Conferences

Saturday, June 27 at 4:30 p.m. (oral presentation)

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Authors: Diana Haj Ahmad, Erin Mann, Syreeta Wilkins, Ridhi Arun, Hitesh Singhal

Background: Hepatitis B disproportionately affects people from sub-Saharan Africa and Asia—regions with high endemic prevalence—yet awareness, informed decision-making, and vaccine completion remain low among refugee, immigrant, and migrant (RIM) populations in the U.S. In clinical encounters, patient silence is often misinterpreted as understanding or consent, obscuring confusion, mistrust, or stigma and contributing to low screening and incomplete multi-dose vaccination.

Methods: Migration Health Initiative and IDEO.org partnered to develop a Hepatitis B Dialogue Guide for healthcare providers serving adult RIM patients. Using mixed methods research—including ethnographic interviews and co-design sessions with providers and RIM community members—we identified key barriers related to communication, power dynamics, and stigma. These insights informed a modular, culturally responsive toolkit integrating trauma-informed principles, motivational interviewing techniques, visual myth-busting fact cards, and mindset exploration prompts to support shared understanding.

Results: Preliminary findings showed increased provider confidence in discussing hepatitis B. Providers found the cheat sheets practical as a quick reference before or during visits. Additionally, providers found the toolkit’s strategies could be applied more broadly beyond hepatitis B—like health maintenance, screening, and patient-centered care. However, providers did feel that the toolkit is a lot to review alongside their workload and would have appreciated more information explaining hepatitis B to reference.

Conclusion/Discussion: A culturally responsive, dialogue-based provider toolkit can meaningfully improve hepatitis B screening and vaccination completion among RIM populations by addressing stigma and fostering patient agency. These findings underscore the value of community-led interventions as a complement to medical counseling, especially in culturally diverse settings.

Saturday, June 27, 2026 at 4:30 p.m. (oral presentation)

Authors: Erin M. Mann, Kelly M. Searle, Jose D. Debes

Background: Hepatitis B virus (HBV) disproportionately affects refugees. Changing patterns in US refugee resettlement underscore the need for updated estimates of HBV prevalence and the impact of family clustering.

Methods: We analyzed HBV screening data from refugees in the process of resettling to the US who underwent overseas health assessments between October 2018 and September 2023. We examined regional variation using log-binomial regression, assessed family clustering, and compared unaccompanied to accompanied minors matched on nationality, age, and sex using conditional logistic regression.

Results: Of 194,931 refugees evaluated, 190,247 (97.6%) were screened for HBV (mean age 22.6 years, 50.1% male); 3,545 (1.9%) tested positive (mean age 32.5 years, 64.4% male). Prevalence declined from 3.1% to 1.5% from 2018 to 2023, persisting after adjustment for region, age, and sex (aRR 0.66, 95% CI 0.58–0.76). Prevalence was highest among refugees from Asia (3.6%) and Africa (2.6%) and lowest from the Americas (0.2%). Adjusted prevalence among adult males was highest in Asia (7.7%) followed by Africa (5.8%), but this reversed among children (0-5: Africa 0.19%, Asia 0.12%; 6-17: Africa 1.23%, Asia 0.79%). HBV risk was higher for unaccompanied versus accompanied minors aged 11-17 (OR 2.05, 95% CI 1.17-3.60). Among nuclear families with ≥1 HBV-positive member, 8.6% had multiple cases. The most common cluster patterns were mother-child (41.4%), spouses-only (20.7%), and multiple children (18.1%).

Conclusion: Despite a decrease in prevalence, HBV remains a significant burden among refugees. Further emphasis should be applied to disproportionately impacted subgroups, such as unaccompanied minors to decrease their HBV burden.

Sunday, June 28, 2026 (poster presentation)

Authors: Erin M. Mann, Claudia Muñoz-Zanzi, Jose D. Debes

Background: US-bound refugees receive hepatitis B virus (HBV) vaccination during overseas health assessments. Recent shifts in refugee origins highlight the need for current coverage estimates.

Methods: We analyzed HBV vaccination data from refugees resettled to the US following overseas health assessments between October 2018 and September 2023, estimating coverage with ≥1 and ≥2 doses by region, age, and year using Poisson regression.

Results: Of 143,474 HBV-negative refugees who departed to the US (mean age 22.7 years, 50.4% male), 92.1% received ≥1 dose and 66.8% received ≥2 doses. Two-dose coverage was highest in Asia (92.7%) and lowest in the Americas (24.1%; aRR 0.26, 95% CI 0.26–0.27) and Europe (48.9%; aRR 0.54, 95% CI 0.53–0.55). Children 0–5 years had higher coverage than adults (90.8% vs 57.3%; aRR 1.48, 95% CI 1.47–1.49). Regional gaps were concentrated among adults; children achieved higher coverage across regions (p<0.001). Prior to overseas
health assessment, children 0-5 from Asia had a mean of 2.97 documented historical doses compared with 1.90 in Europe. Crude two-dose coverage declined from 76.7% (2018) to 65.7% (2023), but adjusted models showed modest improvement, indicating the decline reflected increased arrivals from lower-coverage regions, particularly the Americas and Europe.

Conclusion: HBV vaccination coverage in US-bound refugees is overall high but varies substantially by region and age. Pre-migration vaccination access may contribute to regional disparities. High coverage persisted through a complex resettlement period.