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Not A, Ouaarab‐Essadek H, Montoro M, Treviño B, Buti M, Morillas RM, Bordoy AE, Folch C, Majó X, Casabona J, Prat JGI, Martró E. Hepatitis B and C Screening and Linkage to Care in Migrants From Endemic Countries in Barcelona Through a Community Action. Liver Int 2025; 45:e70126. [PMID: 40351294 PMCID: PMC12067362 DOI: 10.1111/liv.70126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 03/13/2025] [Accepted: 04/28/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND AND AIMS Migrants from endemic areas are key populations for hepatitis B virus (HBV) and hepatitis C virus (HCV) infection screening in Europe. This study assessed the feasibility and outcomes of a community action that combined education, screening, and simplified access to care for migrants in Barcelona. METHODS Adult migrants from Pakistan, Romania, and Senegal were included from 2021 to 2023, through a community action involving education, an epidemiological questionnaire, and rapid testing for HBV surface antigen (HBsAg) and HCV antibodies. If positive, DBS samples were collected for laboratory confirmation. Viremic cases were referred to an International Health Unit (IHU). RESULTS Overall, 786 participants were included (346 from Pakistan, 304 from Senegal and 136 from Romania). Previous screening for HBV and HCV was 8.0% and 7.7%, respectively. HBsAg prevalence was 0.9% for migrants from Pakistan, 8.2% for those from Senegal and 1.4% for those from Romania (n = 30/786, 23 new diagnoses). Among these, 69.6% attended the IHU and were HBV-DNA positive, but none met treatment criteria. Anti-HCV prevalence was 3.5%, 0.7% and 1.4% for migrants from Pakistan, Senegal and Romania, respectively (n = 16/768, 12 new diagnoses), and HCV-RNA prevalence was 0.9%, 0.3% and 0.7%, respectively (N = 6, all new diagnoses); 4 (66.6%) cases were linked to treatment and two were cured. CONCLUSIONS This novel community action successfully reached migrants in a situation of vulnerability and provided them access to testing and care. The high prevalence observed and the limited self-knowledge of their HBV and HCV status justify targeted screening in these groups.
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Affiliation(s)
- Anna Not
- Genetics and Microbiology DepartmentUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
- Microbiology DepartmentLaboratori Clínic Metropolitana Nord (LCMN), Germans Trias i Pujol Research Institute and Hospital (IGTP)BarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos IIIMadridSpain
| | - Hakima Ouaarab‐Essadek
- Community & Public Health Team (ESPIC), Drassanes‐Vall D'hebron Centre for International Health and Infectious DiseasesBarcelonaSpain
| | - Marcos Montoro
- Centre d'Estudis Epidemiològics Sobre les ITS i la Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPCAT)BarcelonaSpain
| | - Begoña Treviño
- Community & Public Health Team (ESPIC), Drassanes‐Vall D'hebron Centre for International Health and Infectious DiseasesBarcelonaSpain
| | - María Buti
- Hepatology DepartmentHospital Universitari Vall HebrónBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos IIIMadridSpain
| | - Rosa M. Morillas
- Consorcio de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos IIIMadridSpain
- Hepatology UnitHospital Universitari Germans Trias i PujolBarcelonaSpain
| | - Antoni E. Bordoy
- Microbiology DepartmentLaboratori Clínic Metropolitana Nord (LCMN), Germans Trias i Pujol Research Institute and Hospital (IGTP)BarcelonaSpain
| | - Cinta Folch
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos IIIMadridSpain
- Centre d'Estudis Epidemiològics Sobre les ITS i la Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPCAT)BarcelonaSpain
| | - Xavier Majó
- Agència de Salut Pública de CatalunyaBarcelonaSpain
| | - Jordi Casabona
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos IIIMadridSpain
- Centre d'Estudis Epidemiològics Sobre les ITS i la Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPCAT)BarcelonaSpain
| | - Jordi Gómez i Prat
- Community & Public Health Team (ESPIC), Drassanes‐Vall D'hebron Centre for International Health and Infectious DiseasesBarcelonaSpain
| | - Elisa Martró
- Genetics and Microbiology DepartmentUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
- Microbiology DepartmentLaboratori Clínic Metropolitana Nord (LCMN), Germans Trias i Pujol Research Institute and Hospital (IGTP)BarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos IIIMadridSpain
