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Bixler D, Roberts H, Panagiotakopoulos L, Nelson NP, Spradling PR, Teshale EH. Progress and Unfinished Business: Hepatitis B in the United States, 1980-2019. Public Health Rep 2023:333549231175548. [PMID: 37300309 DOI: 10.1177/00333549231175548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
During 1990-2019, universal infant and childhood vaccination for hepatitis B resulted in a 99% decline in reported cases of acute hepatitis B among children, adolescents, and young adults aged <19 years in the United States; however, during 2010-2019, cases of acute hepatitis B plateaued or increased among adults aged ≥40 years. We conducted a topical review of surveillance strategies that will be critical to support the elimination of hepatitis B as a public health threat in the United States. In 2019, notifiable disease surveillance for acute hepatitis B showed continued transmission, especially among people who inject drugs and people with multiple sexual partners; rates were highest among people who were aged 30-59 years, non-Hispanic White, and living in rural areas. In contrast, newly reported cases of chronic hepatitis B (CHB) were highest among people who were aged 30-49 years, Asian or Pacific Islander, and living in urban areas. The National Health and Nutrition Examination Survey documented the highest CHB prevalence among non-US-born, non-Hispanic Asian people during 2013-2018; only one-third of people with CHB were aware of their infection. In the context of universal adult vaccination (2022) and screening (2023) recommendations for hepatitis B, better data are needed to support programmatic strategies to improve (1) vaccination rates among people with behaviors that put them at risk for transmission and (2) screening and linkage to care among non-US-born people. Surveillance for hepatitis B needs to be strengthened throughout the health care and public health systems.
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Affiliation(s)
- Danae Bixler
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry Roberts
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lakshmi Panagiotakopoulos
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noele P Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Matsangos M, Ziaka L, Exadaktylos AK, Klukowska-Rötzler J, Ziaka M. Health Status of Afghan Refugees in Europe: Policy and Practice Implications for an Optimised Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159157. [PMID: 35954518 PMCID: PMC9368211 DOI: 10.3390/ijerph19159157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023]
Abstract
Four decades of civil war, violence, and destabilisation have forced millions of Afghans to flee their homes and to move to other countries worldwide. This increasing phenomenon may challenge physicians unfamiliar with the health status of this population, which may be markedly different from that of the host country. Moreover, several factors during their migration, such as transport in closed containers, accidental injuries, malnutrition, and accommodation in detention centres and refugee camps have a major influence on the health of refugees. By taking into account the variety of the specific diseases among migrant groups, the diversity of the origins of refugees and asylum seekers, and the increasing numbers of Afghan refugees, in this review we focus on the population of Afghans and describe their health status with the aim of optimising our medical approach and management. Our literature review shows that the most prevalent reported infections are tuberculosis and other respiratory tract infections and parasitic diseases, for example leishmaniasis, malaria, and intestinal parasitic infections. Anaemia, hyperlipidaemia, arterial hypertension, diabetes, smoking, overweight, malnutrition, low socioeconomic status, and poor access to healthcare facilities are additional risk factors for non-communicable diseases among Afghan refugees. With regards mental health issues, depression and post-traumatic stress disorder (PTSD) are the most common diagnoses and culture shock and the feeling of being uprooted modulate their persistence. Further research is needed in order to provide us with extensive, high-quality data about the health status of Afghan refugees. The main objective of this review is to identify protective factors which could ensure key health concepts and good clinical practice.
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Affiliation(s)
- Michael Matsangos
- Department of General Surgery, Insel Gruppe AG, Kreditorenbuchhaltung, Freiburgstrasse 18, 3010 Bern , Switzerland;
| | - Laoura Ziaka
- Department of Special Needs Education, University of Oslo, 0315 Oslo, Norway;
| | - Artistomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland; (A.K.E.); (J.K.-R.)
