Short communication
Hepatitis B infection prevalence by country of birth in migrant populations in a large UK city

https://doi.org/10.1016/j.jcv.2015.05.009Get rights and content

Highlights

  • •

    HBV screening of migrants is recommended in the UK.

  • •

    HBV prevalence in migrants was lower than estimates based on their country of birth.

  • •

    Overall HBV prevalence was below estimated screening cost effectiveness threshold.

  • •

    More targeted screening based on prevalence in migrant population recommended.

Abstract

Background

Many countries with low prevalence of Hepatitis B Virus (HBV) infection recommend that migrants born in countries with higher prevalence are HBV tested. The cost effectiveness depends on the prevalence of HBV infection in the migrant population. In the UK the National Institute for Health and Care Excellence recommended HBV testing of migrants born in countries with HBV infection prevalence >2%, but the prevalence in migrant populations in the UK is not routinely measured.

Objectives

To estimate HBV infection prevalence by region of birth in migrant populations in a large UK city.

Study Design

By retrospective data linkage HBV infection prevalence in migrant women tested in pregnancy was determined by UN region and sub-region of birth.

Results

Of 5840 migrant women born in regions with HBV infection prevalence >2%, 101 were infected (prevalence 1.7%; 95% CI 1.4–2.1). Sub-regions of birth with low (<2%), intermediate (2–8%) and high (>8%) prevalence in the study population were: low – Northern Africa, Southern Asia, Western Asia, Eastern Europe, South Europe, Central America, Latin America and The Caribbean; intermediate – Eastern Africa, Middle Africa, Western Africa, and South Eastern Asia; high – Eastern Asia. Prevalence in the study populations, was generally lower than published estimates for the region of origin.

Conclusion

In a large ethnically diverse city in the UK the hepatitis B prevalence in migrant populations for whom HBV screening is recommended is below the estimated cost effectiveness threshold. We recommend more targeted screening based on measured prevalence in migrant populations.

Section snippets

Background

Chronic HBV infection prevalence varies widely across the globe, and the World Health Organisation (WHO) divides regions into those with low (<2%), intermediate (2–8%) and high (>8%) prevalence [1]. In many countries with very low overall HBV prevalence, such as the UK, the burden of HBV infection lies within migrants born in countries with higher HBV prevalence [2]. Due to this, a number of national bodies recommend HBV testing of migrants on the basis of HBV prevalence in their country of

Objective

To estimate HBV prevalence by region of birth in migrant populations in a large ethnically diverse city within the UK.

Study design

The study population consisted of women born in countries with high or intermediate HBV prevalence (>2%), resident in Bristol UK, who gave birth between 01/04/2006 and 30/04/2014, and for whom HBV testing results were available. We defined countries as having a high or intermediate HBV prevalence according to the UK National Institute for Health and Care Excellence (NICE) testing guidance [5], which includes all countries in Africa, Asia, South and Central America, The Caribbean, The Pacific,

Results

Of 5840 study women, 101 were infected giving an overall period prevalence of 1.7% (95% CI 1.4–2.1). Sub-regions of birth with low prevalence (<2%) in the study population included Northern Africa, Southern Asia, Western Asia, Eastern Europe, South Europe, Central America, Latin America and The Caribbean; Sub-regions with moderate prevalence (2–8%) included Eastern Africa, Middle Africa, Western Africa, and South Eastern Asia; and the only sub-region with high prevalence (>8%) was Eastern Asia (

Discussion

Previous estimates of HBV prevalence in migrants by region of birth in the UK relied on a small number of targeted testing studies in specific migrant groups including UK–Somalis in Liverpool (prevalence 5.7%) [13], [14], UK–Asians born in India (0.1%), Pakistan (1.8%) or Bangladesh (1.5%) [8], and UK–Asians born in China (11%), Vietnam (17.4%), Pakistan (3.1%) and Bangladesh (0.5%) [15]. Such studies, which rely on people coming forward for testing, may not reflect the whole population being

Funding

This study was supported with an educational grant via the Gilead UK and Ireland Fellowship Programme. The study was supported by the NIHR Health Protection Research Unit in Evaluation of Interventions. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Competing interests

Alexandra Cochrane has received research funding from Gilead UK and Ireland Fellowship Programme. Gilead UK and Ireland Fellowship Programme had no role in design of the study, data collection, analysis, interpretation, abstract preparation, or decision to submit. The other authors have no conflicts of interest to declare.

Ethical approval

This study was judged to be public health surveillance and therefore ethical approval was not required. This decision was accepted by the Regional Ethics Committee Centre (Bristol).

Acknowledgement

We would like to thank Isabel Oliver for her valuable assistance.

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