Assessment of the accuracy of hepatitis B vaccination records among Cuban refugees and parolees Open Access

Fulton, Anna Catherine (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/qr46r097c?locale=en
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Abstract

The United States (US) accepts large numbers of Cuban refugees and parolees, yet there are no published reports assessing the quality of the overseas vaccination records of this population. The objective of this analysis was to evaluate the quality of Cuban refugees' and parolees' overseas vaccination records by comparing reported history of hepatitis B virus (HBV) immunization to demonstrated serologic immunity during the first domestic medical screening.

The study population consisted of all Cuban refugees and parolees who arrived in Texas between January 2010 through December 2013 and whose domestic records could be matched with overseas records. Multivariate logistic regression was used to obtain prevalence ratios (PR) determining the prevalence of immunity to HBV in Cuban refugees and parolees with a complete vaccination series compared to those with no vaccination history and comparing those with an incomplete vaccination series to those with no vaccination history.

The study included 1,416 Cuban refugees and parolees. Prevalence of immunity was 42.9% among those reporting a complete series of hepatitis B vaccination, 44.7% among those reporting an incomplete series of hepatitis B vaccinations, and 29.0% among those reporting no history of hepatitis B vaccination. Individuals with records indicating a complete hepatitis B vaccination series were only 1.48 (95% confidence interval: 1.27, 1.73) times more likely to demonstrate immunity to HBV compared to those with no history of hepatitis B vaccination.

The results suggest that overseas records of hepatitis B vaccination for Cuban refugees and parolees are poor predictors of immunity to HBV, both overall and among all subgroups. Medical providers conducting the initial domestic medical screening for Cuban refugees and parolees arriving in the US should screen all arrivals for antibodies to HBV and vaccinate those who do not demonstrate immunity, rather than relying on overseas vaccination records.

Table of Contents

INTRODUCTION 1
Background 1
Overseas Regulations 1
Domestic Regulations 2
Purpose of Study 3
REVIEW OF THE LITERATURE 4
Overview of Hepatitis B Virus 4
Burden of Disease 5
Hepatitis B Immunology 7
Refugee Health 10
Cuban Refugee Health 11
METHODS 13
Overview 13
Variables 13
Data Sources and Measurement 13
Sources of Bias 16
Study Population 17
Statistical Methods 18
RESULTS 21
Participants 21
Descriptive Data 21
Outcome Data 22
Main Results 23
Other Analyses 24
DISCUSSION 28
Key Results 28
Strengths and Limitations 29
Interpretation 31
Generalizability 31
Future Directions 32
REFERENCES 33
TABLES 42
FIGURES 45
APPENDICES 46

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