Texas Refugee Health Program 2014 Refugee Health Report
Welcome to the Refugee Health Program Report for calendar year (CY) 2014. The goal of the Texas Department of State Health Services Refugee Health Program is to provide program‐ eligible clients (refugees, asylees, parolees, Special Immigrant Visa holders, and international Victims of Trafficking) with culturally and linguistically appropriate comprehensive health assessments, including follow‐up and referrals.
This report includes statewide arrival, demographic, and health outcome information. Source data originated from the Centers for Disease Control and Prevention’s Electronic Disease Notification system (EDN), as well as from the U.S. Department of State’s Worldwide Refugee Admissions Processing System (WRAPS).
All health outcome data included in this report was submitted by local Refugee Health Programs on the Texas Refugee Health Assessment Form and then entered into the Electronic System for Health Assessment of Refugees (eSHARE).
Prepared by Jessica Montour, MPH, State Refugee Health Coordinator Texas Refugee Health Program CY2014 Demographics Texas Refugee Health Program Arrivals with by Country of Origin, CY2014 ETHIOPIA NEPAL SUDAN ERITREA 1% 1% 1% 1% IRAN OTHER CONGO (DEMOCRATIC 3% 4% REPUBLIC) BHUTAN IRAQ 3% 4% 24%
SOMALIA 6%
AFGHANISTAN 10%
CUBA 24% BURMA 18% n= 13,785 Countries with ≥1% shown Arrivals came from 66 countries total During CY2014, Texas received 13,785 arrivals, an increase from the 10,729 arrivals in CY2013. The largest groups were from Iraq, Cuba, and Burma. The percentage of arrivals from Afghanistan showed the greatest change at 8% of total arrivals vs. 2% in CY2013. Texas Refugee Health Program Arrivals by Status, CY2014 9000 8294 8000
7000
6000
5000 Arrivals
of 4000
3064 Number 3000
2000 1796
1000 565 66 0 Refugee Parolee Special Immigrant Visa Asylee Victim of Trafficking
Arrival Status n= 13,785 *All parolees originate from Cuba. Texas Refugee Health Program Arrivals by Status, CY2014
Victim of Trafficking 1% Asylee 4%
Special Immigrant Visa 13%
Parolee 22% Refugee 60%
n= 13,785 *All parolees originate from Cuba. Texas Refugee Health Program Arrivals with Refugee Status by Country of Origin, CY2014
AFGHANISTAN SUDAN ETHIOPIA ERITREA 1% 1% 1% 2%
CUBA CONGO (DEMOCRATIC 3% REPUBLIC) IRAN 6% 4%
IRAQ 35%
BHUTAN 7%
SOMALIA 10%
BURMA 30% n= 8,294 Countries with ≥1% shown Refugees came from 48 countries total Most arrivals classified as refugees came from Iraq (35%) and Burma (30%). Texas Refugee Health Program Arrivals with Special Immigrant Visa Status by Country of Origin, CY2014
IRAQ 29%
AFGHANISTAN 71%
n= 1,796 The majority of arrivals given Special Immigrant Visas were from Afghanistan (71%), an increase from the 21% of Special Immigrant Visa arrivals from Afghanistan in CY2013. Texas Refugee Health Program Arrivals with Asylee Status by Country of Origin, CY2014 VENEZUELA ANGOLA AFGHANISTAN BURMA 2% 2% 1% 1% SUDAN BURUNDI SOMALIA 1% 1% SYRIA 4% CAMEROON 4% 3% RWANDA 2% CHINA CONGO 1% 6% CONGO (DEMOCRATIC OTHER REPUBLIC) 2% PAKISTAN CUBA 3% 5% 1% NIGERIA 1%
EGYPT NEPAL 12% 9%
KENYA 2% ERITREA IRAQ 10% 9%
IRAN ETHIOPIA 5% 11% n= 565 Countries with ≥1% shown HONDURAS Asylees came from 36 countries total 1% Texas Refugee Health Program Arrivals with Victim of Trafficking Status by Country of Origin, CY2014 NIGERIA CAMBODIA 2% 2% CHINA NIGER 2% 2% NICARAGUA PHILIPPINES 2% 6% ETHIOPIA EL SALVADOR 3% 9% NEPAL 8%
GUATEMALA 9%
MEXICO 24% HONDURAS 18%
