Splenomegaly of Unknown Etiology in Congolese Refugees Applying for Resettlement to the United States - Uganda, 2015

Approximately 70,000-90,000 refugees are resettled to the United States each year, and during the next 5 years, 50,000 Congolese refugees are expected to arrive in the US. The International Organization for Migration (IOM) performs refugee medical examinations overseas for the U.S. Refugee Resettlement Program. In 2014, IOM reported that a large number of US-bound Congolese refugees from Uganda had spleens that were enlarged on examination. During two evaluations of refugee populations in western Uganda in March and July 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing. Fewer than 33% of refugees had evidence of an active infection known to cause splenomegaly at the time of assessment (via positive malaria antigen, hepatitis B antigen, or Schistosoma ova). Low rates of serologic evidence of past or current leishmaniasis and hepatitis C eliminated these diseases as a common etiology.