Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011
Many U.S.-bound refugees originate from countries with intermediate or high hepatitis B virus (HBV) infection prevalence and have risk for severe liver disease. We evaluated HBV screening and vaccination of newly arrived refugees in four states to identify program improvement opportunities. Data on HBV testing at domestic health assessments (1/1/2009–12/31/2011) were abstracted from state refugee health surveillance systems. Logistic regression identified correlates of infection. Over 95% of adults aged ≥19 years (N = 24,647) and 50% of children (N = 12,249) were tested. Among 32,107 refugees with valid results, the overall infection prevalence was 2.9% (0.76–9.25%); HBV prevalence reflected the burden in birth countries. Birth in the Western Pacific region carried the greatest infection risk (adjusted prevalence ratio = 4.8, CI 2.9, 7.9). Care linkage for infection was unconfirmed. Of 7409 susceptible persons, 38% received 3 doses of hepatitis B vaccine. Testing children, documenting care linkage, and completing 3-dose vaccine series were opportunities for improvement.
KeywordsHepatitis B virus Screening Vaccination Refugees
The authors would like to thank the staff of the refugee health programs in the CA, MA, MN, and Washington for supporting this evaluation; Trudy Murphy, Centers for Disease Control and Prevention (CDC), Chong-Gee Teo, CDC, Saleem Kamili, CDC, for providing technical input in the interpretation of HBV serologies and laboratory testing; Anthony Yartel, CDC, for providing statistical consultation; Jia Feng, CDC, for conducting exploratory data analyses; and Monina Klevens, Massachusetts Department of Public Health, for a careful review and helpful feedback of the manuscript.
Compliance with Ethical Standards
Conflict of interest
This work was supported by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. All authors have no conflicts of interest.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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