KYRGYZSTAN 2% INDIA 9% KOREA, DEMOCRATIC n= 66 PEOPLES REP KENYA Countries with ≥1% shown 3% 2% Victims of Trafficking came from 16 countries total Texas Refugee Health Program Arrivals by Resettlement County, CY2014 TAYLOR NON‐CONTRACT 3% 1%
POTTER 4% BEXAR 7%
HARRIS 38% TRAVIS 13%
TARRANT 15%
DALLAS 19%
n= 13,785 The proportional distribution of arrivals to resettlement counties in CY2014 was similar to the distribution in CY2013. Texas Refugee Health Program Arrivals by Resettlement County, CY2014 6000
5285
5000
4000 Arrivals 3000 of 2571
2050
Number 1717 2000
1023 1000 553 463 123 0
Resettlement County n= 13,785 The greatest number of arrivals resettled in Harris County, more than double that of any other resettlement location. Texas Refugee Health Program Arrivals by Gender, CY2014
Female 45%
Male 55%
n= 13,785 55% of arrivals to Texas were male and 45% were female in CY2014. Texas Refugee Health Program Arrivals by Age at Arrival, CY2014 2400 2240 2200
2000
1800 1608 1584 1600 1548
1400 Arrivals 1179 1121 of
1200 1018 1000 956
Number 852 800
580 600
378 400 249 200 162 130 58 66 31 16 5 4 0 <1 1‐56‐10 11‐15 16‐20 21‐25 26‐30 31‐35 36‐40 41‐45 46‐50 51‐55 56‐60 61‐65 66‐70 71‐75 76‐80 81‐85 86‐90 91‐95 n= 13,785 Age at Arrival Ages of arrival ranged from less than 1 year old up to 95 years of age. Refugee Health Program Arrivals by Need for Interpreter, CY2014
No 10%
Yes 90%
n=12,012 90% of arrivals that received a health assessment in CY2013 needed an interpreter. Texas Refugee Health Program Arrivals by Interpreter Language, CY2014 Tigrinya Swahili/Kiswahili 1% 2%
Arabic 25% Spanish 28%
Burmese 12%
Kinyarwanda 1% Chin 3% Dari Nepali Pashto Farsi 4% 2% 5% 4% n= 10,810 Other French Languages with ≥1% shown Kinyarwanda Karen 3% 1% 50 different languages used in total 1% 3% The language most requested was Spanish (28%) followed by Arabic (25%) and Burmese (12%). Arrivals of Secondary Migrants in the Texas Refugee Health Program, CY2014
Secondary Migrant 4%
Primary Arrivals 96% n= 13,785 Secondary migrants most often relocate to be with family and friends from their home country or for employment reasons. Secondary migrant arrivals constituted 4% of clients served in CY2014. Secondary Migrants in the Texas Refugee Health Program by Final Resettlement County, CY2014
BEXAR 6% TRAVIS 20%
DALLAS 18%
TAYLOR HARRIS 14% 4%
POTTER 12%
TARRANT 26% n= 578 Secondary Migrants in the Texas Refugee Health Program by Country of Origin, CY2014 AFGHANISTAN SOUTH AFRICA SUDAN 3% 1% 2% RWANDA 1% NEPAL SOMALIA 1% 7% BURMA 17%
BURUNDI 1% CHINA 1%
IRAQ 27% CONGO (DEMOCRATIC REPUBLIC) 13%
CUBA IRAN 21% 1% n= 578 EGYPT ETHIOPIA 1% Countries with ≥1% shown 3% Secondary migrants came from 19 countries total Of the 578 documented secondary migrants, 27% came from Iraq and 21% came from Cuba. Secondary Migrants in the Texas Refugee Health Program by Original Resettlement State, CY2014 Missouri Washington Nevada Oklahoma Utah Other 1% 1% 1% 1% Oregon 1% 2% 1% Connecticut Ohio 2% 2% Florida Wisconsin 18% 2% Indiana Maryland 2% 2%
Kansas 2% Michigan Idaho 7% 2% Tennessee 3% Virginia 6% Massachusetts 3% Illinois Georgia 3% 6% Arizona Louisiana 3% 5% Pennsylvania North California 3% Carolina 5% Colorado 4% n= 578 4% New York States with ≥1% shown 4% Secondary migrants came from 35 states total Texas Refugee Health Program Arrivals‐ Screening Rate, CY2014
Not Screened 9%
Screened 91% n= 13,785 Clients are eligible for initial health assessments within 90 days of arrival, date granted asylum, or date of certification of international severe human trafficking. Of the 13,785 arrivals, 91% were screened. Texas Refugee Health Program Arrivals Not Screened by Reason, CY2014