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Cruz A, Sequeira-Aymar E, Gonçalves AQ, Camps-Vila L, Monclús-González MM, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Cuxart-Graell A, Rosa Dalmau Llorca M, Aguilar-Martín C, Requena-Méndez A. Epidemiology of infectious diseases in migrant populations from endemic or high-endemic countries: A multicentric primary care-based study in Spain. Trop Med Int Health 2024; 29:820-832. [PMID: 39031944 DOI: 10.1111/tmi.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVES We aimed to evaluate the epidemiology of seven infections (Chagas disease, strongyloidiasis, schistosomiasis, human immunodeficiency virus, hepatitis B and C virus, and active tuberculosis) in migrant populations attended at primary care facilities in Catalonia, Spain. METHODS This is a cross sectional study conducted from March to December 2018 at eight primary care centres in Catalonia, Spain where health professionals were recommended to systematically screen multiple infections in migrants considering the endemicity of the pathogens in their country of birth. Routine health data were retrospectively extracted from electronic health records of the primary care centres. The proportion of cases among individuals tested for each infection was estimated with its 95% confident interval (CI). Mixed-effects logistics regression models were conducted to assess any possible association between the exposure variables and the primary outcome. RESULTS Out of the 15,780 migrants that attended primary care centres, 2410 individuals were tested for at least one infection. Of the 508 (21.1%) migrants diagnosed with at least one condition, a higher proportion originated from Sub-Saharan Africa (207, 40.7%), followed by South-East Europe (117, 23.0%) and Latin-America (88, 17.3%; p value <0.001). The proportion of migrants diagnosed with Chagas disease was 5/122 (4.1%, 95%CI 0.5-7.7), for strongyloidiasis 56/409 (13.7%, 95%CI 10.3-17.0) and for schistosomiasis 2/101 (2.0%, 95%CI 0.0-4.7) with very few cases tested. The estimated proportion for human immunodeficiency virus was 67/1176 (5.7%, 95%CI 4.4-7.0); 377/1478 (25.5%, 95%CI 23.3-27.7) for hepatitis B virus, with 108/1478 (7.3%, 95%CI 6.0-8.6) of them presenting an active infection, while 31/1433 (2.2%, 95%CI 1.4-2.9) were diagnosed with hepatitis C virus. One case of active tuberculosis was diagnosed after testing 172 migrant patients (0.6%, 95%CI 0.0-1.7). CONCLUSIONS We estimated a high proportion of the studied infections in migrants from endemic areas. Country-specific estimations of the burden of infections in migrants are fundamental for the implementation of preventive interventions.
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Affiliation(s)
- Angeline Cruz
- ISGlobal, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Ethel Sequeira-Aymar
- ISGlobal, Barcelona, Spain
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - Laura Camps-Vila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Catalunya Central, Institut Català de la Salut Carrer Pica d'Estats, Barcelona, Spain
| | | | - Elisa M Revuelta-Muñoz
- Centre d'Atenció Primària Rambla Ferran, Institut Català de la Salut (ICS), Lleida, Spain
| | - Núria Busquet-Solé
- Centre d'Atenció Primària Sagrada Família, Institut Català de la Salut (ICS), Barcelona, Spain
| | | | | | | | - M Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut (ICS), Tarragona, Spain
| | - Carina Aguilar-Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tarragona, Spain
| | - Ana Requena-Méndez
- ISGlobal, Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Coppola N, Alessio L, De Pascalis S, Macera M, Di Caprio G, Messina V, Onorato L, Minichini C, Stanzione M, Stornaiuolo G, Starace M, Monari C, Calò F, Sagnelli C, Pisaturo M. Effectiveness of test-and-treat model with direct-acting antiviral for hepatitis C virus infection in migrants: a prospective interventional study in Italy. Infect Dis Poverty 2024; 13:39. [PMID: 38802954 PMCID: PMC11131219 DOI: 10.1186/s40249-024-01200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Migrants, mainly undocumented and low-income refugees, are at high risk of hepatitis C virus (HCV) infection, but are a difficult-to-reach and to-treat population. The aim of the study was to evaluate the effectiveness of a test and treat model with direct-acting antiviral for HCV infection in these migrants coming from low-income and living in southern Italy. METHODS A prospective, multicenter, collaborative study based on a