Kylee Gore

Final Paper

Title: Giving It Our Best Shot? Human Papillomavirus and Hepatitis B Virus Immunization
Among Refugees in Massachusetts, 2011–2013.

Introduction: Cervical cancer and the Hepatitis B infection are diseases that are caused by

Human Papillomavirus, also known as HPV, and Hepatitis B virus or HBV. Since 2009, there has

been roughly 70,000 refugees that have immigrated to the United States, bringing over these

health problems with them. Although some are adults, close to 40% are children that suffer

from these health conditions. As they compared the rates of immunization with the refugees

immigrating to the US verses the rates among adolescents in the US, they noticed that

adolescents in the US had a higher percentage at 93%, but by 2013 the percentage had

dropped to 45% that got the new vaccination. Although each of these conditions are

preventable by a three dose vaccination series, they have studied that environmental

conditions play an important role in whether someone gets the vaccinations or not.

Reason for research: The aim of this study was to analyze the lack of immunization that these

refugees had, if any and to compare their records to adolescents in the US so they could then

better the lives in other countries that lack the vaccines.

This study focused on refugees aged 9-26 that had resettled in Massachusetts between

2011 and 2013 that were then screened by the Refugee Health Assessment Program (RHAP) to

provide immunization according to the results of their health screening.
Methods and Materials: The study began by taking the health screenings of each refugee then

requiring them to come back to the clinic for two visits within a 90-day trial. During the first

visit, the refugees’ vision, hearing, behavioral responses, and dental records were screened. For

the second visit, laboratory samples were taken to screen for hepatitis B, parasites, the human

immunodeficiency virus, anemia, vitamin D deficiency, abnormal urine chemistry, and exposure

to tuberculosis. After both visits, vital signs were recorded and medications were prescribed

before and after the trial started to help with some of the refugee’s poor nutrition and

conditions. At the first visit, the first dose of the vaccine was given since most countries that the

refugees migrated from couldn’t access the vaccines. The second visit is when the second dose

of the vaccine was given. Different sub categories were considered such as the date of arrival,

age, nationality, sex, race, acute or chronic medical conditions, HBV surface antigen status, anti-

HBV surface antibody status, and total number of vaccines received before arrival and after

their arrival. Rates were then analyzed to see if since the RHAP was administering and

encouraging the vaccine, if refugees began to get the full set of vaccines they needed to

prevent the viruses or diseases.

Results: Once all the results were totaled, they found that 56% percent of all refugees from

ages 9 to 26 received 1 dose of the HPV vaccine, whether that be before or after their arrival.

Among that 56% that received at least one of the vaccines, 3.3 more vaccines were received

than the refugees that chose not to get any vaccine at all. It also seemed that refugees from

ages 9-12 were more likely to want to receive the vaccine and get the vaccine compared to

those aged 13-26. Refugees that arrived in 2011 were less likely to get vaccinated than those

who arrived in 2012-2013. Although those refugees aged 13-26 were less likely to get
vaccinated, ages 13-17 were more likely to be vaccinated with one dose than the adolescents in

the US. Overall, 91% of refugees received at least 1 dose, 63% received 2 doses, and 10%

received 3 doses, making it so a lot of the refugees were still left unprotected for the viruses.

Discussion: The HBV immunization rates were higher than the HPV immunization rates when

looking at the results above but the immunization rates seemed to increase from where they

started in the beginning but didn’t seem to get full immunization records due to some of the

refugees not getting the full doses. Although both male and females participated in this study,

females held a higher standing in this study and participated more and were more willing to get

vaccinated. Those who participated in the study were safer and were able to prevent getting

the infections, viruses, and cervical cancer.

Conclusion: In conclusion, the specialized post-arrival health assessment is possible to help

improve refugees’ immunization rates. This study suggests that refugees can have the

resources to get the vaccinations to prevent the possible health problems they could bring over

when immigrating from their countries. Although that is what the study suggests, the results

they found don’t support the suggestion because they had less refugees finish all doses than

what they anticipated.

Limitation of this study: This study was based on refugees that resettled in Massachusetts from

ages 9-26. Massachusetts isn’t the only state that is migrated to by refugees. To get a wide

range or idea of how many refugees go unvaccinated, they should be running this study in

other areas. Also, if refugees didn’t show up for their second visit, the study wasn’t able to

make a complete conclusion.