ventive care so that at-risk people receive serologic testing for hepatitis B virus and hepatitis C virus and chronically infected patients receive appropriate medical management.

The committee has included recommendations regarding coverage of vaccination for infants, children, and adults in Chapter 4.

Foreign-Born People

There are over 37 million foreign-born residents in the United States; they represent about 12% of the nation’s population (U.S. Census Bureau, 2008). Of the foreign-born population, 27% were born in Asia, 4% in Africa, and roughly 7% in other regions that have intermediate or high HBV endemicity (see Box 3-1). Nearly half the US foreign-born population (6% of the total population) originated in HBV-endemic countries (U.S. Census Bureau, 2008), and 40,000–45,000 legal immigrants from these countries enter the United States each year (U.S. Department of Homeland Security, 2009; Weinbaum, 2008). It is increasingly urgent that culturally appropriate programs provide hepatitis B screening and related services to this high-risk population.

Efforts to deliver hepatitis B–related services to the foreign-born population have been sparse. At the federal level, there are limited and fragmented resources to track and fund such services. On the local and regional levels, some culturally tailored community-based or faith-based screening programs target foreign-born people, such as those involving Asian and Pacific Islander populations in San Francisco, Maryland, and New York City (CDC, 2006; Chao et al., 2009a; Hsu et al., 2007). However, few of the independent programs have been replicated in other communities of at-risk foreign-born populations, so many regions in the United States that have at-risk foreign-born populations lack community-based hepatitis B screening (Rein et al., 2009). Few HBV screening programs are designed for other high-risk foreign-born populations, including Africans, Middle Easterners, eastern Europeans, and others from HBV-endemic regions. It is unknown whether the model programs developed for Asians and Pacific Islanders could be adapted for some of those populations or whether new culturally tailored programs would need to be created.

The key to eliminating HBV transmission is identification of people who are living with chronic HBV infection. As described in Chapter 3, there is a pervasive ignorance about hepatitis B among Asians and Pacific Islanders, and it can be assumed that other foreign-born populations in the United States are similarly uninformed about HBV risks, prevention, testing, and management. That contributes to the observation that up to two-thirds of those who are chronically infected with HBV are unaware of their infection



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