four-phase-program (educational counseling, screening, linkage-to-care and treatment) was designed in southern Italy; the study started in June 2018, was stopped in February 2020 because of the outbreak of SARS-CoV2 infection in Italy and was resumed in February 2021 until November 2021. After educational counseling on infectious diseases that are transmitted through blood or sexually pseudonymized HCV screening was offered to all undocumented migrants and low-income refugees observed at one of the 1st level clinical centers. The HCV-RNA-positive subjects were referred to one of the 3rd level units of Infectious Diseases (ID) and treated with a 12-week course of sofosbuvir-velpatasvir and observed for 12 weeks after the end of direct antiviral agents (DAA) treatment. STATISTICAL ANALYSIS For the descriptive analysis, the categorical variables were reported as absolute numbers and relative frequencies. Continuous variables were summarized as mean and standard deviation (SD) if normally distributed, or as a median and interquartile range (IQR) if not normally distributed. We used Pearson chi-square or Fisher's exact test for categorical variables and Student's t test or Mann-Whitney test for continuous variables. A P value < 0.05 was considered to be statistically significant. Analyses were performed with SPSS 21.0. RESULTS Of the 3501migrants observed in the study period, 3417 (97.6%) agreed to be screened; 185 (4.7%) were anti-HCV-positive and, of these, 53 (28.6%) were HCV-RNA-positive. Of these 53 subjects, 48 (90.5%) were referred to an ID unit and started DAA treatment. The HCV-RNA-positive-subjects were older [median 36 years (IQR: 32-21) vs 27.19 (IQR: 30.5-19.25); P = 0.001], and less frequently males [35 (66.03 %) vs 119 (90.1%), P < 0 .0001] than seronegative participants. They more frequently came from Eastern Europe (70.8%) stayed longer in Italy [months of stay in Italy, mean ± SD: 51.02 ± 52.84 vs 25.7 ± 42.65, P = 0.001], and had more years of schooling [years of schooling, mean ± SD: 9.61±2.81 vs 7.10 ± 4, P = 0.0001]. HCV-RNA-positive-subjects less frequently reported piercing, tattoos and tribal scars as risk factors (23.6%). Of these 48 HCV RNA positive subjects who started DAA, 47 (97.9%) showed a sustained virological response and one dropped-out in follow-up after DAA treatment. No subject had any adverse event. CONCLUSIONS This model of HCV screening and linkage to care seems effective to eliminate HCV infectionin a difficult-to-reach and to-treat population, such as undocumented migrants and low-income refugees. The participation of cultural mediators in the study made possible a better interaction between migrants and physicians, as is evident from the large number of subjects enrolled. Eliminating HCV among migrants will have a long-term positive impact from a public health and healthcare perspective by reducing the number of individuals who potentially develop HCV-related complications such as liver cirrhosis and hepatocellular carcinoma and reducing the circulation of HCV in the regions that host them which often, as in the case of Italy, are low endemic for HCV infection.
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Affiliation(s)
- Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy
| | - Loredana Alessio
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy
- Medical Center, "Abraham's Tent" Reception Center, Caserta, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Margherita Macera
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy
| | - Giovanni Di Caprio
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Vincenzo Messina
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Lorenzo Onorato
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy
| | - Carmine Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Maria Stanzione
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Gianfranca Stornaiuolo
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Mario Starace
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Caterina Monari
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
| | - Federica Calò
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical Center, Center for the Protection of the Health of Immigrants, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy
- Medical center, Center for the Missionary Sisters of Charity, Naples, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via: L. Armanni 5, 80131, Naples, Italy.
- Medical Center, " Former Canapificio Social Centre ", Caserta, Italy.
