Refugee Health Guidance
CDC developed domestic and overseas medical screening guidance for healthcare providers who may see refugees during the resettlement process. This guidance aims to:
- promote and improve refugee health
- prevent disease
- familiarize refugees with the US healthcare system
This guidance is based on current medical knowledge and the advice of experts in refugee health. The guidance is a recommendation, not a mandate, and should not be confused with CDC’s Technical Instructions for Panel Physicians and Civil Surgeons.
The domestic medical screening guidance is for state public health departments and healthcare providers in the United States who conduct the initial medical screening for refugees. These screenings usually occur 30-90 days after the refugee arrives in the United States
The overseas medical screening guidance provides panel physicians guidance on pre-departure presumptive treatments for malaria and intestinal parasites. These screenings are usually conducted days to weeks before the refugee departs for the United States.
Medical Screening of Asylees
Asylees are persons who meet the definition of a refugee but are already in the United States or are seeking admission at a US port of entry. From 2000 to 2010, the top ten countries of origin for people granted asylum in the United States were China, Colombia, Haiti, India, Ethiopia, Iraq, Armenia, Albania, Iran, and Somalia. Those who are living in the United States or are seeking admission at a US port of entry when they apply for asylum are recommended to have a domestic medical exam once they have been granted asylum status. When an asylee applies for adjustment of status, an I-693 medical examination (including vaccinations) by a civil surgeon is required. Once an asylee has been granted asylum status, their family members may follow to join them in the US, and therefore these family members would undergo the required medical examination overseas, prior to immigration.
Currently, there are very little data available about the health problems of asylees after they migrate to the United States. Many asylum seekers originate in, or transfer through, countries with public health issues similar to those facing refugees arriving through the US Refugee Admissions Program. Therefore we recommend that medical providers screening asylees apply the same screening and treatment recommendations in the CDC Refugee Domestic Guidance when performing a medical evaluation of an asylee. For individuals who have been in the United States for more than one year, special attention should be paid to diseases with long latency and associated severe morbidity such as tuberculosis, hepatitis B, and Strongyloides infection.