Increasing COVID-19 Vaccination Coverage for Newcomer Communities: The Importance of Disaggregation by Language.

2023

04/2023

1476-1645

The COVID-19 pandemic has disproportionately affected refugee, immigrant, and migrant populations. Vaccines are essential for decreasing transmission and severity of COVID-19 infection. Understanding differences in vaccination coverage based on preferred language is crucial for focusing efforts to decrease COVID-19-related disparities. Four sites in the Minnesota Center of Excellence in Newcomer Health collaboratively evaluated completion of primary COVID-19 vaccination series on or before December 31, 2021, for patients who were 12 years or older on June 30, 2021, by preferred language. The non-English/non-Spanish speaking population included 46,714 patients who spoke 174 languages; COVID-19 vaccination coverage by language ranged from 26.2% to 88.0%. Stratifying vaccination coverage by specific language is a critical first step toward dismantling disparities and shaping interventions that best meet the needs of communities served.

10.4269/ajtmh.22-0724

Am J Trop Med Hyg

37068751

Acceptance of COVID-19 Vaccine Among Refugees in the United States.

2021

333549211045838

2021 Sep 21

1468-2877

<p><strong>OBJECTIVE: </strong>Little is known about COVID-19 vaccination intentions among refugee communities in the United States. The objective of this study was to measure COVID-19 vaccination intentions among a sample of refugees in the United States and the reasons for their vaccine acceptance or hesitancy.</p>

<p><strong>METHODS: </strong>From December 2020 through January 2021, we emailed or text messaged anonymous online surveys to 12 bilingual leaders in the Afghan, Bhutanese, Somali, South Sudanese, and Burmese refugee communities in the United States. We asked community leaders to complete the survey and share the link with community members who met the inclusion criteria (arrived in the United States as refugees, were aged ≥18, and currently lived in the United States). We compared the characteristics of respondents who intended to receive the COVID-19 vaccine with those of respondents who did not intend to receive the vaccine or were unsure. We then conducted crude and adjusted logistic regression analysis to measure the association between employment as an essential worker and COVID-19 vaccine acceptance.</p>

<p><strong>RESULTS: </strong>Of 435 respondents, 306 (70.3%) indicated that they planned to receive a COVID-19 vaccine. Being an essential worker (adjusted odds ratio [aOR] = 2.37; 95% CI, 1.44-3.90) and male sex (aOR = 1.87; 95% CI, 1.12-3.12) were significantly associated with higher odds of intending to receive a COVID-19 vaccine. Among respondents who intended to receive a COVID-19 vaccine, wanting to protect themselves (68.6%), family members (65.0%), and other people (54.3%) were the main reasons.</p>

<p><strong>CONCLUSION: </strong>Many refugees who responded to the survey, especially those who worked in essential industries, intended to receive a COVID-19 vaccine. Community organizations, health care providers, and public health agencies should work together to ensure that vaccine registration and vaccination sites are accessible to refugees.</p>

10.1177/00333549211045838

Public Health Rep

34546812

Hepatitis B Evaluation and Linkage to Care for Newly Arrived Refugees: A Multisite Quality Improvement Initiative.

2020

2020 Jul 25

1557-1920

<p>A quality improvement collaborative evaluated Hepatitis B virus (HBV) care for resettled refugees and identified strategies to enhance care. 682 of the 12,934 refugees from five refugee health clinics in Colorado, Minnesota, and Pennsylvania had chronic HBV. Timely care was defined relative to a HBsAg + result: staging (HBV DNA, hepatitis Be antigen, hepatitis Be antibody, alanine transaminase testing) within 14&nbsp;days, comorbid infection screening (hepatitis C virus and HIV) within 14&nbsp;days, and linkage to care (HBV specialist referral within 30&nbsp;days and visit within 6&nbsp;months). Completed labs included: HBV DNA (93%), hepatitis Be antigen (94%), hepatitis Be antibody (92%), alanine transaminase (92%), hepatitis C screening (86%), HIV screening (97%). 20% had HBV specialist referrals within 30&nbsp;days; 36% were seen within 6&nbsp;months. Standardized reflex HBV testing and specialist referral should be prioritized at the initial screening due to the association with timely care.</p>

10.1007/s10903-020-01058-7

J Immigr Minor Health

32712852

Growth Trajectories of Refugee and Nonrefugee Children in the United States.

