and Information Card Template

G6PD deficiency allele frequency map:
The Malaria Atlas Project. G6PD Deficiency Allele Frequency.

Substances to Avoid with G6PD Deficiency:
  • Analgesics/Antipyretics
    • Acetanilide, ASA, Acetophenetidin, Antipyrine, Dipyrone, Phenazopyridine
  • Sulfa drugs
    • Sulfanilamide, Sulfapyridine, Sulfacetamide, Sulfamethoxazole, Sulfisoxazole
  • Antimalarials
    • Aminoquinolones (Amodiaquine, Choloroquine), Primaquine, Pemaquine, Pentaquine, Quinacrine, Quinine 
  • Antibiotics
    • Chloramphenicol, Dapsone, Furazolidone, Nalidixic acid, Nitrofurantoin, Niridazole, Para-aminosalicylic acid 
  • Miscellaneous
    • Aminopyrine (used in liver tests); Dimercaprol (antidote); Mestranol (contraceptive); Methylene blue (antidote); Probenecid (gout), Prochlorperazine (antipsychotic, antiemetic, anxiety); Quinidine (antiarrhythmic); Synthetic Vitamin K; Toluidine blue; Uricase, Rasburicase (gout) 
  • Food/Domestic
    • Fava (broad) beans, Naphthalene (mothballs, henna), Isobutyl Nitrate (Poppers drugs)


*** The underlined substances are especially unsafe.

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Appendix A4

Distribution of Schistosomiasis

Centers for Disease Control and Prevention. 
Refugees from Syria should only be screened if they were living near the Euphrates or Balikh Rivers: 
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Appendix A5

List of Countries with a High TB Incidence
List compiled by Calgary TB Services based on:
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Appendix A6

Distribution of Malaria
All malaria species:
Centers for Disease control and Prevention. CDC Malaria Maps.

* The CDC website contains specific information for each country. This information is constantly updated and should thus preferably be accessed online. 
 
Plasmodium falciparum only (2017):
* Clinical cases per 1,000 population per annum
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Appendix A7

Global Iodine Status
In school-age children:
In pregnant women:
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Appendix A8

Distribution of Zika and Testing Algorithm
Centers for Disease Control and Prevention. 
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Appendix A9

List of Countries with a High Prevalence of Hepatitis B Infection
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Appendix A10

Distribution of loa loa
World Health Organization - Africane Progamme for Onchocerciasis Control (APOC). 

 *** Patients from these areas who have a positive strongyloides serology should NOT be given ivermectin before a concomitant loa loa infection is ruled out.
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Appendix A11

Syphilis Diagnosis Procedure
Here is the diagnostic algorithm used at the Calgary Refugee Health Program for positive syphilis serology results (diagnostic and treatment recommendations may vary depending on the province):
Flowchart created by Dr. Annalee Coakley (Calgary Refugee Health Program)

References

CANADIAN REFUGEES - BASIC FACTS
1. USA for UNHCR. Refugee Facts. — Accessed on February 1, 2019. 
2. Government of Canada. Resettle in Canada as a refugee. — Accessed on February 1, 2019. 
3. Government of Canada. Find out if you’re eligible – Refugee status from inside Canada. — Accessed on February 1, 2019. 
4. Refugee Alberta. Refugees Coming to Canada. — Accessed on February 1, 2019. 
5. Calgary Catholic Immigration Society. Refugees. — Accessed on February 12, 2019. 

INTERIM FEDERAL HEALTH PROGRAM
6. Government of Canada. Interim Federal Health Program – Information for Health-Care Professionals. — Accessed on January 8, 2019. 
7. Government of Canada. Interim Federal Health Program: Summary of Coverage. — Accessed on January 8, 2019. 
8. Government of Alberta. Interactive Drug Benefit List. — Accessed on January 8, 2019. 

INITIAL MEDICAL HISTORY IN REFUGEE PATIENTS
9. LanguageLine Solutions. — Accessed on February 12, 2019. 
10. Pottie K, Greenaway C, Feightner J, et al. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011;183(12):E824-E925. 
11. Kirmayer LJ, Narasiah L, Munoz M, et al. Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ. 2011;183(12):E959-67. 
12. US Preventive Services Task Force., Curry SJ, Krist AH, et al. Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2018 Oct 23;320(16):1678-1687. 
13. Canadian Collaboration for Immigration and Refugee Health. Clinical Guidelines Checklist. — Accessed on February 12, 2019. 
14. American Psychiatry Association. Cultural Formulation Interview. — Accessed on January 8, 2019. 

SPECIFICITIES OF THE INITIAL PHYSICAL EXAM IN REFUGEE PATIENTS
15. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med. 2017 Aug 24;377(8):713-722. 