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Perez-Molina JA, Cancio-Suárez MR, Moreno S. Is It Time for Treatment as Prevention of Chronic Hepatitis B? Pathogens 2023; 12:1137. [PMID: 37764945 PMCID: PMC10537200 DOI: 10.3390/pathogens12091137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Hepatitis B is a major global health problem with high morbidity and mortality. Approximately 296 million people are living with chronic HBV, and 1.5 million new infections are detected each year, even though a highly effective vaccine has been available for decades and viral replication and transmission can be contained with the use of drugs. Nucleoside therapy, while not curative in most cases, can control viral replication, improve prognosis, and prevent mother-to-child transmission safely. Current treatment guidelines do not include a significant number of chronically infected patients or pregnant women and are often complex to implement. Since these populations continue to have a detectable HVB viral load, they could perpetuate transmission. Expanding and facilitating treatment indications, including treatment as a public health intervention, could help control the spread of the HBV pandemic, thus bringing us closer to the goal of the United Nations General Assembly for the year 2030.
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Affiliation(s)
- Jose A. Perez-Molina
- National Reference Centre for Tropical Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain; (M.R.C.-S.); (S.M.)
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Marta Rosas Cancio-Suárez
- IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain; (M.R.C.-S.); (S.M.)
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Medicine, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Santiago Moreno
- IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain; (M.R.C.-S.); (S.M.)
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Medicine, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
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Stroffolini T, Stroffolini G. Five Decades of HBV Infection in Italy: A Continuous Challenge. BIOLOGY 2023; 12:1075. [PMID: 37626961 PMCID: PMC10451692 DOI: 10.3390/biology12081075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
In Italy, Hepatitis B virus (HBV) infection has been characterized by several changes over the last five decades. In 2019, the incidence of acute HBV among subjects targeted by the vaccination campaign was 0 cases in the age group 0-14 years and 0.1/100,000 in the age group 15-24. Nowadays, the burden of different stages of HBV-related chronic liver diseases is minimal. Intravenous drug use is no longer a risk factor (O.R. 0.7; 95% C.I. 0.5-1.02) for acquiring acute HBV; the proportion of cases reporting this exposure fell from 29.8% to 3.3% over the last two decades. The key public health intervention has been the compulsory vaccination campaign started in 1991 for infants 3 months old and 1-2 years old (the latter group for the first 12 years of the campaign). Moreover, non-immunogenic factors and the availability of effective oral antiviral drugs have played and continue to play a prominent role. The potential availability of new oral antiviral drugs with the inherent ability to eliminate the genomic HBV reservoirs may represent a further crucial step in the elimination of the virus in people that are already infected.
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Affiliation(s)
- Tommaso Stroffolini
- Department of Tropical and Infectious Diseases, Policlinico Umberto I, 00186 Rome, Italy;
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni, 5, Negrar, 37024 Verona, Italy
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Ricco G, Coco B, Colombatto P, Oliveri F, Cavallone D, Bleve P, Vianello B, Romagnoli V, Salvati A, Surace L, Bonino F, Brunetto MR. Highly dynamic changes of regional HBV epidemiology over two decades. Dig Liver Dis 2023; 55:519-526. [PMID: 36404234 DOI: 10.1016/j.dld.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIM HBV epidemiology is highly heterogeneous and rapidly evolving worldwide: we studied its last two-decades dynamics in a large single center cohort. METHODS In all consecutive HBsAg-positive subjects firstly admitted (2000-2019) at the Pisa-University-Hospital Hepatology-Referral-Center, demographic, virologic and clinical variables were analyzed by admission decade (2000-2009 vs 2010-2019) and origin (Italian vs non-Italian natives). RESULTS Of 2003, 1878 (93.7%) subjects were eligible: 1798(95.7%) with HBV-chronic [126(7%) HDV, 72(4%) HCV, 11(0.6%) HIV co-infected] and 80(4.3%) HBV-primary infections (93.7% Italians). Among 1589(88.4%) mono-infected, 496(31.2%) were immigrants, younger than Italians [34.0(5.1-77.1)-52.5(10.0-87.2) years], with female prevalence [204/496(41.1%)-340/1093(31.1%); p<0.001] increasing overtime (14.6-45.0%; p<0.001). Italians aged across decades [50.3(11.1-87.2)-56.2(10.0-86.7) years; p<0.001], HBeAg-positivity remained stable (12.3-14.5%) and acute hepatitis increased (4.0-8.0%; p = 0.003). CHB declined [439/721(60.9%)-320/868(36.9%); p<0.001] whereas HBeAg-negative infection increased [277/626(44.2%)-538/755(71.3%); p<0.001]. Cirrhosis declined [195/721(27.0%)-125/868(14.4%); p<0.001], except in anti-HDV-patients [93/126(73.8%); 42(45.1%) non-Italians], younger than HBV-mono-infected (47.4-57.6 years; p<0.001). CONCLUSION Effective preventive health care policies and immigration flows account for increasing prevalence of HBeAg-negative infection across the last two decades. Antiviral therapy mitigated disease progression in aging Italian CHB but not in CHD patients, mainly young immigrants, emphasizing the unmet need of effective CHD therapies; HBeAg-positive CHB and acute hepatitis B persist in non-vaccinated Italian adults, prompting vaccination in the elderly with risky behaviors.
