Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin

Abstract

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Low hepatitis B testing among migrants: a cross-sectional study in a UK city

“…10 A 2013 UK study demonstrated that 1.1% of tested individuals were positive for HBsAg; 11 in 2009, the prevalence of HBV among migrants in the UK was estimated to be 4%, 12 ranging from 0.1% to 17.4% depending on ethnic group and study method. [13][14][15][16][17][18] In 2012, the National Institute for Health and Care Excellence (NICE) recommended that all people born in a country with HBV prevalence of ≥2% should be offered a HBV test and that testing is offered in primary care. 19 In 2011, approximately 7.5 million (13%) individuals living in England and Wales were born outside of the UK.…”

988 Outcomes of Hepatitis C Screening Programs Targeted at Risk Groups Hidden in the General Population: A Systematic Review

“…The 67 studies identified were done in the USA (n = 27), Europe (n = 27; mostly France and the United Kingdom [UK]), Asia (n = 4), Australia (n = 4), South America (n = 3), Egypt (n = 1) and Saudi Arabia (n = 1). We identified 24 nonintegrated and 41 integrated studies, plus two studies that used both strategies (the latter are shown in the paragraph below for the results of the nonintegrated part of their program, and in the subsequent paragraphs for the results of the integrated part of their program) [46,47]. A total of 85% (22/26) of the nonintegrated programs and all of the integrated programs were from low HCV-prevalence countries.…”

“…A program targeted at firefighters [49] used home specimen collection kits for serum collection. A program targeted at migrants [46] initially used oral fluid HCV antibody tests followed by a blood test for those who tested positive (no further details reported). In the majority (16/22) of the programs, participants were also screened for other infections (mostly HIV and hepatitis B virus …”

Therapy for chronic viral hepatitis: current indications, optimal therapies and delivery of care

“…Prevalence rates vary by region and have changed over time, so the rate of infection in immigrants is difficult to estimate from the country of origin alone. 22 Only 300 of the 7,700 new cases of chronic HBV diagnosed each year acquire the infection in the UK, the rest acquiring the chronic infection overseas. 7 …”