2016

2016 Dec

1098-4275

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Limited data examine longitudinal nutrition outcomes of refugee children after United States resettlement. Among refugee children, our aims were to (1) assess the changes in weight-based nutritional status between baseline (0-3 months) and 10-24 months after arrival and (2) compare the BMI (BMIz) or weight-for-length z score (WFLz) trajectories to nonrefugee children for up to 36 months after arrival.</p>

<p><strong>METHODS: </strong>We conducted a retrospective study of refugees aged 0-16 years from Washington and Pennsylvania and compared them with an age and sex-matched nonrefugee low-income sample from Washington. Data included anthropometric measurements from the initial screening medical visit and subsequent primary care visits. Multilevel linear mixed-effects regression models evaluated the change in BMIz or WFLz trajectory.</p>

<p><strong>RESULTS: </strong>The study included 512 refugee and 1175 nonrefugee children. The unadjusted prevalence of overweight/obesity increased from 8.9% to 20% (P &lt; .001) for 2- to 16-year-old refugees from baseline to 10-24 months. Refugees (2-16 years old) had a steeper increase in their BMIz per 12 months compared with nonrefugees (coefficient 0.18 vs 0.03; P &lt; .001). Refugees &lt;2 years old had a less steep increase in their WFLz per 12 months compared with nonrefugees (coefficient 0.12 vs 0.36, P = .002).</p>

<p><strong>CONCLUSIONS: </strong>Older refugee children exhibited a higher risk of obesity than nonrefugees, whereas refugees &lt;2 years old exhibited a slower increase in their risk of obesity than nonrefugee children. All age groups experienced increasing obesity prevalence. Targeted and culturally tailored obesity prevention interventions may mitigate health and nutrition inequities among refugee children.</p>

10.1542/peds.2016-0953

Pediatrics

27940678

Increasing Hepatitis B Vaccine Prevalence Among Refugee Children Arriving in the United States, 2006-2012.

2016

e1-e3

2016 Jun 16

1541-0048

<p><strong>OBJECTIVES: </strong>To determine whether the addition of hepatitis B virus (HBV) vaccine to national immunization programs improved vaccination rates among refugee children, a marginalized population with limited access to care.</p>

<p><strong>METHODS: </strong>The sample included 2291 refugees younger than 19 years who completed HBV screening after arrival in the United States. Children were categorized by having been born before or after the addition of the 3-dose HBV vaccine to their birth country's national immunization program. The outcome was serological evidence of immunization.</p>

<p><strong>RESULTS: </strong>The odds of serological evidence of HBV immunization were higher for children born after the addition of HBV vaccine to their birth country's national immunization program (adjusted odds ratio = 2.54; 95% confidence interval = 2.04, 3.15).</p>

<p><strong>CONCLUSIONS: </strong>National HBV vaccination programs have contributed to the increase in HBV vaccination coverage observed among US-bound refugee children.</p>

<p><strong>PUBLIC HEALTH IMPLICATIONS: </strong>Ongoing public health surveillance is needed to ensure that vaccine rates are sustained among diverse, conflict-affected, displaced populations. (Am J Public Health. Published online ahead of print June 16, 2016: e1-e3. doi:10.2105/AJPH.2016.303203).</p>

10.2105/AJPH.2016.303203

Am J Public Health

27310356

Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012.

2016

128-35

2016 Jan

1541-0048

<p><strong>OBJECTIVES: </strong>We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State.</p>

<p><strong>METHODS: </strong>Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged &lt; 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia.</p>

<p><strong>RESULTS: </strong>We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period.</p>

<p><strong>CONCLUSIONS: </strong>Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.</p>

10.2105/AJPH.2015.302873

Am J Public Health

26562126