Died before screening 1%
Unable to locate 5%
Refused screening 17% Missed appointment 31%
Never arrived 15%
Moved to unknown destination 1% Moved out of state Moved to another county 28% 2%
Reasons with ≥1% shown Texas Refugee Health Program Screening Rate by Resettlement County, CY2014
100% 97% 95% 92% 89% 90% 88% 85%
80% 75%
70%
60% Rate
50%
Screening 40%
30%
20%
10%
0% BEXAR DALLAS HARRIS POTTER TARRANT TAYLOR TRAVIS Resettlement County
The screening rate ranged from 75% to 97% in resettlement counties. Texas Refugee Health Program CY2014 Health Screening Outcomes Texas Refugee Health Program Arrivals by Tuberculin Skin Test Results, CY2014
Positive 25%
Negative 75%
n= 1,812 *Over 10mm Induration 1,812 arrivals were given the tuberculin skin test (TST). 25% had an induration over 10mm, indicating a positive skin test result (*not necessarily an indication of active disease). Texas Refugee Health Arrivals with Positive Tuberculin Skin Test Results by Country, CY2014 SUDAN ERITREA IRAN ETHIOPIA 2% 2% 2% 1% BHUTAN 3% CONGO (DEMOCRATIC REPUBLIC) 5%
AFGHANISTAN BURMA 11% 44%
SOMALIA 12%
IRAQ 18% n= 452 Countries with ≥1% shown Over 10mm Induration 44% of arrivals from Burma had a positive Tuberculin Skin Test, while 18% of arrivals from Iraq had a positive test result. Texas Refugee Health Program Arrivals by TB IGRA* Result, CY2014
Positive Indeterminate 14% 1%
Negative 85% n= 10,338 * Tuberculosis Interferon Gamma Release Assay (Blood Test) 10,338 arrivals were given the Interferon Gamma Release Assay (IGRA) test. 14% had a positive test result (*not necessarily a sign of active disease). Texas Refugee Health Program Arrivals with Positive IGRA* Results by Country, CY2014
NEPAL SUDAN BURUNDI Other 1% 1% 1% 3% IRAN ETHIOPIA 1% 2% ERITREA 2%
CUBA BURMA 6% 28%
CONGO (DEMOCRATIC REPUBLIC) 7%
AFGHANISTAN 9%
IRAQ BHUTAN 16% 9% n= 1,416 SOMALIA Countries with ≥1% shown 14% *Tuberculosis Interferon Gamma Release Assay 1,416 arrivals tested positive with the Interferon Gamma Release Assay (IGRA) test. 28% were from Burma. Texas Refugee Health Program Arrivals by Hepatitis B (HBsAg*+) Screening Result, CY2014 Positive 2%
Negative 98% n=10,972 *Hepatitis B surface antigen 10,972 arrivals were screened for Hepatitis B (HBsAg+). 2% tested positive. Texas Refugee Health Program Arrivals Positive for Hepatitis B (HBsAg*+) by Country of Origin, CY2014 RWANDA CONGO IRAN LIBERIA EGYPT 1% 1% 1% 1% SUDAN 1% OTHER 1% ERITREA 4% 2% BHUTAN 2%
AFGHANISTAN 4%
IRAQ 7% BURMA 47%
CUBA 7%
SOMALIA 10% CONGO (DEMOCRATIC REPUBLIC) 11% n=252 Countries with ≥1% shown *Hepatitis B Surface Antigen The majority (47%) of arrivals with positive Hepatitis B (HBsAg+) results were from Burma. Texas Refugee Health Program Arrivals Screened for Elevated Lead Level by Result, CY2014
Positive 13%
Negative 87% n= 3,600 *Lead reading of 5µg/dl or more (Effective in 2014, previously 10µg/dl) Arrivals 6 months to 16 years screened Arrivals between 6 months and 16 years of age are tested for elevated blood lead levels. 13% of those tested had elevated levels. Texas Refugee Health Program Arrivals Positive for Elevated Lead Levels by Country of Origin, CY2014 IRAN ANGOLA CONGO (DEMOCRATIC 1% 1% OTHER REPUBLIC) 1% 3%
CUBA 4% BHUTAN 6%
SOMALIA AFGHANISTAN 7% 39%
BURMA 18%
n= 458 IRAQ 20% Lead reading of 5µg/dl or more (Effective in 2014, previously 10µg/dl) Arrivals 6 months‐ 16 years screened