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Affiliation(s)
- Gabriele Ricco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Barbara Coco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Piero Colombatto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Filippo Oliveri
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Daniela Cavallone
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Patrizia Bleve
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Barbara Vianello
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Veronica Romagnoli
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Antonio Salvati
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Lidia Surace
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging, National Research Council, Via De Amicis 95, 80145 Naples, Italy
| | - Maurizia Rossana Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Reference Center of the Tuscany Region for Chronic Liver Disease and Cancer, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy; Institute of Biostructure and Bioimaging, National Research Council, Via De Amicis 95, 80145 Naples, Italy.
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Sagnelli C, Sica A, Creta M, Calogero A, Ciccozzi M, Sagnelli E. Epidemiological and clinical aspects of hepatitis B virus infection in Italy over the last 50 years. World J Gastroenterol 2022; 28:3081-3091. [PMID: 36051347 PMCID: PMC9331523 DOI: 10.3748/wjg.v28.i26.3081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
A relevant gradual reduction of both the incidence rate of acute hepatitis B (AHB) and prevalence of chronic hepatitis B has occurred in Italy in the last 50 years, due to substantial epidemiological changes: Improvement in socioeconomic and hygienic conditions, reduction of the family unit, accurate screening of blood donations, abolition of re-usable glass syringes, hepatitis B virus (HBV)-universal vaccination started in 1991, use of effective well tolerated nucleo(t)side analogues able to suppress HBV replication available from 1998, and educational mediatic campaigns against human immunodeficiency virus infection focusing on the prevention of sexual and parenteral transmission of infections. As an example, AHB incidence has gradually decreased from 10/100000 inhabitants in 1985 to 0.21 in 2020. Unfortunately, the coronavirus disease 2019 (COVID-19) pandemic has interrupted the trend towards HBV eradication. In fact, several HBV chronic carriers living in the countryside have become unable to access healthcare facilities for screening, diagnosis, clinical management, and nucleo(t)side analogue therapy in the COVID-19 pandemic, mainly for anxiety of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), movement restrictions, and reduced gains from job loss. In addition, one-third of healthcare facilities and personnel for HBV patients have been devolved to the COVID-19 assistance.
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Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples 80138, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences-UO General Surgery, University Federico II of Naples, Naples 80127, Italy
| | - Massimo Ciccozzi
- Medical Statistics and Molecular Epidemiology Unit, Campus Bio-Medico University, Rome 80138, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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Klok S, van Dulm E, Boyd A, Generaal E, Eskander S, Joore IK, van Cleef B, Siedenburg E, Bruisten S, van Duijnhoven Y, Tramper-Stranders G, Prins M. Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infections among undocumented migrants and uninsured legal residents in the Netherlands: A cross-sectional study, 2018-2019. PLoS One 2021; 16:e0258932. [PMID: 34714867 PMCID: PMC8555813 DOI: 10.1371/journal.pone.0258932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Migrants are not routinely screened for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in the Netherlands. We estimated the prevalence and determined factors associated with HBV, HCV and/or HIV infections among undocumented migrants and uninsured legal residents. METHODS In this cross-sectional study, undocumented migrants and uninsured legal residents were recruited at a non governmental organization (NGO), healthcare facility in the Netherlands and were invited to be tested for hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibodies (anti-HBcAb), HCV-RNA, and anti-HIV antibodies or HIV antigen at a local laboratory. RESULTS Of the 1376 patients invited, 784 (57%) participated. Participants originated from Africa (35%), Asia (30%) and North/South America (30%). 451/784 (58%) participants went to the laboratory for testing. Of participants 30% were HBV exposed (anti-HBcAb-positive), with 27% (n = 119/438, 95% CI 23.1% to 31.6%) having resolved HBV infection (HBsAg-negative) and 2.5% (n = 11/438, 95%CI 1.3% to 4.5%, 64% new infection) having chronic HBV infection (HBsAg-positive). Compared to HBV non-exposed, HBV exposed individuals were older (p = 0.034) and more often originated from Africa (p<0.001). Prevalence of chronic HCV infection (HCV-RNA-positive) was 0.7% (n = 3/435, 95%CI 0.1% to 2.0%, all new infections) and HIV infection 1.1% (n = 5/439, 95%CI 0.04% to 2.6%, 40% new infection). CONCLUSION Prevalence of chronic HBV, chronic HCV and HIV infections in our study population is higher compared to the Dutch population, thus emphasizing the importance of case finding for these infections through primary care and public health in this specific group of migrants. Screening uptake could be improved by on-site testing.
