Refugee Health Update 2009
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1 Refugee Health Update 2009 Susan Dicker, PHN, MS, MPH 3 rd rd Annual LPH / VOLAG Forum December 2, 2009 Minnesota Department of Health
2 Ann O Fallon Blain Mamo Susan Dicker Sara Chute Jenny Kluznik
3 Refugee Admissions Ceilings for FY2009 Unallocated 6% Africa 15% Near East/ South Asia 46% East Asia 24% Latin America/ Caribbean 6% Europe & Central Asia 3% N=80, 000 Africa East Asia Europe & Central Asia Latin America/Caribbean Near East/South Asia Unallocated Source: US Department of State
4 Refugee Admissions Ceilings for FY2010 Unallocated 6% Africa 19% Near East/ South Asia 45% East Asia 21% Latin America/ Caribbean 6% Europe & Central Asia 3% N=80, 000 Africa East Asia Europe & Central Asia Latin America/Caribbean Near East/South Asia Unallocated Source: US Department of State
5 Top U.S. States for Refugee* Resettlement FY California 9, Texas 5, Florida 3, New York 3, Michigan 3, Arizona 3, Illinois 2, Georgia 2, North Carolina 2, Washington 2, Minnesota 1,329 Total admitted 60,193 * Numbers include Amerasian, Asylees (Derivatives), Entrants/Parolees and Primary Refugee arrivals Source: U.S. Office of Refugee Resettlement
6 Who is coming to MN?
7 Primary Refugee Arrivals, Minnesota 01/01/ /15/2009 Refugee Health Program, Minnesota Department of Health Eritrea Liberia Ethiopia 3% 2% Other 3% 9% Bhutan 8% Iraq 9% Burma 35% FSU 11% Somalia 20% N=1069 Other includes Benin, Bolivia, Cambodia, Cameroon, China (incl. Tibet), Congo (DR), Congo, Cuba, Djibouti, Guinea, Iran, Kenya, Laos (Hmong), Mali, Nepal, Sudan, Thailand, Togo, Vietnam, Zimbabwe and Unknown FSU includes Belarus, Kyrgyzstan, Moldova, Russia and Ukraine
8 Top 6 MN Counties of Primary Refugee Resettlement 2009* 1. Ramsey (563) 2. Hennepin (243) 3. Anoka (77) 4. Olmsted (68) 5. Dakota (26) 6. Scott (25) *01/01/ /15/2009 Refugee Health Program, Minnesota Department of Health
9 Country of Origin by County of Resettlement, 2009* Burma Bhutan Somalia Eritrea Ethiopia Other Somalia FSU Liberia Ethiopia Eritrea Other 0 Ramsey N=563 0 Hennepin N= FSU Iraq Other Iraq Somalia Sudan Anoka N=77 Olmsted N=68 Refugee Health Program, Minnesota Department of Health *01/01/09-11/15/09
10 Primary Refugees from Iraq, Minnesota, N MN = 167 (arrivals From Apr To Nov. 2009) Olmsted 81 (48%) Anoka 43 (26%) Ramsey 16 (10%) Hennepin 14 (8%) Other 13 (8%) 89 (53%) Female 62 (37%) <15 yrs old 78 (47%) Male 61 (37%) yrs old Refugee Health Program, Minnesota Department of Health
11 Primary Free Case Refugees, Minnesota, 01/01/ /15/2009 Eritrea 11% Ethiopia 2% Bhutan 21% Iraq 36% Refugee Health Program, Minnesota Department of Health Burma 30% *The total number may be incomplete due to delay in notification N=149* Jul - Dec 2008: The first Free Cases arrived in Minnesota. All 44 were from Iraq who settled in Olmsted Co.
12 Refugee Health Screening in MN Exam w/in the first 90 days of arrival Public health clinics and private providers Goal:...to control communicable disease among, and resulting from, the arrival of new refugees through: health assessment treatment referral
13 Health Status of New Refugees, Minnesota, 2009 Health status upon arrival No of refugees No(%) with infection screened among screened TB infection* 432 (94%) 131 (30%) Hep B infection** 445 (97%) 30 (7%) Parasitic Infection*** 361 (79%) 79 (22%) Sexually Transmitted 200 (44%) 6 (3%) Infections(STIs)**** Malaria Infection 12 (3%) 0 (0%) Lead***** 50 (89%) 0 (0%) Hemoglobin 446 (97%) 74 (17%) 2009 results for arrivals between 01/01/2009 and 06/30/2009 Total screened: N=459 (87% of the 528 eligible refugees) * Persons with LTBI (>= 10mm induration/normal CXR) or suspect/active TB disease ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI *****Children <6 years old (N=56 RHAs) Refugee Health Program, Minnesota Department of Health
14 Health Status of New Refugees, Minnesota Immunization Status, * Percent Year Overseas Domestic *1/1/2009 and 6/30/2009 Refugee Health Program, Minnesota Department of Health
15 Health Status of Iraqi Refugees, Minnesota, Health status upon arrival No of refugees No(%) with infection screened among screened TB infection* 78 (92%) 12 (15%) Hep B infection** 82 (96%) 0 (0%) Parasitic Infection*** 72 (85%) 11 (15%) Sexually Transmitted 42 (49%) 3 (7%) Infections(STIs)**** Malaria Infection 3 (4%) 0 (0%) Lead***** 11 (69%) 1 (9%) Hemoglobin 84 (99%) 12 (14%) Results for arrivals between 1/1/2008 and 6/30/2009 Total screened: N=85 (88% of the 97 eligible refugees) * Persons with LTBI (>= 10mm induration/normal CXR) or suspect/active TB disease ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI *****Children <6 years old (N=16) Refugee Health Program, Minnesota Department of Health
16 Refugee Health Highlights 2009
17 Immunizations **NEW CRITERIA as of Dec. 14, 2009: The vaccine must be age-appropriate for the immigrant applicant The vaccine must protect against a disease that has the potential to cause an outbreak. The vaccine must protect against a disease that has been eliminated or is in the process of being eliminated in the United States.
