A research letter yesterday in the New England Journal of Medicine describes the serostatus (the presence of absence of antibodies in the blood) of asylum seekers in the United States and shows that substantial proportions are susceptible to vaccine-preventable infections such as measles, hepatitis A, and varicella (chickenpox).
The population of asylum seekers in the United States is growing, with at least 1.1 million asylum applications pending. Most asylum seekers live in congregate, temporary housing, where outbreaks of contagious diseases are frequent.
In the research letter, the authors assessed the serostatus of 1,147 asylum seekers who lived in temporary housing in New York City, and who sought primary care at Ryan Health, a federally qualified health center, from January to November 2023.
The researchers measured serologic evidence of immunity against varicella, measles, mumps, rubella, hepatitis A, and hepatitis B. The average age of participants was 13, and 53.2% were female.
Children most at risk
Almost one third of the participants were seronegative for measles (26.9%), varicella (32.0%), and hepatitis A (32.0%)—meaning they did not have protective antibodies against those diseases. In the general US population, seronegative status for those viruses ranges from 2.2% to 12.4%.
A total of 41.6% of asylum seekers were seronegative for hepatitis B.
Children were most likely to have an absence of antibody titers against measles (adjusted odds ratio (aOR), 1.69; 95% confidence interval [CI], 1.24 to 2.30) and adolescents (aOR, 2.10; 95% CI, 1.37 to 3.19) than in adults.
"In contrast to most other immigrants in the United States, asylum seekers are not required to undergo predeparture or postarrival evaluations to screen for active infections, nor are they systematically offered immunizations against vaccine-preventable infections," the authors wrote.
Clinicians and public health officials must prioritize routine vaccination for asylum seekers, along with addressing current structural barriers to their well-being.
"Clinicians and public health officials must prioritize routine vaccination for asylum seekers, along with addressing current structural barriers to their well-being," the authors concluded.