RECOMMENDED INITIAL SCREENING TESTS
16. Centers for Disease Control and Prevention. Guidelines for the U.S. Domestic Medical Examination for Newly Arriving Refugees. — Accessed on July 3, 2019.
17. European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm; 2018.
18. Caring for Kids New to Canada. Medical Assessment of Immigrant and Refugee Children. — Accessed on July 3, 2019.
19. Schär F, Trostdorf U, Giardina F, et al. Strongyloides stercoralis: Global Distribution and Risk Factors. PLoS Negl Trop Dis. 2013;7(7):e2288.
20. Asundi A, Beliavsky A, Liu XJ, et al. Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis. Lancet Glob Health. 2019 Feb;7(2):e236-e248.
21. DeVetten G, Dirksen M, Weaver R, Chowdhury TT, Aucoin MW. Parasitic stool testing in newly arrived refugees in Calgary, Alta. Can Fam Physician. 2017;63(12):e518-e525. 
22. Government of Canada. Panel Members' Handbook 2013 - Chapter 4: Immigration Medical Examination (IME). — Accessed on July 3, 2019.
23. Alberta Health Services. Zika Virus (ZIKV) Interim Guidance — Updated March 29, 2018. — Accessed on January 8, 2019.
24. Desai M, ter Kuile FO, Nosten F, et al. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007 Feb;7(2):93-104.
25. Moore KA, Simpson JA, Scoullar MJL, McGready R, Fowkes FJI. Quantification of the association between malaria in pregnancy and stillbirth: a systematic review and meta-analysis. Lancet Glob Health. 2017 Nov;5(11):e1101-e1112. 

COMMON FINDINGS ON SCREENING TESTS AND SUGGESTED MANAGEMENT
26. Toward Optimized Practice Iron Deficiency Anemia Committee. 2018 March. Iron deficiency anemia clinical practice guideline. Edmonton, AB: Toward Optimized Practice. Available from: http://www.topalbertadoctors.org
27. MyHealth.Alberta.ca. Getting Enough Iron. — Accessed on January 8, 2019.
28. Berliner N. Approach to the adult with unexplained neutropenia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
29. Weller PF, Klion AD. Approach to the patient with unexplained eosinophilia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
30. National Heart, Lung, and Blood Institute (NHLBI). Thalassemias. — Accessed on January 8, 2019. 
31. National Heart, Lung, and Blood Institute (NHLBI). Sickle Cell Disease. — Accessed on January 8, 2019. 
32. Canadian Haemoglobinopathy Association. Consensus Statement on the Care of Patients with Sickle Cell Disease in Canada. Version 2.0. Ottawa; 2015. 
33. Glader B. Diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency.Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
34. World Health Organization. Testing for G6PD deficiency for safe use of primaquine in radical cure of P. vivax and P. ovale (Policy brief). October 2016. 
35. Centers for Disease Control and Prevention. Interpretation of Hepatitis B Serologic Test Results.— Accessed on January 8, 2019. 
36. Public Health Agency of Canada. Primary Care Management of Hepatitis B - Quick Reference. Ottawa; March 2013. 
37. Shah H, Bilodeau M, Burak KW, et al. The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver. CMAJ. 2018;190(22):E677-E687. 
38. Lee E. Canadian HIV treatment, care and support guidelines. Canadian AIDS Treatment Information Exchange (CATIE). Fall 2017. Available from: https://www.catie.ca/en/pif/fall-2017/canadian-hivtreatment-care-and-support-guidelines
39. Centers for Disease Control and Prevention. Strongyloidiasis.— Accessed on January 8, 2019. 
40. The Medical Letter. Drugs for Parasitic Infections. 2013; Vol. 11 (Suppl). 
41. Centers for Disease Control and Prevention. Schistosomiasis Infection. — Accessed on January 8, 2019. 
42. Friedman JF, Olveda RM, Mirochnick MH, Bustinduy AL, Elliott AM. Praziquantel for the treatment of schistosomiasis during human pregnancy. Bull World Health Organ. 2017;96(1):59-65. 
43. Public Health Agency of Canada. Canadian Tuberculosis Standards, 7th Edition. Ottawa; 2014. 
44. Alberta Health Services. Alberta Treatment Guidelines for Sexually Transmitted Infections (STI) in Adolescents and Adults. Alberta; 2018.

