Prevalence and risk factors of hepatitis B virus infection in Middle‐Limburg Belgium, year 2017: Importance of migration

Abstract

Background and Aim: The hepatitis B virus (HBV) prevalence study performed in 2003 in Belgium is believed to be underestimating HBV prevalence due to underrepresentation of the non-Belgian population. Therefore, we assessed the prevalence and risk factors of HBV infection in a multi-ethnic region situated in Middle-Limburg Belgium, in 2017. Methods: Between May and November 2017, blood samples and questionnaires were taken from patients who presented at the emergency department of a large educational hospital. Blood samples were tested for hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies (anti-HBc). A sample size of 1000 persons was required to obtain a representative sample of the general Middle-Limburg population.Results: Of the 1131 patients screened, the overall HBsAg prevalence was 0.97% with differences between Belgians (0.67%) and first-generation-migrants (2.55%), (P = 0.015). Five (45.5%) of 11 HBsAg-positive individuals were not aware of their HBV status. All five (100%) newly diagnosed HBsAg-positive patients had further clinical evaluation and all had a normal level of alanine aminotransferase (ALT). The prevalence of anti-HBc was 8.4%, and was significantly associated with age-genderethnicity interaction, presence of HBV-infected household member, hepatitis C virus infection, men who have sex with men, and hemodialysis. Conclusions:In this area with large immigrant populations, we found a higher prevalence of HBV infection compared with the nationwide study of 2003. National HBV screening for first-generation migrants is needed as this high-risk group will go unnoticed due to the possible incorrect interpretation of normal ALT values. K E Y W O R D SBelgium, hepatitis B, migrants, prevalence, risk factors

Early detection of chronic hepatitis B and risk factor assessment in Turkish migrants, Middle Limburg, Belgium

“…Our finding of 3% HBsAg positivity in Turkish FGM is in line with previous findings reported in the Netherlands and Germany (HBsAg prevalence varying from 3-5%), and reflects the high prevalence in the country of origin [10,12,13,20]. However, the 1.5% prevalence of chronic HBV infection in Turkish SGM is higher than the reported 0.7% HBsAg prevalence in native Belgians [6][7][8]. This finding is novel and might in part be explained by the interaction of high prevalence in the country of origin and suboptimal coverage by primary prevention strategies in the country of birth.…”

“…In low endemic countries (< 2% hepatitis B surface antigen (HBsAg) positive), migrants born in intermediate (2)(3)(4)(5)(6)(7).99% HBsAg positive) or high endemic (� 8% HBsAg positive) regions are an important risk group for chronic HBV infection [6]. In Belgium, the prevalence of chronic HBV infection is estimated to be 0.67% in the general population and 4.69% in first-generation migrants (FGM) born in intermediate or high endemic countries [6][7][8]. Migrants from intermediate or high endemic countries account for more than half of the patients with chronic HBV infection in Belgium [9].…”

Acute hepatitis B notification rates in Flanders, Belgium, 2009 to 2017

“…Countries in eastern and southern Europe have a higher prevalence of chronic HBV infection than countries in the northern and western parts [5]. Belgium is classified as a country of low HBV endemicity, with ca 0.7% of the population positive for hepatitis B surface antigen (HBsAg) [6-8].…”

The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates

“…The cut-off was chosen since children born in 1986 or after were covered by the universal infant HBV vaccination programme in Belgium. 28,29 Age was grouped as 18-to 24-yearolds, 25-to 40-year-olds, 40-to 64-year-olds and ≥65-year-olds as defined by the Medical Subject Headings (MeSH). Selected analysis was performed comparing <40-year-olds and ≥40-year-olds in line with prior hepatitis B vaccine efficacy studies.…”

“…In Belgium, universal infant HBV vaccination began in 1999 with catch-up vaccination for 10-to 13-year-olds (birth cohort born in 1986 or after). 28,29 2 | PATIENTS AND ME THODS…”