Hepatitis A and B among newly arrived refugees: Vaccinate all, or test first for immunity?

Aim: When screening newly arrived refugees, physicians must decide whether to vaccinate against hepatitis A and B at first encounter, thereby minimising missed opportunity, or to test for immunity and vaccinate only the susceptible, minimising unnecessary intervention. Better knowledge of hepatitis A and B immunity in refugee populations from different parts of the world is needed. Method: Overseas and domestic medical records of refugees from Africa, Asia, and the Middle East who entered Marion County (Indiana) between 1 September 2016 and 31 December 2017 were reviewed. Results: Of 1191 refugees, 1163 and 1153 were tested for immunity to hepatitis A and B respectively. Among <19 year-olds, immunity to hepatitis A ranged from 52.1% to 79.6%, and immunity to hepatitis B ranged from 75.5% to 87.6%. Among >= 19 year-olds, immunity to hepatitis A was greater than 90% for each of the three regions, whereas immunity to hepatitis B ranged from 19.3% to 94.4%. 96% of refugees in the subset of Burmese >= 19 years old were immune to hepatitis B. Of individuals immune to hepatitis B, immunity was due to vaccination in 94.1% of <19 year-olds and 57.4% of >= 19 year-olds. 10% of refugees with at least three documented doses of hepatitis B vaccine were negative for hepatitis B surface antibody. 34.1% of uninfected refugees with no documented doses of hepatitis B vaccination were positive for hepatitis B surface antibody. Conclusion: It is reasonable to begin hepatitis A vaccination of <19 year-olds in this refugee population at first encounter but to test first for hepatitis A susceptibility before vaccinating those >= 19 years old. Similarly delaying hepatitis B vaccination might be appropriate only for a subset of Burmese adults.