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Abstract Details
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. 2020 Mar 31;17(3):e1003083. doi: 10.1371/journal.pmed.1003083.eCollection 2020 Mar.
Gayathri S Kumar1, Clelia Pezzi1, Simone Wien1, Blain Mamo2, Kevin Scott3, Colleen Payton3, Kailey Urban2, Stephen Hughes4, Lori Kennedy5, Nuny Cabanting6, Jessica Montour7, Melissa Titus8, Jenny Aguirre9, Breanna Kawasaki5, Rebecca Ford10, Emily S Jentes1
Author information
1Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, Immigrant, Refugee, and Migrant Health Branch, Atlanta, Georgia, United States of America.
2Minnesota Department of Health, Saint Paul, Minnesota, United States of America.
3Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
4Bureau of Tuberculosis Control, New York State Department of Health, Albany, New York, United States of America.
5Colorado Department of Public Health and Environment, Disease Control and Environmental Epidemiology Division, Refugee Health Program, Denver, Colorado, United States of America.
6Office of Refugee Health, Center for Infectious Diseases, California Department of Public Health, Sacramento, California, United States of America.
7Texas Department of State Health Services, Austin, Texas, United States of America.
8Marion County Public Health Department, Indianapolis, Indiana, United States of America.
9Illinois Department of Public Health, Refugee Health Program, Chicago, Illinois, United States of America.
10University of Louisville Division of Infectious Diseases, Louisville, Kentucky, United States of America.
Abstract
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.