| | - Mairi Ziaka
- Department of Internal Medicine, General Hospital of Thun, 3600 Thun, Switzerland
- Correspondence:
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Duodu PA, Darkwah E, Agbadi P, Duah HO, Nutor JJ. Prevalence and geo-clinicodemographic factors associated with hepatitis B vaccination among healthcare workers in five developing countries. BMC Infect Dis 2022; 22:599. [PMID: 35799107 PMCID: PMC9264656 DOI: 10.1186/s12879-022-07556-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a four-fold risk for hepatitis B infection among healthcare workers compared to the general population. Due to limited access to diagnosis and treatment of hepatitis B in many resource-constrained settings, there is a real risk that only few healthcare workers with viral hepatitis may get screened or diagnosed and treated. Studies on hepatitis B vaccination among healthcare workers in developing countries are sparse and this bodes ill for intervention and support. The aim of the study was to estimate the prevalence and explored the associated factors that predicted the uptake of the required, full dosage of hepatitis B vaccination among healthcare workers (HCWs) in five developing countries using nationally representative data. Methods We used recent datasets from the Demographic and Health Surveys Program’s Service Provision Assessment Survey. Descriptive summary statistics and logistic regressions were used to produce the results. Statistical significance was pegged at p < 0.05. Results The proportion of HCWs who received the required doses of hepatitis B vaccine in Afghanistan, Haiti, Malawi, Nepal, and Senegal were 69.1%, 11.3%, 15.4%, 46.5%, and 17.6%, respectively. Gender, occupational qualification, and years of education were significant correlates of receiving the required doses of hepatitis B among HCWs. Conclusions Given the increased risk of hepatitis B infection among healthcare workers, policymakers in developing countries should intensify education campaigns among HCWs and, perhaps, must take it a step further by making hepatitis B vaccination compulsory and a key requirement for employment, especially among those workers who regularly encounter bodily fluids of patients.
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Affiliation(s)
- Precious Adade Duodu
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, England, UK
| | - Ernest Darkwah
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong, SAR, China
| | | | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
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Lindsay K, Hanes G, Mutch R, McKinnon E, Cherian S. Looking beyond: complex holistic care needs of Syrian and Iraqi refugee children and adolescents. Arch Dis Child 2022; 107:461-467. [PMID: 34702714 DOI: 10.1136/archdischild-2021-322718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Protracted international conflict has seen escalating numbers of displaced and resettled Syrian and Iraqi refugees, raising concerns for their health and well-being. This paper describes the demographic and clinical profiles of recently resettled Syrian and Iraqi refugee children and adolescents across physical, psychosocial, developmental and educational domains using standardised multidisciplinary assessments. DESIGN A cross-sectional observational study was undertaken of initial specialist paediatric multidisciplinary Refugee Health Service assessments completed at the tertiary paediatric hospital (Western Australia) between June 2015 and September 2019. RESULTS Three hundred and twenty-seven children and adolescents (264 Syrian, 63 Iraqi) were assessed following resettlement. Witnessed trauma (86%) and disclosed adversity (median Refugee Adverse Childhood Experiences score 3, range 1-14) were universally high. Almost all patients had health issues identified across physical (99%), psychosocial (76%) and developmental/educational (75%) domains. Interrupted education (65%) and death of a family member (16%) were significantly associated with psychological morbidities. Common comorbidities included dental caries (78%), non-infectious disease (76%), vitamin D deficiency (72%), malnutrition (46%; overweight/obesity 23%), and psychological (32%; post-traumatic stress disorder 4.3%) and developmental (9.5%) concerns. Emerging and alarming child protection concerns were prevalent (17%), with females demonstrating especially high risks. CONCLUSION This is the largest comprehensive study demonstrating the complex and cross-dimensional health needs and specific vulnerabilities of resettled Syrian and Iraqi refugee children and adolescents. Early comprehensive standardised multidisciplinary paediatric assessments, and culturally safe, trauma-informed interventions and follow-up are required to optimise resettlement outcomes and promote well-being.
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Affiliation(s)
- Kristen Lindsay
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Gemma Hanes
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Raewyn Mutch
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Sarah Cherian
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
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Fellows KM, Samy S, Rodriguez Y, Whittaker SG. Investigating aluminum cookpots as a source of lead exposure in Afghan refugee children resettled in the United States. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:451-460. [PMID: 35501355 PMCID: PMC9119854 DOI: 10.1038/s41370-022-00431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Afghan refugee children resettled in Washington State have the highest prevalence of elevated blood lead levels (BLLs) of any other refugee or immigrant population. Resettled families brought several lead-containing items with them from Afghanistan, including aluminum cookpots. OBJECTIVES To evaluate the potential contribution of lead-containing cookpots to elevated BLLs in Afghan children and determine whether safer alternative cookware is available. METHODS We screened 40 aluminum cookpots for lead content using an X-ray fluorescence (XRF) analyzer and used a leachate method to estimate the amount of lead that migrates into food. We also tested five stainless steel cookpots to determine whether they would be safer alternatives. RESULTS Many aluminum cookpots contained lead in excess of 100 parts per million (ppm), with a highest detected concentration of 66,374 ppm. Many also leached sufficient lead under simulated cooking and storage conditions to exceed recommended dietary limits. One pressure cooker leached sufficient lead to exceed the childhood limit by 650-fold. In contrast, stainless steel cookpots leached much lower levels of lead. SIGNIFICANCE Aluminum cookpots used by refugee families are likely associated with elevated BLLs in local Afghan children. However, this investigation revealed that other U.S. residents, including adults and children, are also at risk of poisoning by lead and other toxic metals from some imported aluminum cookpots. IMPACT STATEMENT Some aluminum cookware brought from Afghanistan by resettled families as well as cookpots available for purchase in the United States represent a previously unrecognized source of lead exposure.