Of the arrivals with elevated blood lead levels, 39% were from Afghanistan and 20% were from Iraq. Texas Refugee Health Program Arrivals by HIV Result, CY2014 Positive 0.5%
Negative 99% n= 11,654 0.5% of arrivals screened for HIV tested positive. Texas Refugee Health Program Arrivals Positive for HIV by Country of Origin, CY2014
RWANDA SOMALIA BHUTAN 2% 3% 2% GUATEMALA 2% IRAQ 3%
ETHIOPIA BURMA 5% 24%
ERITREA 8%
BURUNDI 2% CAMEROON 3%
CONGO (DEMOCRATIC REPUBLIC) 15% CUBA 31%
Of the arrivals that tested positive for HIV, 31% of them were from Cuba and 24% were from Burma. Texas Refugee Health Program Arrivals by Syphilis Result, CY2014
Positive 0.8%
Negative 99% n= 9,177 *Arrivals age 15 and above tested
Arrivals 15 years of age and above are screened for syphilis. 0.8% tested positive. Texas Refugee Health Program Arrivals with Positive Syphilis Results by Country of Origin, CY2014
SUDAN AFGHANISTAN SOMALIA 3% 4% 3% LEBANON 1% IRAN 1% IRAQ 8% BURMA 21% GUATEMALA 1%
ETHIOPIA 6% BURUNDI 2% ERITREA 3% CONGO (DEMOCRATIC REPUBLIC) 4%
CUBA 43%
Of the arrivals that tested positive for syphilis, the largest group came from Cuba, accounting for 43% of positive test results. Texas Refugee Health Program Arrivals by O&P* or Presumptive Treatment Results, CY2014
Unable to obtain specimen Screened, both parasites 5% found 3%
Screened, no parasites found 16%
Overseas Presumptive Treatment Given 36% Screened, non‐pathogenic parasites found 19%
Domestic Presumptive Treatment Given Screened, pathogenic 19% parasites found n= 11,972 2% *Ovum & Parasite 36% of arrivals were given overseas presumptive treatment for parasites, while 19% were given domestic presumptive treatment. Texas Refugee Health Program Arrivals by Schistosomiasis Serology Result, CY2013
Not Done ‐ Unable to Positive obtain specimen 4% 4%
Negative 27%
Not Done ‐ Overseas Presumptive Treatment Given 43% Not Done ‐ Domestic Presumptive Treatment Given 22%
n= 1,091 Clients from Sub‐Saharan Africa are either presumptively treated or given a serology test for schistosomiasis. Texas Refugee Health Program Arrivals with Positive Schistosomiasis Serology Results by Country of Origin, CY2014 SUDAN 3%
CONGO (DEMOCRATIC REPUBLIC) 15%
SOMALIA 44%
ERITREA 33%
ETHIOPIA 5% n= 39 44% of the arrivals from Sub‐Saharan Africa with positive schistosomiasis results were from Somalia. Texas Refugee Health Program 2014 Country Profiles Afghanistan Health Outcome Profile of Texas Refugee Health Program Arrivals from n= 841 Afghanistan, CY2014
HIV 0.0%
SYPHILIS 0.3%
HEPATITIS B 1.1%
TB IGRA 12.0%
0% 5% 10% 15% 20% 25% Percentage Positive Burma Health Outcome Profile of Texas Refugee Health Program Arrivals from n=2,003 Burma, CY2014
HIV 0.7%
SYPHILIS 1.0%
HEPATITIS B 5.8%
TB IGRA 21.2%
0% 5% 10% 15% 20% 25% Percentage Positive Cuba
Health Outcome Profile of Texas Refugee Health Program Arrivals from n= 2,477 Cuba, CY2014
HIV 0.6%
SYPHILIS 1.1%
HEPATITIS B 0.6%
TB IGRA 3.5%
0% 5% 10% 15% 20% 25%
Percentage Positive Democratic Republic Of The Congo
Health Outcome Profile of Texas Refugee Health Program Arrivals from n= 403 Democratic Republic of Congo, CY2014
HIV 2.2%
SYPHILIS 1.0%
HEPATITIS B 7.3%
TB IGRA 22.3%
0% 5% 10% 15% 20% 25% Percentage Positive Iraq
Health Outcome Profile of Texas Refugee Health Program Arrivals from n= 3,135 Iraq, CY2014
HIV 0.1%
SYPHILIS 0.3%
HEPATITIS B 0.6%
TB IGRA 10.5%
0% 5% 10% 15% 20% 25% Percentage Positive Photos by UNHCR For more information, please contact:
Jessica Montour, MPH [email protected] (512) 533‐3161
Please visit our website at: www.RefugeeHealthTX.org