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Hepatitis B screening and prevalence among resettled refugees - United States, 2006-2011
Insights
Hepatitis B virus (HBV) infection prevalence varies among refugees resettled in the U.S. Burmese refugees and adult males showed higher rates of past or current HBV infection, informing public health strategies.
Area of Science:
- Infectious Diseases
- Hepatology
- Public Health
Background:
- Hepatitis B virus (HBV) infection is a global health concern, with over two billion people infected worldwide.
- Chronic HBV infection affects approximately 3.5 million refugees, necessitating targeted screening and treatment strategies.
- The U.S. Centers for Disease Control and Prevention (CDC) recommends HBV screening for refugees from high-prevalence regions or those with specific risk factors.
Purpose of the Study:
- To determine the prevalence of past HBV infection, current infection, and immunity among refugees resettled in the United States.
- To characterize the burden of hepatitis B within this specific population.
- To provide data to inform HBV screening recommendations and public health planning for refugee resettlement.
Main Methods:
- A retrospective, multisite study was conducted.
- Data were collected from a large state refugee health program's surveillance records.
- Chart reviews were performed at three U.S. sites conducting refugee medical screenings.
Main Results:
- HBV infection prevalence varied significantly based on country of origin.
- Burmese refugees exhibited higher rates of current or past HBV infection compared to refugees from Bhutan or Iraq.
- Adult refugees (over 18 years) and male refugees demonstrated higher prevalence of HBV infection.
Conclusions:
- The prevalence of hepatitis B infection among resettled refugees in the U.S. is not uniform and is influenced by geographic origin and demographic factors.
- Findings highlight the need for tailored screening approaches based on refugee demographics and origin.
- Data can assist states, resettlement agencies, and healthcare providers in optimizing HBV screening and management strategies for refugee populations.
Abstract:
Globally, more than two billion persons have been infected at some time with the hepatitis B virus (HBV), and approximately 3.5 million refugees have chronic HBV infection. The endemicity of HBV varies by region. Because chronic hepatitis B is infectious and persons with chronic infection benefit from treatment, CDC recommends screening for HBV among all refugees who originate in countries where the prevalence of hepatitis B surface antigen (HBsAg; a marker for acute or chronic infection) is ≥2% or who are at risk for HBV because of personal characteristics such as injection drug use or household contact with an individual with HBV infection. Currently, almost all refugees are routinely screened for hepatitis B. However, prevalence rates of HBV infection in refugee populations recently resettled in the United States have not been determined. A multisite, retrospective study was performed to evaluate the prevalence of past HBV infection, current infection, and immunity among refugees resettled in the United States; to better characterize the burden of hepatitis B in this population; and to inform screening recommendations. The study incorporated surveillance data from a large state refugee health program and chart reviews from three U.S. sites that conduct medical screenings of refugees. The prevalence of HBV infection (current or past as determined by available titer levels) varied among refugees originating in different countries and was higher among Burmese refugees than among refugees from Bhutan or Iraq. Current or past HBV infection was also higher among adults (aged >18 years) and male refugees. These data might help inform planning by states and resettlement agencies, as well as screening decisions by health care providers.