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Affiliation(s)
- Katie M Fellows
- Hazardous Waste Management Program in King County, Seattle, WA, USA
| | - Shar Samy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Yoni Rodriguez
- Hazardous Waste Management Program in King County, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Kumar GS, Pezzi C, Payton C, Mamo B, Urban K, Scott K, Montour J, Cabanting N, Aguirre J, Ford R, Hughes SE, Kawasaki B, Kennedy L, Jentes ES. Health of Asylees Compared to Refugees in the United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis. Clin Infect Dis 2021; 73:1492-1499. [PMID: 34043768 DOI: 10.1093/cid/ciab502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice. METHODS We conducted a retrospective cross-sectional analysis of domestic medical examination data from nine US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C, and select sexually transmitted infections and parasites by refugee or asylee visa status. RESULTS The leading nationalities for all asylees were China (24%) and Iraq (10%), while the leading nationalities for refugees were Burma (24%) and Iraq (19 %). Approximately 15% of asylees were diagnosed with LTBI, and 52% of asylee adults were susceptible to HBV infection. Prevalence of LTBI (Prevalence Ratio [PR]=0.8), hepatitis B (0.7), hepatitis C (0.5) and Strongyloides (0.5) infections were significantly lower among asylees than refugees. Prevalence of other reported conditions did not differ by visa status. CONCLUSIONS Compared to refugees, asylees included in our dataset were less likely to be infected with some infectious diseases but had similar prevalence of other reported conditions. The Centers for Disease Control and Prevention's Guidance for the US Domestic Medical Examination for Newly Arrived Refugees can also assist clinicians in the care of asylees during the routine domestic medical examination.
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Affiliation(s)
| | - Clelia Pezzi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Colleen Payton
- Thomas Jefferson University, Philadelphia, PA.,Moravian College, Bethlehem, PA, USA
| | - Blain Mamo
- Minnesota Department of Health, Saint Paul, MN, USA
| | - Kailey Urban
- Minnesota Department of Health, Saint Paul, MN, USA
| | - Kevin Scott
- Thomas Jefferson University, Philadelphia, PA
| | | | - Nuny Cabanting
- California Department of Public Health, Sacramento, CA, USA
| | - Jenny Aguirre
- Illinois Department of Healthcare and Family Services, Chicago, IL, USA
| | - Rebecca Ford
- Kentucky Office for Refugees, Louisville, KY, USA
| | | | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Lori Kennedy
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Emily S Jentes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Xie S, Shalaby-Rana E, Hester A, Honeycutt J, Fu CL, Boyett D, Jiang W, Hsieh MH. Macroscopic and microscopic imaging modalities for diagnosis and monitoring of urogenital schistosomiasis. ADVANCES IN PARASITOLOGY 2021; 112:51-76. [PMID: 34024359 DOI: 10.1016/bs.apar.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urogenital schistosomiasis remains a major global challenge. Optimal management of this infection depends upon imaging-based assessment of sequelae. Although established imaging modalities such as ultrasonography, plain radiography, magnetic resonance imaging (MRI), narrow band imaging, and computerized tomography (CT) have been used to determine tissue involvement by urogenital schistosomiasis, newer refinements in associated technologies may lead to improvements in patient care. Moreover, application of investigational imaging methods such as confocal laser endomicroscopy and two-photon microscopy in animal models of urogenital schistosomiasis are likely to contribute to our understanding of this infection's pathogenesis. This review discusses prior use of imaging in patients with urogenital schistosomiasis and experimentally infected animals, the advantages and limitations of these modalities, the latest radiologic developments relevant to this infection, and a proposed future diagnostic standard of care for management of afflicted patients.
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Affiliation(s)
- Shelly Xie
- Division of Urology, Children's National Hospital, Washington, DC, United States
| | - Eglal Shalaby-Rana
- Diagnostic Imaging and Radiology, Children's National Hospital, Washington, DC, United States
| | - Austin Hester
- Division of Urology, Children's National Hospital, Washington, DC, United States
| | - Jared Honeycutt
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, United States
| | | | - Deborah Boyett
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael H Hsieh
- Division of Urology, Children's National Hospital, Washington, DC, United States.
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