|
Hepatitis C virus (HCV) infection can lead to a chronic, generally asymptomatic viral hepatitis that can eventually result in cirrhosis and hepatocellular carcinoma. HCV is transmitted through exposure to infected blood or other body fluids. In developed countries, infection primarily results from injection drug use. However, in developing countries, HCV is predominantly transmitted in medical settings where needles or surgical equipment may be reused or through transfusions of infected blood products. The Centers for Disease Control and Prevention and the Minnesota Domestic Refugee Health Guidance recommends HCV screening during the domestic medical exam (DME) for the following populations:
- All new adult arrivals (≥18 years of age)
- All pregnant people during each pregnancy
- Children <18 with risk factors
For primary refugee and Special Immigrant Visa-holder arrivals to Minnesota from Jan. 1, 2023, to June 30, 2024, 2,068 (97%) of 2,122 adults who received a DME were screened for HCV infection using an HCV antibody test (Table 1).
Table 1. Hepatitis C Antibody Testing Rate and Prevalence Among Primary Refugees and Special Immigrant Visa-holders to Minnesota, Jan. 1, 2023, to June 30, 2024
|
Country of Origin
|
Adults (≥18 years)
who received a DME
|
Tested for
Hepatitis C (%)
|
|
Somalia
|
802
|
779 (97%)
|
|
Afghanistan
|
212
|
207 (98%)
|
|
Dem. Rep. of Congo
|
161
|
157 (98%)
|
|
Burma
|
152
|
152 (100%)
|
|
Ethiopia
|
131
|
127 (97%)
|
|
Other*
|
664
|
646 (97%)
|
|
Total
|
2,122
|
2,068 (97%)
|
*”Other” includes Belarus, Cambodia, Central African Republic, Chad, Colombia, Rep. of Congo, El Salvador, Eritrea, Guatemala, Guinea, Haiti, Honduras, Iran, Iraq, Ivory Coast, Kazakhstan, Kenya, Moldova, Nicaragua, Pakistan, Russia, Rwanda, South Sudan, Sri Lanka, Sudan, Syria, Tajikistan, Ukraine, Uzbekistan, Venezuela, Vietnam, and Yemen
Among the 2,068 (97%) adults tested for hepatitis C, 33 (1.6%) had a positive antibody test. People who have a positive HCV antibody test should be tested for HCV RNA. Among the 33 with a positive antibody test, only 9 (27%) were found to be currently infected (HCV RNA positive) (Table 2). Those found to be currently infected are referred for hepatitis C treatment and management of chronic liver disease. Patients with HCV infection are also counseled on preventing transmission.
Table 2. Hepatitis C Antibody Testing Rate Among Primary Refugees and Special Immigrant Visa-holders to Minnesota, Jan. 1, 2023, to June 30, 2024
|
Region of Origin
|
Adults (≥18 years) who Received a DME
|
Tested for
Hepatitis C (%)
|
Positive Hepatitis C Antibody (%)
|
|
Sub-Saharan Africa
|
1,276
|
1,242 (97%)
|
20 (1.6%)
|
|
South/Southeast Asia
|
371
|
366 (99%)
|
8 (2.2%)
|
|
Latin America/Caribbean
|
221
|
218 (99%)
|
3 (1.4%)
|
|
North Africa/Middle East
|
115
|
107 (93%)
|
0 (0%)
|
|
Eastern Europe/Central Asia
|
104
|
101 (97%)
|
2 (2.0%)
|
|
East Asia/Pacific
|
35
|
34 (97%)
|
0 (0%)
|
|
Total
|
2,122
|
2,068 (97%)
|
33 (1.6%)
|
Minnesota Domestic Refugee Health Screening Guidance Update: Blood Lead Screening
The Minnesota Department of Health (MDH) Lead Poisoning Prevention Program recently released updated versions of the Childhood Blood Lead Clinical Treatment Guidelines for Minnesota, the Childhood Blood Lead Case Management Guidelines for Minnesota, and the Childhood Blood Lead Screening Guidelines for Minnesota. The updates reflect changes in Minnesota statute, including:
- Recommending follow-up and case management for those under age 18 with blood lead levels of 3.5 µg/dL and above.
- Detailing requirements for environmental risk assessments for those with blood lead levels of 5.0 µg/dL and above.
The Minnesota Department of Health Domestic Refugee Health Screening Guidance on blood lead screening will be updated to reflect these changes, recommending that any person with a blood lead level of 3.5 µg/dL and above should receive clinical follow-up. Previous guidance followed the former definition of elevated blood level as being 5.0 µg/dL and above.
Other lead screening guidance has not changed: All refugee arrivals under age 17 should be evaluated for an elevated blood lead level with repeat testing 3-6 months after resettlement for those age 6 and under. More information can be found at Minnesota Domestic Refugee Health Screening Guidance: Blood Lead Screening.
CDC Update: Recommendation for Hepatitis B Vaccination in Pregnant People
The Advisory Committee on Immunization Practices (ACIP) recommends that all adults over 18 and under 60 years old receive hepatitis B vaccinations. Refugee arrivals should receive updated vaccinations as clinically appropriate based on ACIP guidelines. On Sept. 11, 2024, the U.S. Food and Drug Administration approved labeling updates for the Heplisav-B vaccine indicating its use among pregnant people. This recommendation follows a recent study which found no major birth defects or miscarriage risk among pregnant people who received the Heplisav-B vaccine before or during pregnancy. Refer to CDC MMWR: Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19–59 Years — United States, 2024 for more information.
