The impact of immigration and vaccination in reducing the incidence of hepatitis B in Catalonia (Spain)

Abstract

BackgroundThe Hepatitis B virus (HBV) infection is a major cause of liver disease and liver cancer worldwide according to the World Health Organization. Following acute HBV infection, 1-5% of infected healthy adults and up to 90% of infected infants become chronic carriers and have an increased risk of cirrhosis and primary hepatocellular carcinoma. The aim of this study was to investigate the relationship between the reduction in acute hepatitis B incidence and the universal vaccination programme in preadolescents in Catalonia (Spain), taking population changes into account, and to construct a model to forecast the future incidence of cases that permits the best preventive strategy to be adopted.MethodsReported acute hepatitis B incidence in Catalonia according to age, gender, vaccination coverage, percentage of immigrants and the year of report of cases was analysed. A statistical analysis was made using three models: generalized linear models (GLM) with Poisson or negative binomial distribution and a generalized additive model (GAM).ResultsThe higher the vaccination coverage, the lower the reported incidence of hepatitis B (p <0.01). In groups with vaccination coverage > 70%, the reduction in incidence was 2-fold higher than in groups with a coverage <70% (p <0.01). The increase in incidence was significantly-higher in groups with a high percentage of immigrants and more than 15% (p <0.01) in immigrant males of working age (19-49 years).ConclusionsThe results of the adjusted models in this study confirm that the global incidence of hepatitis B has declined in Catalonia after the introduction of the universal preadolescent vaccination programme, but the incidence increased in male immigrants of working age. Given the potential severity of hepatitis B for the health of individuals and for the community, universal vaccination programmes should continue and programmes in risk groups, especially immigrants, should be strengthened.

Impact of hepatitis B vaccination on acute hepatitis B epidemiology in European Union/European Economic Area countries, 2006 to 2014

“…This finding is consistent with previous reports published in the literature. A study conducted in Spain in 2012 showed an increased HBV incidence between 2000 and 2004 among immigrants [ 27 ] and a recent study from Portugal in 2016 indicated a very high HBsAg prevalence among high-risk groups (people who inject drugs (PWIDs) and prisoners) that may have influenced the increase in the HBV reported cases in the country [ 28 ]. Both Spain and Portugal have implemented a universal HBV vaccination programme but both implemented these programmes after 1995 and without catch-up strategies, resulting in a proportion of the at risk population remaining unprotected.…”

Are men who have sex with men in Europe protected from hepatitis B?

“…We identified three sources for targeted vaccination programmes: the European Centre for Disease Prevention and Control (ECDC) [12], the Vaccine European New Integrated Collaboration Effort (VENICE) [13] and the European Liver Patients Association (ELPA) [14]. For 18 countries, we found additional sources on their vaccination programmes for indication groups MSM or people with frequently changing sexual partners [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Furthermore, contact persons from 34 European countries answered our short survey.…”

The Public Health perspective on Migratory Health – Displaced Populations in Global Disease Epidemics

“…Epidemiological studies is currently inclusive of chronic diseases [13] like cancer malignancies [14], kidney renal failure [15] and severe cardiovascular diseases [8,16], mental and psycho-Topics in Public Health social health [17] maternal and child health [12,18]. Lifestyle diseases and associated health issues (metabolic diseases), frequent tobacco use, alcohol use and substance of abuse, are critically being studied and considered in relation to the process of migration in some migrant receiving countries [19].…”

“…In many displaced migrant populations caused by war, natural disasters, civil disobedience and other macro environmental problems, there are always public health problems caused by disease burden that are either communicable or non-communicable in nature in the affected area. Other consequences of massive displaced population include food insecurity, famine, lack of basic access to health care, and the difficulties in developing a standard health programme, policies for a good standard of care [5,13,31].The impact of mass displacement of population on public health disease management programmes has had a significant impact in low income economies The other drawback caused by mass displaced population includes increasing death and morbidity ratios. In most low resource countries like in sub-Saharan Africa, there is high mortality rates due to significant increase in disease burden, extreme poverty, unemployment and the most common causes of death within the displaced population are associated with water borne diseases like diarrheal and dysentery, measles, acute respiratory infections, malaria and most recent in sub Saharan Africa, ebola virus disease [9,14,37].…”