Infection Screening in Asylum Seeking Children, Are We Getting It Right?

Background: In 2017 in the UK, there were 2,206 asylum applications from unaccompanied asylum seeking children (UASC). Our local population had the third highest numbers of asylum seekers in the region. They are at an increased risk of health complications including blood borne viruses and tuberculosis.

Objective: The aim of this audit was to compare the current practice of infection screening of UASC in our department with the screening advice set out in the migrant health guide by Public Health England.

Methods: The ‘looked after children assessment’ reports of all UASC in 2018 were retrospectively analysed. The recommendations regarding screening for blood borne viruses and TB were noted. A search was conducted on the trust’s pathology system to confirm what testing the patient had received and what the results were. The patient’s country of origin was then referenced with the recommended screening set out by Public Health England.

Results: Out of 23 children, more than half had screening recommendations that were incorrect. This included both under and over-testing. Most frequently, testing was requested when it not necessary. Infrequently it was not requested when it was required. 7 of the 23 patients who were recommended to have screening for blood borne viruses did not have the necessary tests. 16 of the 23 patients did not have TB screening despite it being recommended.

Conclusion: The infection risk for asylum seeking children varies greatly by country and so the screening advice needs to reflect this. Over testing can have negative impacts to a child by subjecting them to unnecessary blood tests, and has cost implications. It is equally important that patients at a higher risk are screened appropriately. Improvement interventions have included follow up letters for missed tests and addressing the referral process for TB screening.