Of note, Heplisav-B is currently not being administered through the Vaccination Program for U.S.-bound Refugees. Refugees who receive vaccines through this program are offered a three-dose hepatitis B series.
Dr. Uyen Truong and Dr. Peter Ladner, Gillette Children’s Hospital and Clinics
Gillette Children’s Complex Care Clinic provides medical care and ancillary support to children and young adults with complex medical conditions who require multiple specialists involved in their care. The clinic is comprised of multidisciplinary teams that support their patients and families in achieving their health care goals. They also collaborate with patients’ specialists outside of Gillette’s clinics, including primary care providers and community support teams like resettlement agencies and other organizations.
Dr. Uyen Truong and Dr. Peter Ladner are two of the Complex Care Physicians on the Gillette team. They both bring their own experiences with newcomer populations to their work at Gillette. In these experiences, they share the insights they have learned about what it takes to provide the best care to their patients. Dr. Ladner’s training included the continuity clinic at the HealthPartners Midway Clinic, where he cared for many new immigrant patients soon after their arrival to the state. His experiences highlighted how systems are not always aligned to best support individuals with the most complex medical needs, especially within newcomer communities.
Dr. Truong’s lived experience includes being a first generation American of two immigrant parents from Vietnam. As a child, she watched her parents navigate the complexities of medical systems and witnessed the delays it created in establishing care and getting connected to the proper resources. From her own direct experiences, she is driven to support newcomer families in her role at Gillette.
Being able to provide medical care to newcomers at Gillette has been both a dream and very intentional venture for both providers. They share that working with this community shows them the resiliency of the people and that, with quality care, intentionality, and a tremendous team of care coordinators and specialists, newcomers with complex medical needs are able to show everything they are capable of doing and being.
|
Share our travel postcards!
Our postcard collaboration with Minneapolis College graphic design students is available on our website! Check out the "measles" and “travel planning” sections on Materials and Resources: International Travel & Infectious Disease to download our postcards. Each postcard contains a different travel health message for you to share with family, friends, or colleagues, or to print and stick on your own refrigerator.
New Plan Ahead Before Travel webpage
If you have an international trip planned and aren’t sure where to get started with travel health, check out MDH’s new Plan Ahead Before Travel webpage! It lays out what to do in two easy steps and provides a month-by-month checklist to follow when planning your trip abroad.
Affordable malaria medications
In many tropical countries, mosquito-borne diseases like malaria are still a concern. We have seen an increase in malaria cases in Minnesota from traveling abroad. If you are planning to travel internationally, visit CDC Traveler's Health: Destinations to check if malaria is a concern for your destination.
Malaria is preventable, so please share these resources and advice with your patients, clients, or communities for safer travel:
Before travel
-
Visit a travel clinic and check with your health care provider about malaria prophylaxis. Medication options are available for almost everyone, including young children and pregnant people.
-
Shop around. Malaria prophylaxis medicine prices can be different based on the medication and where it is purchased. These differences in prices are especially important if you are uninsured, underinsured, or your insurance doesn’t cover the medicines. However, there are now several online and in-person retailers that may offer these medications at more affordable prices of around $1 per day or less. Dr. Megan Shaughnessy provides tips on where to find discount pharmacies in the Tips from a Travel Clinic Physician Q&A. We also recommend talking with your health care provider about different medication options to prevent malaria with different prices.
During travel
- Use EPA-registered insect repellents.
- Apply permethrin to clothing.
- Wear loose-fitting, long-sleeved shirts and pants.
- Use insecticide-treated bed nets if sleeping outside or when screened rooms are not available.
Glossary of Public Health Terms
MDH produced a Glossary of Public Health Terms in collaboration with the National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM). This is a resource guide for “public health agencies, translation and interpreter stakeholders, and partners working with diverse communities,” and it includes public health terms and phrases in English translated into Hmong, Spanish, and Somali. Each glossary term includes a sentence in each of the four languages using definitions from CDC and the Merriam-Webster dictionary. This resource can be used to increase cross-cultural communication by providing standardized, accessible public health terminology that can be shared across languages and cultures.
LanguageRef
The Minnesota Center of Excellence in Newcomer Health manages LanguageRef, a directory of vendors that offer interpretation services for rare or less common languages spoken in the U.S. LanguageRef is meant for community partners, health care providers, and others who need interpretation services for rare languages. To suggest additional language(s) or interpreter vendor(s) to the directory, please use the LanguageRef Request Form. New submissions may be added to LanguageRef after verification. You can access the current directory through the form.
NEW University of Minnesota Course - Global Health in Local Contexts
“Global Health in Local Contexts: A Transnational Experiential Course on the Social Determinants, Health Equity, and Leading Change” is a University of Minnesota course that is open to all members of the Twin Cities community with interest and experience in health-related careers. The course is held entirely in community settings, and students will explore local health disparities and community-based solutions throughout the Twin Cities. Students will also engage in collaborative learning with peers in Uganda and Haiti taking parallel, geographically-based courses. Visit UMN: Global Health in Local Contexts to learn more about the program, fees, dates, location, and how to apply. Applications opened on April 10, 2025.
|
