Covid-19 Pandemic Impact on Unaccompanied Asylum Seeking Children (Uasc) Tuberculosis Screening Service

ABSTRACT

Aims Unaccompanied asylum-seeking children (UASC) are a vulnerable group who experience lot of physical and mental health difficulties during their journey. In the UK, it is statutory for all UASC to have Initial Health Assessment (IHA). NICE recommends screening for specific high-risk groups in the UK. These groups include close contacts of patients with TB (Tuberculosis), healthcare workers, immunosuppressed patients (for example those with HIV) and migrants from countries where TB is common. Some of UASC come from countries with high incidence of TB infection. It is important to ensure that children at high risk of TB are identified and screened to avoid potential public health consequences. The effect of the pandemic on USAC is not fully understood. It is important to ensure that children at high risk of TB are identified and screened to avoid potential public health consequences. The effect of the pandemic on USAC is not fully understood. An audit was completed in a big paediatric setting at a children's hospital in the United Kingdom exploring the local TB screening uptake pre-pandemic (prior to 2020) and midpandemic (2020-2021). The audit compared practice of the local USAC clinic with the national guidelines on migrant health guidance. The pattern of USAC pre-pandemic and midpandemic were compared. Methods Details of the USAC children were retrieved from the 'Looked after Children' database in the hospital. Following the initial health assessment, the USAC who were deemed to be at increased risk of TB were referred to the asylum-seeking service for the screening and subsequent referrals to the chest clinic. The risk factors were guided by the country of origin, their symptoms and the BCG immunisation status. Results 33 USAC were seen for initial health assessment over 2 years period. The demographic characteristics and country of origin were similar prior to and after March 2020. 18 UASC were seen in 12-month period prior to March 2020. 77.7% of these qualified for TB screening. 15 USAC were seen in the 12-month period after March 2020. 73.3% of these qualified for TB screening. Of the 33 USAC, 25 met the criteria for TB screening and were therefore referred to the asylum-seeking team for the screen. 15/25 (60%) received the screening. None of these 15 children were diagnosed with active TB but 3 (16.6%) were diagnosed and treated for latent TB. Each of 10 young people who missed the screening were identified and advised to be followed through. The missed screening was mainly due to non-clinic attendance or young person's move out of the area. Conclusion In this audit, the number of UASC and the proportion of them that required TB screening did not change during the pandemic. TB screening identified a significant number of cases of latent TB but no active TB. A few of young people missed their TB screening which has potentially serious consequences if they were infected. Joint working groups with the local authority established and UASC pathway streamlined to avoid similar situations in future.