Prevalence of hepatitis B surface antigen among refugees entering the United States between 2006 and 2008

Abstract

The Centers for Disease Control and Prevention (CDC) recommends hepatitis B surface antigen (HBsAg) testing to identify chronic hepatitis B virus (HBV) infection for foreign-born persons from countries or regions with HBsAg prevalence of 2%. However, limited contemporary data exist to indicate which countries meet this definition. To address this data gap, we estimated the HBsAg prevalence among refugees entering the United States between 2006 and 2008.. We contacted state refugee health coordinators and asked them to report the number of refugees, country of origin, and HBsAg prevalence among refugees screened in their jurisdiction during the most recently available 12 month time period prior to August of 2008. We pooled data across jurisdictions and calculated prevalence for any country with more than 30 refugees entering the United States, and where this level of data was not available by country, continents were considered. Of the 47 jurisdictions contacted we received basic information from 31, with 9 jurisdictions reporting HBsAg prevalence by country of origin applicable to 31,980 refugees (approximately 42% of refugees entering the United States during the observation period). We estimated an HBsAg prevalence of 2.8% (95% CI: 2.6%--3.0%) for refugees overall. Of the 37 countries with 30 or more refugees entering the United States, 25 had prevalence of 2%. Prevalence was highest among refugees from Africa and Southeast Asia, and lowest among refugees from the Middle East and South/Central America. In the eight countries for which we had comparison data, six had lower HBsAg prevalence than in 1991.