Abstract
Chronic hepatitis B (CHB) related morbidity and mortality can be reduced through risk group screening, linkage to care and anti-viral treatment. This study estimates the number of CHB cases among foreign-born (migrants) in the European Union and European Economic Area (EU/EEA) countries in order to identify the most affected migrant populations. The CHB burden was estimated by combining: demographic data on migrant population size by country of birth in the EU/EEA, extracted from European statistical databases; and CHB prevalence in migrants’ countries of birth and in EU/EEA countries, derived from a systematic literature search. The relative contribution of migrants from endemic countries to the total CHB burden in each country was also estimated. The reliability of using country of birth prevalence as a proxy for prevalence among migrants was assessed by comparing it to the prevalence found in studies among migrants in Europe. An estimated 1–1.9 million CHB-infected migrants from endemic countries (prevalence ≥2%) reside in the EU/EEA. Migrants from endemic countries comprise 10.3% of the total EU/EEA population but account for 25% (15%–35%) of all CHB cases. Migrants born in China and Romania contribute the largest number of infections, with over 100,000 estimated CHB cases each, followed by migrants from Turkey, Albania and Russia, in descending order, with over 50,000 estimated CHB cases each. The CHB prevalence reported in studies among migrants in EU/EEA countries was lower than the country of birth prevalence in 9 of 14 studies. Migrants from endemic countries are disproportionately affected by CHB; their contribution however varies between EU/EEA countries. Migrant focused screening strategies would be most effective in countries with a high relative contribution of migrants and a low general population prevalence. In countries with a higher general population prevalence and a lower relative contribution of migrants, screening specific birth cohorts may be a more effective use of scarce resources. Quantifying the number of CHB infections among 50 different migrant groups residing in each of the 31 EU/EEA host countries helps to identify the most affected migrant communities who would benefit from targeted screening and linkage to care.
Highlights
Chronic hepatitis B (CHB) related morbidity and mortality can be reduced through risk group screening, linkage to care and anti-viral treatment
Part 2: Systematic literature search for Hepatitis B surface antigen (HBsAg) prevalence in migrant populations in Europe The online databases Medline, Embase, the Cochrane library, Web of Science, Scopus, PubMed publisher and Google Scholar were searched in November 2014 for studies in English that estimate the prevalence of hepatitis B among migrants in any of the 31 European Economic Area (EU/EEA) countries
The results suggests that an approach focused solely on migrants would have limited impact in most Eastern European countries, Bulgaria, Lithuania, Poland, Romania, Slovakia and Slovenia, where the relative contribution of migrants to the overall national burden of CHB is low and the proportion of migrants from endemic countries is low (
Summary
Chronic hepatitis B (CHB) related morbidity and mortality can be reduced through risk group screening, linkage to care and anti-viral treatment. Since the Second World War, economic and geopolitical factors such as decolonisation, labour migration, the collapse of communism, air travel, economic growth and political crisis have changed this and migration to Europe has increased [1]. Much of this migration has been from low- and middle-income countries in Asia and Africa, many of which have a high prevalence of hepatitis B and C [2, 3]. Hepatitis B virus (HBV) infection primarily affects the liver. It usually has an insidious onset and can remain undetected for many years. Up to 5% of HBV infections in adults (up to 90% in young children) can progress to become chronic and up to 30% of chronic cases may develop liver cirrhosis [5]
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