Abstract
Hepatitis B virus infection (HBV) remains highly endemic in many parts of the world. Refugees resettling in their host countries may carry a significant burden of disease due to HBV and may require long-term medical care. A retrospective descriptive study was conducted to assess the epidemiology of HBV and entry into medical care in refugee communities resettled in the State of Georgia over a five-year period: 2003–2007. Among 6,347 refugees (89.7% of those resettled) screened for HBV infection, six hundred and eighty (10.7%) were found to be HBsAg seropositive. Those between the ages of 10–39 years of age contributed to the majority of cases; and most originated from Africa (71%). All HBsAg positive cases were adequately referred to a primary care physician for further management but there are no formal feedback mechanisms in place to learn if those who tested positive for HBsAg accessed the primary healthcare system. HBV infection is a frequent infection among refugees resettled in the US. but their entry into healthcare to treat those with chronic infection is often unknown. Further efforts are required to assure their entry into the healthcare system. Primary care physicians caring for refugee patients should think about verifying HBV-infection status as part of health maintenance protocols.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gish R, Giodavi M. Chronic hepatitis B: current epidemiology in the Americas and implication for management. J Viral Hepatitis. 2006;13:787–98.
Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current emerging prevention and control measure. J Viral Hepatitis. 2004;11:97–107.
Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein S, Wang SA, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B Virus Infection in the United States. MMWR Morb Mortal Wkly Rep 2005;54(RR16):1–23.
Goldstein S, Zhou F, Hadler S, Bell B, Mast E, Margolis H. A mathematical model to estimate global hepatitis B disease burden and vaccination impact. Int J Epidemiol. 2005;34:1329–39.
Chen CJ, Wang LY, Yu MW. Epidemiology of hepatitis B virus infection in the Asia-Pacific region. J Gastroentol Hepatol. 2000;15(Suppl):E3–6.
World Health Organization (WHO). Hepatitis B. World Health Organization FACT SHEET 204 department of Communicable diseases Surveillance and response. 2008. Available at http://who.int/inf-fs/en/fact204.htm. Retrieved 12 Dec 2008.
Franco-Paredes C, Dismukes R, Nicolls D, Hidron A, Workowski K, Rodriguez-Morales A, et al. Short report: persistent and untreated tropical infectious diseases among Sudanese refugees in the United States. Am J Tropical Med Hygiene. 2007;77(4):635–63.
World Health Organization. Vaccine—preventable diseases: monitoring systems, 2004 global summary. 2008. Available at http://www.who.int/vaccines_documents/GlobalSummary/GlobalSummary. Retrieved 15 Dec 2008.
Centers for Disease Control and Prevention (CDC). Recommendations for identification and public health management of person with chronic hepatitis B virus infection. . In surveillance summaries. 2008. Morbidity and Mortality Weekly Report (MMWR), 57 (No.RR-8).
Brooks EA, Lacey LF, Payne SL, Miller DW. Economic evaluation of lamivudine compared with interferon-alpha in the treatment of chronic hepatitis B in the United States. Am J Managed Care. 2001;7(7):677–82.
Metcalf M, Brown N, Peterson S. Health care costs associated with chronic hepatitis B. Am J Health Syst Pharm. 1999;56(3):232–6.
Margolis HS, Schatz GC, Kane MA. Development of recommendations for control of hepatitis B virus infection: the role of cost analysis. Vaccine. 1990;8 Suppl:S69–73; Discussion S93-94.
Wong JB, Koff RS, Tine F, Pauker SG. Cost-effectiveness of interferon alpha 2b treatment for hepatitis B e antigen-positive chronic hepatitis B. Ann Internal Med. 1990;122(9):664–75.
Stauffer WM, Kamat D, Walker PF. Screening of international immigrant, refugees, and adoptees. Primary Care Clinical Office Practice. 2002;29:881–905.
Ugwu C, Varkey P, Bagnieski S, Lesnick T. Sero-epidemiology of Hepatitis B among new refugees to Minnesota. J Immigrant Minority Health 2008;10:469–474.
Georgia Refugee Health Program. Refugees resettled in Georgia, 1995–2006. Georgia Refugee Health Program. 2007.
United States Census. Available at http://www.census.gov. Accessed 20 Oct 2009.
Bond W, Favero M, Petersen N, Gravelle C, Ebert J, Maynard JE. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981;1(8219):550–1.
Center for Disease Control and Prevention. Screening for Hepatitis B infection among Refugees arriving in the United States 1979–1991. MMWR Morb Mortal Wkly Rep. 1991;40(45):784–6.
Museru O, Franco CP. Epidemiology and clinical outcome of hepatitis B virus infection among refugees seen at a US. Travel Medicine Clinic: 2005—2008. J Travel Med Infect Dis 2009;7(3):171–174.
Fadman A. The spirit catches you and you fall down: a Hmong child, her American doctors and the collision of two cultures. New York: Farrar Straus, and Giroux; 1997.
Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. Hepatology. 2008;48:335–52.
Acknowledgments
Supported by the Emory Global Health Institute and the Healthcare Georgia Foundation. Very special thanks go to DeKalb County - Refugee Health Program and the Division of Infectious Diseases and Georgia State Refugee Health Program.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Museru, O.I., Vargas, M., Kinyua, M. et al. Hepatitis B Virus Infection Among Refugees Resettled in the U.S.: High Prevalence and Challenges in Access to Health Care. J Immigrant Minority Health 12, 823–827 (2010). https://doi.org/10.1007/s10903-010-9335-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-010-9335-7