Hepatitis B virus burden in developing countries

Hepatitis B virus(HBV) infection has shown an intermediate or high endemicity level in low-income countries over the last five decades. In recent years, however, the incidence of acute hepatitis B and the prevalence of hepatitis B surface antigen chronic carriers have decreased in several countries because of the HBV universal vaccination programs started in the nineties. Some countries, however, are still unable to implement these programs, particularly in their hyperendemic rural areas. The diffusion of HBV infection is still wide in several low-income countries where the prevention, management and treatment of HBV infection are a heavy burden for the governments and healthcare authorities. Of note, the information on the HBV epidemiology is scanty in numerous eastern European and Latin-American countries. The studies on molecular epidemiology performed in some countries provide an important contribution for a more comprehensive knowledge of HBV epidemiology, and phylogenetic studies provide information on the impact of recent and older migratory flows.

Hepatitis B virus infection in immigrant populations

Hepatitis B virus(HBV) is the most common cause of hepatitis worldwide, with nearly 350 million people chronically infected and 600000 deaths per year due to acute liver failure occurring during acute hepatitis or, more frequently, in HBV-related liver cirrhosis or hepatocellular carcinoma. Ongoing immigration from countries with a high HBV endemicity to those with a low HBV endemicity warrants particular attention to prevent the spread of HBV infection to the native population. This review article analyzes the epidemiology and virological and clinical characteristics of HBV infection in immigrant populations and in their host countries, and suggests prophylactic measures to prevent the spread of this infection. Among the immigrants from different geographical areas, those from South East Asia and sub-Saharan Africa show the highest prevalences of hepatitis B surface antigen(HBs Ag) carriers, in accordance with the high endemicity of the countries of origin. The molecular characteristics of HBV infection in immigrants reflect those of the geographical areas of origin: HBV genotype A and D predominate in immigrants from Eastern Europe, B and C in those from Asia and genotype E in those from Africa. The literature data on the clinical course and treatment of HBs Agpositive immigrants are scanty. The management of HBV infection in immigrant populations is difficult and requires expert personnel and dedicated structures for their assistance. The social services, voluntary operators and cultural mediators are essential to achieve optimized psychological and clinical intervention.

Epidemiology and management of hepatitis C virus infections in immigrant populations

Background:At present,there is a continuous flow of immigrants from the south of the world to north-western countries.Often immigrants originate from areas of high-prevalence of viral hepatitis and pose a challenge to the healthcare systems of the host nations.Aims of this study is to evaluate the prevalence and virological and clinical characteristics of hepatitis C virus(HCV)infection in immigrants and the strategies to identify and take care of the immigrants infected with HCV.Main body:We conducted an electronic literature search in several biomedical databases,including PubMed,Google Scholar,Scopus,Web of Science,using different combinations of key words:"HCV infection;chronic hepatitis C,immigrants;low-income countries".We included studies written in English indicating the epidemiological data of HCV infection in the immigrant population,studies that assessed the clinical presentation,clinical management and treatment with directly acting antiviral agent in immigrants,HCV infection is unevenly distributed in different countries,with worldwide prevalence in the general population ranging from 0.5 to 6.5%.In Western countries and Australia this rate ranges from 0.5 to 1.5%,and reaches 2.3%in countries of south-east Asia and eastern Mediterranean regions,3.2%in China,0.9%in India,2.2%in Indonesia and 6.5%in Pakistan;in sub-Saharan Africa the prevalence of HCV infection varies from 4 to 9%.Immigrants and refugees from intermediate/high HCV endemic countries to less-or non-endemic areas are more likely to have an increased risk of HCV infection due to HCV exposure in their countries of origin.Because of the high HCV endemicity in immigrant populations and of the high efficacy of directly acting antiviral agent therapy,a campaign could be undertaken to eradicate the infection in this setting.Conclusions:The healthcare authorities should support screening programs for immigrants,performed with the help of cultural mediators and including educational aspects to break down the barriers limiting access to treatments,which obtain the HCV clearance in 95%of cases and frequently prevent the development of liver cirrhosis and hepatocellular carcinoma.

Hepatitis B virus infection in undocumented immigrants and refugees in Southern Italy:demographic,virological,and clinical features

Background:The data on hepatitis b virus(HBV)infection in immigrants population are scanty.The porpoise of this study was to define the demographic,virological,and clinical characteristics of subjects infected with HBV chronic infection in a cohort of immigrants living in Naples,Italy.Methods:A screening for HBV infection was offered to 1,331 immigrants,of whom 1,212(91%)(831 undocumented immigrants and 381 refugees)accepted and were screened for hepatitis B surface antigen(HBsAg)and anti-hepatitis B core antibody(HBc).Those found to be HBsAg positive were further investigated at third-level infectious disease units.Results:Of the 1,212 immigrants screened,116(9.6%)were HBsAg positive,490(40.4%)were HBsAg negative/anti-HBc positive,and 606(50%)were seronegative for both.Moreover,21(1.7%)were anti-human immunodeficiency virus positive and 45(3.7%)were anti-hepatitis C virus positive.The logistic regression analysis showed that male sex(OR:1.79;95%CI:1.28-2.51),Sub-Saharan African origin(OR:6.18;95%CI:3.37-11.36),low level of schooling(OR:0.96;95%CI:0.94-0.99),and minor parenteral risks for acquiring HBV infection(acupuncture,tattoo,piercing,or tribal practices,OR:1.54;95%CI:1.1-2.16)were independently associated with ongoing or past HBV infection.Of the 116 HBsAg-positive immigrants,90(77.6%)completed their diagnostic itinerary at a third-level infectious disease unit:29(32.2%)were asymptomatic non-viremic HBsAg carriers,43(47.8%)were asymptomatic viremic carriers,14(15.6%)had chronic hepatitis,and four(4.4%)had liver cirrhosis,with superimposed hepatocellular carcinoma in two.Conclusions:The data illustrate the demographic,clinical and virological characteristics of HBV infection in immigrants in Italy and indicate the need for Italian healthcare authorities to enhance their support for providing screening,HBV vaccination,treatment,and educational programs for this populations.