Screening for chronic hepatitis B and C in migrants from Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam in the Arnhem region, The Netherlands

Abstract

Migrants born in hepatitis B virus (HBV) and hepatitis C virus (HCV) endemic countries are at increased risk of being infected with these viruses. The first symptoms may arise when liver damage has already occurred. The challenge is to identify these infections early, since effective treatment has become available. In 2011 we conducted a screening project in first-generation migrants (FGMs) born in Afghanistan, Iran, Iraq, the former Soviet Republics, and Vietnam and living in Arnhem and Rheden. All participants were offered free blood screening for HBV and HCV. In total 959 participants were tested, with the country of origin known for 927, equating to 28·7% of all registered FGMs from the chosen countries. Nineteen percent (n = 176) had serological signs of past or chronic HBV infection and 2·2% (n = 21) had chronic HBV infection. The highest prevalence of chronic HBV infection was found in the Vietnamese population (9·5%, n = 12). Chronic HCV was found in two persons from the former Soviet Republics and one from Vietnam. Twenty-four percent (n = 5) of the newly identified patients with chronic HBV and one of the three patients with chronic HCV received treatment. Three of the patients, two with HCV and one with HBV, already had liver cirrhosis. The highest (9·5%) HBV prevalence was found in FGMs from Vietnam, indicating a high need for focusing on that particular immigrant population in order to identify more people with silent HBV infection. The fact that three patients already had liver cirrhosis underlines the necessity of early identification of HBV and HCV infection in risk groups.

Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence

“…For example, a prevalence of chronic hepatitis of 14% among Africans and 1.6% among Latin Americans was reported in Spain [30]. However, migrants appear to be at higher risk of complications and mortality as a consequence of HBV infection [14,23,25].…”

Immigration and viral hepatitis

“…In response to these barriers, various outreach programs have been developed in order to educate, screen, vaccinate and offer treatment to migrants at risk for viral hepatitis [34,[65][66][67][68][69][70]. Successful campaigns, such as the BFreeNYC project, have combined education and awareness initiatives with screening events in order to both educate and identify migrant populations most at risk of viral hepatitis [71].…”

Detecting Hepatitis B and C by Combined Public Health and Primary Care Birth Cohort Testing

“…A higher prevalence was expected based on previous estimations in these hotspots (0.5% to 1%), 27,28 or other Dutch studies focusing on risk groups (0.3% to 4.8%), 32,34,38,39 and on (inter)national estimations that a substantial population is untested. [2][3][4][5] Estimates of the hidden HCV-infected population, however, are largely derived from mathematical models (43% to 72%).…”

“…A priori, we expected a test uptake of 40% based on international targeted-testing studies and Dutch studies using personal letter invitations. [29][30][31][32][33][34] A positive anti-HCV test rate higher than the estimated Dutch prevalence of 0.1%-0.4% would be considered promising to explore further assessment and implementation of the testing strategy. [23][24][25] Test uptake and rates of positive test results were calculated among the patients invited and participants, and associated determinants were assessed using multivariate logistic regression analyses; determinants included hotspot, sex, age, educational level, and hepatitis exposure risk factors as non-Western migrant, surgery abroad, blood transfusion or organ transplant before 1992, HIV positive, or a history of intravenous drug use.…”

“…The current test uptake of 51% was higher compared with international studies targeted to risk factors (10% to 49%) and other Dutch studies with a personal invitation (18% to 42%). [29][30][31][32][33][34][35][36] The family physicians' personal invitation appeared key for achieving this high uptake, as confirmed by the reported main reason to get tested. Test uptake in specific settings, such as the emergency department, may be even higher (up to 65%), 37 as here tests can be offered and performed within the routine diagnostic work-up.…”