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Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011

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Abstract

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.

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Acknowledgements

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.

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Author notes

  1. Kiren Mitruka & Brittney Baack

    Present address: Division of Global HIV/AIDS and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-04, Atlanta, GA, 30333, USA

  2. Kathy Byrd

    Present address: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

Authors and Affiliations

  1. Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Kiren Mitruka, Brittney Baack & Kathy Byrd

  2. Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Clelia Pezzi & Heather Burke

  3. Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA

    Jennifer Cochran

  4. Office of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, WA, USA

    Jasmine Matheson

  5. Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, Saint Paul, MN, USA

    Kailey Urban

  6. Center for Infectious Diseases, California Department of Public Health, Sacramento, CA, USA

    Marisa Ramos

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  1. Kiren Mitruka
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Correspondence to Kiren Mitruka.

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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.

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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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Mitruka, K., Pezzi, C., Baack, B. et al. Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011. J Immigrant Minority Health 21, 39–46 (2019). https://doi.org/10.1007/s10903-018-0705-x

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  • DOI: https://doi.org/10.1007/s10903-018-0705-x

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