Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014–2016: A cross-sectional analysis


Autoři: Gayathri S. Kumar aff001;  Clelia Pezzi aff001;  Simone Wien aff001;  Blain Mamo aff002;  Kevin Scott aff003;  Colleen Payton aff003;  Kailey Urban aff002;  Stephen Hughes aff004;  Lori Kennedy aff005;  Nuny Cabanting aff006;  Jessica Montour aff007;  Melissa Titus aff008;  Jenny Aguirre aff009;  Breanna Kawasaki aff005;  Rebecca Ford aff010;  Emily S. Jentes aff001
Působiště autorů: Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America aff001;  Minnesota Department of Health, Saint Paul, Minnesota, United States of America aff002;  Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America aff003;  Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York, United States of America aff004;  Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America aff005;  Office of Refugee Health, Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America aff006;  Texas Department of State Health Services, Austin, Texas, United States of America aff007;  Marion County Public Health Department, Indianapolis, Indiana, United States of America aff008;  Illinois Department of Public Health, Refugee Health Program, Chicago, Illinois, United States of America aff009;  University of Louisville Division of Infectious Diseases, Louisville, Kentucky, United States of America aff010
Vyšlo v časopise: Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014–2016: A cross-sectional analysis. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003083
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003083

Souhrn

Background

Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations.

Methods and findings

This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18–44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6–17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5–2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6–6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4–3.2) and EBLL (PR: 2.0; 95% CI 1.5–2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively.

Conclusion

In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage.

Klíčová slova:

Hepatitis B – Hepatitis B virus – Intestinal parasites – Screening guidelines – SIV – Tuberculosis – Vaccination and immunization – Iraq


Zdroje

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