OTHER COMMONLY ENCOUNTERED MEDICAL CONDITIONS IN REFUGEE PATIENTS
45. Centers for Disease Control and Prevention. Parasites - Alphabetical Index of Parasitic Diseases. — Accessed on January 8, 2019. 
46. Bartelt LA. Giardiasis: Treatment and prevention. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on February 15, 2019. 
47. Jones NL, Koletzko S, Goodman K, A, et al. ESPGHAN, NASPGHAN. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr. 2017 Jun;64(6):991-1003. 
48. Calgary Zone Primary Care Networks. Enhanced Primary Care Pathway: Dyspepsia. Dec 2017. Available from: http://www.calgarygi.com/Uploads/documents/DYSPEPSIA_Enhanced_Primary_Care_Pathway_for_websites_Dec_2017.pdf
49. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013. 
50. Orchid Project. What is FGC? — Accessed on February 20, 2019. 
51. Unicef. Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change. 2013. 
52. Mishori R, Warren N, Reingold R. Female Genital Mutilation or Cutting. Am Fam Physician. 2018 Jan 1;97(1):49-52. 
53. Caring for Kids New to Canada. Female genital mutilation/cutting. — Accessed on February 20, 2019. 
54. World Health Organization. Classification of female genital mutilation. — Accessed on February 20, 2019. 
55. Hearst AA, Molnar AM. Female genital cutting: an evidence-based approach to clinical management for the primary care physician. Mayo Clin Proc. 2013 Jun;88(6):618-29. 
56. Caring for Kids New to Canada. Hearing Screening. — Accessed on July 1, 2019. 
57. Kurtz M, Feldman A, Perazella MA. Etiology and evaluation of hematuria in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
58. Lowry JA. Childhood lead poisoning: Clinical manifestations and diagnosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
59. Committee to Advise on Tropical Medicine and Travel (CATMAT). Fever in the Returning International Traveller - Initial Assessment Guidelines. Canada Communicable Disease Report. 2011 Jul;37. 
60. Wilson ME. Centers for Disease Control and Prevention. Fever in Returned Travelers. — Accessed on January 8, 2019. 
61. Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian Recommendations for the Prevention and Treatment of Malaria. Ottawa; May 2014. 
62. U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). — Accessed on January 8, 2019. 
63. U.S. Department of Veterans Affairs. PTSD: National Center for PTSD. PTSD Checklist for DSM-5 (PCL5). — Accessed on January 8, 2019. 
64. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14 Suppl 1:S1. 
65. Osser DN. Psychopharmacology Algorithm Project at the Harvard Medical School Dept. of Psychiatry, South Shore Program. Psychopharmacology Algorithms. — Accessed on January 8, 2019. 
66. Centers for Disease Control and Prevention. Scabies. — Accessed on January 8, 2019. 
67. DermNet NZ. Scabies. — Accessed on January 8, 2019. 
68. DermNet NZ. Tinea capitis. — Accessed on January 8, 2019. 
69. Treat JR. Tinea capitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. — Accessed on January 8, 2019. 
70. Aucoin M, Weaver R, Thomas R, Jones L. Vitamin D status of refugees arriving in Canada: findings from the Calgary Refugee Health Program. Can Fam Physician. 2013 Apr;59(4):e188-94. 

APPENDIX
71. The Malaria Atlas Project. Interactive Map - G6PD Deficiency Allele Frequency. — Accessed on July 3, 2019. 
72. Centers for Disease Control and Prevention. Distribution of schistosomiasis. — Accessed on January 8, 2019. 
73. World Health Organization. Atlas of the global distribution schistosomiasis - Syrian Arab Republic - Turkey - Lebanon. 1987. 
74. The World Bank. Incidence of tuberculosis (per 100,000 people). — Accessed on March 8, 2019. 
75. Centers for Disease Control and Prevention.CDC Malaria Maps. — Accessed on January 8, 2019. 
76. Centers for Disease Control and Prevention. Malaria Information and Prophylaxis, by Country. — Accessed on March 8, 2019.
77. The Malaria Atlas Project. Interactive Map - Plasmodium falciparum Incidence Rate (2017). — Accessed on July 3, 2019. 
78. Gizak M, Rogers L, Gorstein J, Zimmermann M, Andersson M. Iodine Global Network - Global iodine status in school-age children, women of reproductive age, and pregnant women in 2017 (Poster). — Accessed on July 3, 2019. 
79. Centers for Disease Control and Prevention. World Map of Areas with Risk of Zika. — Accessed on January 8, 2019. 
80. Alberta Medical Association. Hepatitis B Virus Infection - High Endemic Geographic Areas. — Accessed on January 8, 2019. 
81. World Health Organization - African Programme for Onchocerciasis Control (APOC). Map of the estimated prevalence of eye worm history in Africa. — Accessed on January 8, 2019. 
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