18 HIV Removal of HIV infection from list of diseases that keep people who are not U.S. citizens from entering the United States Effective date: January 4, 2010 No longer overseas screening for HIV Implications for refugee health exam in US
19 LPH VOLAG Training Manual Highlights The Players Why is the health screening important? Timeline of health screening process Procedures for VOLAG Case Managers & LPH Refugee Health Nurses Tools at your disposal FAQ s
20 Updated Health Screening Protocol HIV Lead Parasite Rollout: begin January 2010 Pink form eshare Refugee Health Provider Guide on web Pocket guide
21 Mental Health Screening Partnering with CVT Applying for RWJ grant Tool for refugee health screening Surveying states 4 basic questions
22 County Reports Kittson Marshall Polk Norman Clay Wilkin Roseau Pennington Red Lake Ottertail Grant Mahnomen Becker Douglas Beltrami Clear Water Lake of the Woods Hubbard Wadena Todd Cass Morrison Koochiching Itasca Crow Wing Aitkin Mille Lacs 2008 Primary Refugee Arrival to Minnesota (N=1,205) Kanabec St. Louis Carlton Pine Lake Cook Number of Refugees Arrival By Initial County Of Resettlement 0 Refugee Health County Reports 2008 Benton Traverse Stevens Pope Stearns Isanti Big Stone Sherburne Chisago Swift Kandiyohi Anoka Meeker Wright 71 Washing- Chippewa Ram Hennepin - ton Lac Qui Parle sey McLeod Carver Renville Yellow Medicine Scott Dakota Sibley Lincoln Lyon Redwood Le Ric Nicollet Sueur Goodhue e Brown Wabasha Pipestone Murray Cottonwood Watonwan Blue Earth Waseca Steele Dodge Olmsted Winona Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston Anoka Hennepin Olmsted Ramsey Scott Metro Region Carver Dakota Washington Central Region Otter Tail Sherburne Stearns Wright Southern Region Kandiyohi Nobles Rice Steele Welcome to the third edition of the Refugee Health County Report. This volume is a compilation of the individualized reports of those counties that received at least 15 new primary refugee arrivals to their county during the past year. In 2008, five counties met this criterion: Anoka, Hennepin, Olmsted, Ramsey and Scott. Counties that received less than 15 primary arrivals to their county were grouped into Metro, Central and Southern regions. The reports provide a snapshot of the demographics and the health needs of newly arrived primary refugees to a particular county. Each report is broken down into three sections: health screening indicators; significant findings and trends regarding demographics, screening rates, flat fee reimbursement, and health status data summary; and state and regional data. Statewide and regional demographics and health status data are included in the reports as a means of comparison for the counties. Any questions regarding this report may be directed to the Minnesota Department of Health, Refugee Health Program,
23 MN Refugee Health Program Phone: or Website: Refugee Health Program, Minnesota Department of Health
Primary* Refugee Arrivals to MN by Region of World
8 Primary* Refugee Arrivals to MN by Region of World 1979-216 7 6 5 4 3 2 1 1979 1981 1983 1985 Number of arrivals 1987 1989 1991 1993 1995 1997 1999 21 23 25 27 29 211 213 215 Southeast Asia Sub-Saharan
Primary* Refugee Arrivals to Minnesota by Region of World,
Primary* Refugee Arrivals to Minnesota by Region of World, 1979-217 8 7 Number of arrivals 6 5 4 3 2 1 1979 198 1981 1982 1983 1984 1985 1986 1987 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 1998
Primary* Refugee Arrivals to MN by Region of World
Primary* Refugee Arrivals to MN by Region of World 1979-214 8 7 Number of arrivals 6 5 4 3 2 1 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 21 23 25 27 29 211 213 Southeast Asia Sub-Saharan Africa
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