Infectious Disease Burden and Vaccination Needs Among Asylees Versus Refugees, District of Columbia

Background. Unlike US-bound refugees, asylum seekers (asylees) apply for asylum while residing in the United States and are not provided a medical screening. Infectious disease burden and vaccination needs have not been described among US asylees. Methods. We conducted a retrospective cohort study of 630 asylees and 151 refugees referred to the District of Columbia (DC) Department of Health screening program for an initial US medical screening during September 2003 August 2007. We assessed the prevalence of latent tuberculosis infection (tuberculin skin test reactivity >= 10 mm), human immunodeficiency virus (HIV) and hepatitis B seropositivity, intestinal parasite test positivity, need for vaccinations, and time from date of US arrival to receipt of screening. Results. Asylees in DC had a similar prevalence as refugees of latent tuberculosis infection (39% vs 38%, respectively, P = .83), pathogenic intestinal parasites (4% vs 2%, P = .36), and need for adult vaccinations (80% vs 80%, P = .95). Asylees were screened significantly later after US arrival compared with refugees (55 weeks vs 1 week, P < .001). Asylees had higher prevalence of latent tuberculosis infection, hepatitis B and HIV seropositivity, and child and adult vaccination needs than the US population (P < .001). Conclusions. This study of the infectious disease concerns of a US asylee population suggests that in DC, asylees have similar infectious disease burden and prevention needs as refugees and should be screened with the same urgency. Because applicants for US asylum are not linked to prompt medical screenings, DC asylees are typically screened much later, placing them and US communities at risk.