ORIGINAL PAPER Characterization of Chronic Hepatitis B Cases Among Foreign-Born Persons in Six Population-Based Surveillance Sites, United States 2001–2010 Stephen J. Liu • Kashif Iqbal • Sue Shallow • Suzanne Speers • Elena Rizzo • Kristin Gerard • Tasha Poissant • R. Monina Klevens Ó Springer Science+Business Media New York (Outside the USA) 2014 Abstract National surveys indicate prevalence of chronic hepatitis B among foreign-born persons in the USA is 5.6 times higher than US-born. Centers for Disease Control and Prevention funded chronic hepatitis B surveillance in Emerging Infections Program sites. A case was any chronic hepatitis B case reported to participating sites from 2001 to 2010. Sites collected standardized demographic data on all cases. We tested differences between foreign- and US-born cases by age, sex, and pregnancy using Chi square tests. We examined trends by birth country during 2005–2010. Of 36,008 cases, 21,355 (59.3 %) reported birth in a country outside the USA, 2,323 (6.5 %) were US-born. Compared with US-born, foreign-born persons were 9.2 times more frequent among chronic hepatitis B cases. Foreign-born were more frequently female, younger, ever pregnant, and born in China. Percentages of cases among foreign-born persons were constant during 2005–2010. Our findings support information from US surveillance for Hepatitis B screening and vaccination efforts. Keywords Chinese-born Á Birth country Á HBsAg prevalence Á Perinatal transmission Á Provider screening Introduction Chronic hepatitis B, a life-long liver disease caused by the hepatitis B virus (HBV), leads to cirrhosis of the liver in 20 % of infected individuals and 100 times higher risk of hepatocellular carcinoma (HCC) [1]. HBV is spread by percutaneous and mucosal routes through body fluids such as serum and semen [2]. Modes of transmission include sexual contact, sharing injection needles, household con- tact with a hepatitis B-infected person, exposure to hepa- titis B-infected blood in health care settings, and perinatally from mother to child [3]. Travelers to HBV- endemic regions have elevated risk, when engaging in such activities in those countries [3]. Chronic hepatitis B is an important global issue, espe- cially in certain areas in Asia and Africa [4]. Data from the US National Health and Nutrition Examination Survey (NHANES) for 1999–2006 found that persons with HBV infection were 5.6 times more likely to be foreign born when compared with US-born cases [5]. Recent estimates indicate that about 730,000 persons are chronically infected with hepatitis B in the United States [5]. However, the Institute of Medicine states that estimates of chronic hepatitis B prevalence from NHANES are likely underestimates, because the persons at greater risk for S. J. Liu Á K. Iqbal Á R. M. Klevens Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA S. J. Liu (&) Division of Viral Hepatitis, Epidemiology and Surveillance Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop, G-37, Atlanta, GA 30333, USA e-mail: Sliu1110@gmail.com S. Shallow San Francisco Department of Public Health, San Francisco, CA, USA S. Speers Á K. Gerard Connecticut Department of Public Health, Hartford, CT, USA E. Rizzo New York State Department of Health, Albany, NY, USA T. Poissant Oregon Health Authority, Portland, OR, USA 123 J Immigrant Minority Health DOI 10.1007/s10903-014-0012-0