Testing for infections: getting it right for children in care

Abstract

Children who are looked after (CLA), including children and young people seeking asylum and refugees who are unaccompanied (CYPSAR-U), experience multiple intersecting vulnerabilities leading to an increased risk of infections throughout childhood. This population experiences a higher risk of maternal to child transmission of blood borne viruses as well as a higher risk of acquiring infections in childhood and adolescence. This article summarizes the infections of importance in children who are looked after, including blood borne viruses (TB, HIV, hepatitis B and C and syphilis) as well as more commonly neglected infectious diseases with maternal to child transmission (e.g. herpes simplex virus and Chlamydia) and infections of particular relevance to the CYPSAR-U population (e.g. schistosomiasis and strongyloidiasis). It is the responsibility of health care professional to identify and reduce the risks of infection in CLA. This article describes best practice at every stage of care; from identifying risk factors, through informed consent and counselling, to testing and sharing results, and finally with robust follow-up and ongoing education. We also describe where services are currently falling short, and give recommendations for service improvement and further research, with a particular emphasis on integrating the views of the children themselves.