Giving It Our Best Shot? Human Papillomavirus and Hepatitis B Virus Immunization Among Refugees, Massachusetts, 2011–2013

Abstract

IntroductionThe receipt rate of hepatitis B virus vaccine among adolescents in the United States is high, while the receipt rate of human papillomavirus vaccine is low. Rates have not been closely studied among refugees, whose home countries have high rates of disease caused by these viruses.MethodsWe examined human papillomavirus and hepatitis B virus immunization rates among 2,269 refugees aged 9 to 26 years who resettled in Massachusetts from 2011 through 2013. This was a secondary analysis of data from their medical screenings. We used binary logistic regression to assess characteristics associated with immunization and bivariate analyses to compare refugee immunization rates with those of the general US population.ResultsForty-five percent of US adolescents aged 13 to 17 years received 1 dose of human papillomavirus vaccine, compared with 68% of similarly aged refugees. Males (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.52–0.74), refugees older than 13 years (aOR, 0.74; 95% CI, 0.60–0.93), and refugees not from Sub-Saharan Africa (aOR, 0.74; 95% CI, 0.59–0.92) were less likely to receive human papillomavirus vaccine, while arrivals in 2012 through 2013 were more likely (aOR, 1.6; 95% CI, 1.3–1.9) than those arriving in 2011. Refugees older than 13 years were less likely to receive 2 doses of hepatitis B virus vaccine (aOR, 0.49; 95% CI, 0.37–0.63) than older refugees.ConclusionSpecialized post-arrival health assessment may improve refugees’ immunization rates.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

“…Systematic health programs designed for timely health screening and vaccination have been shown to improve vaccination rates among certain RIM. 81 Required health screenings and vaccination within 30–90 days of arrival guarantee access and interface with a health system designed to meet the needs of a culturally diverse population. Ensuring that these programs sustain federal funding will secure access for diverse RIM populations who arrive with limited health literacy.…”

Implementation of an Immunisation Project for the Refugees Using the Logic Model

“…It is a common finding that the immunisation status of refugees in many countries is low. Watts et al 7 reported that only 39% of a predominantly Vietnamese refugee population had evidence of adequate immunisation at their initial visit; Roberton et al 27 reported that only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunised through routine immunisation services, while Berman et al 12 reported that only 10% of the refugees received three doses of Hepatitis B virus immunisation. Low coverage does not assure protection from communicable diseases.…”

“…A long list of reasons includes bad experience of severe adverse reaction after immunisation, concern about safety, side effect and effectiveness of vaccine, preferred use of complementary medicine for the children, inadequate knowledge and awareness of immunisation, not trusting public immunisation service, weak public health education program, religious persecution, disparities in health and access to care by race and ethnicity as well as language and cultural barriers, certain beliefs about the vaccine among specific ethnic and racial groups that deter caregivers from initiating immunisation from their children. 8,12,13 Tracking difficulty Mahimbo et al 11 identified that the immunisation program lack clarity regarding who is responsible for ensuring completion of catch-up immunisation and inadequate referral pathways. To ensure the continuity of immunisation, the program requires communication between providers, notably the refugees' transition from refugee health service to primary care for mid-catch-up.…”

What Do We Know About the Health Status of Asylum Seekers in the United States?

“…Despite this clear high-risk status, relatively little has been published about the particular health problems (eg, burden of disease and prevalent conditions) of asylum seekers in the United States. A few of the existing studies have begun to shed light on this issue, one study noting that more than half of the participants of US asylees had chronic health issues and another study noting 100% prevalence of mental health issues in one population (Bosnian torture survivors) and more than 50% prevalence in another (Colombian torture survivors) (Alexander et al, 2007; Dookeran et al, 2010). Despite these findings, another study found that 57% of the studied asylum seekers did not have any contact with the health care system, despite almost all having physical and psychological conditions (Asgary et al, 2013).…”