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Because of immigration to the United States, the number of persons who speak languages other than English has grown over the past several decades. In addition, many groups whose primary language is not English are exhibiting rapid population growth rates. As a result, health care providers may find they require an interpreter to communicate with patients. Guidelines are presented to facilitate the effective choice and utilization of interpreters in primary care. Suggestions are also presented to help interpreters work effectively in the health care setting.

Hepatitis B virus (HBV) infection is prevalent among Southeast Asian refugees. HBV infection causes acute and chronic hepatitis and cirrhosis, and is associated with primary hepatocellular carcinoma. Health care providers must be able to make an accurate diagnosis of acute or chronic HBV infection when performing medical evaluations of Southeast Asian refugees. It is essential that appropriate follow-up care and teaching regarding infection control be provided. In this article, a protocol is presented that aids interpretation of hepatitis B screening tests. The protocol uses testing for the immunoglobulin M antibody against hepatitis B core antigen (anti-HBc/IgM) to aid differentiation between acute and chronic HBV infection. If testing is interpreted to show the presence of the hepatitis B chronic carrier state, a second protocol is used to guide follow-up testing, treatment and referral of patients.

The hepatitis D virus (HDV) was first detected in Italy in 1977 and is the etiologic agent of type D hepatitis. A defective RNA virus, HDV depends completely on the hepatitis B virus for its expression and replication. HDV infection can cause a severe form of hepatitis with high mortality rates. In the United States, hepatitis D most commonly affects intravenous drug abusers and hemophiliacs. Diagnosis is based on interpretation of the body's immune response to the hepatitis D antigen. At present, there is no specific treatment for type D hepatitis. Prophylaxis against HDV infection depends entirely on the prevention of hepatitis B. Patients found to have hepatitis D virus infection should be referred to a gastroenterologist for management.