Hepatitis B virus (HBV) infection is endemic in many parts of the world, and prevailing conditions in refugee situations result in greater risk of infection. The objectives of this study were to determine the period prevalence of HBV infection among primary refugees in Minnesota during 1998-2001; describe trends in prevalence over time and identify patterns of infection and immunity in various refugee populations. A retrospective analysis of health examination data from the Minnesota Department of Health was conducted to examine serologic markers for hepatitis B: HBcAb, HbsAg, and HBsAb among 12,505 refugees who participated in the voluntary domestic health examination from 1998 to 2001. One hundred and eleven refugees had at least one immunization before arrival and were excluded. There was documented HBV test results in 8,754 (70.6%) of refugees; period prevalence of hepatitis B infection was 7.1%. Africans were three times more likely and Asians 2.4 times more likely to be infected than Europeans (P < 0.001). Older African refugees and African males were more likely to be infected than younger African refugees and women African refugees (P < 0.001). Younger persons below 30 years of age accounted for over 70% of all infected refugees in this study. Reducing the burden of infection among refugees requires enhanced provider awareness as well as intensified efforts aimed at identifying new at-risk populations, modifying risk factors, and implementing preventive and treatment strategies at various levels in the refugee resettlement process.