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Affiliation(s)
- Sarineke Klok
- NGO health care clinic Kruispost, Amsterdam, The Netherlands
| | - Eline van Dulm
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Ellen Generaal
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Sally Eskander
- NGO health care clinic Kruispost, Amsterdam, The Netherlands
| | - Ivo Kim Joore
- Department of Infectious Diseases, Public Health Service Flevoland, Lelystad, The Netherlands
| | - Brigitte van Cleef
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Evelien Siedenburg
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Sylvia Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Yvonne van Duijnhoven
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
| | - Gerdien Tramper-Stranders
- NGO health care clinic Kruispost, Amsterdam, The Netherlands
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service Amsterdam (GGD), Amsterdam, The Netherlands
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, Univ. of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, Univ. of Amsterdam, Amsterdam, the Netherlands
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Prevalence and associated risk factors for hepatitis B and C viruses among refugee populations living in Mahama, Rwanda: A cross-sectional study. PLoS One 2021; 16:e0257917. [PMID: 34634039 PMCID: PMC8504757 DOI: 10.1371/journal.pone.0257917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION As part of the integration of refugees into Rwanda's national hepatitis C elimination agenda, a mass screening campaign for hepatitis B (HBV) and hepatitis C (HCV) was conducted among Burundian refugees living in Mahama Camp, Eastern Rwanda. This cross-sectional survey used data from the screening campaign to report on the epidemiology of viral hepatitis in this setting. METHODS Rapid diagnostic tests (RDTs) were used to screen for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) among people of ≥15years old. We calculated seroprevalence for HBsAg and anti-HCV by age and sex and also calculated age-and-sex adjusted risk ratios (ARR) for other possible risk factors. RESULTS Of the 26,498 screened refugees, 1,006 (3.8%) and 297 (1.1%) tested positive for HBsAg and Anti-HCV, respectively. HBsAg was more prevalent among men than women and most common among people 25-54 years old. Anti-HCV prevalence increased with age group with no difference between sexes. After adjusting for age and sex, having a household contact with HBsAg was associated with 1.59 times higher risk of having HBsAg (95% CI: 1.27, 1.99) and having a household contact with anti-HCV was associated with 3.66 times higher risk of Anti-HCV (95% CI: 2.26, 5.93). Self-reporting having HBV, HCV, liver disease, or previously screened for HBV and HCV were significantly associated with both HBsAg and anti-HCV, but RDT-confirmed HBsAg and anti-HCV statuses were not associated with each other. Other risk factors for HBsAg included diabetes (ARR = 1.97, 95% CI: 1.08, 3.59) and family history of hepatitis B (ARR = 1.32, 95% CI: 1.11, 1.56) and for anti-HCV included heart disease (ARR = 1.91, 95% CI: 1.30, 2.80) and history of surgery (ARR = 1.70, 95% CI: 1.24, 2.32). CONCLUSION Sero-prevalence and risks factors for hepatitis B and C among Burundian were comparable to that in the Rwandan general population. Contact tracing among household members of identified HBsAg and anti-HCV infected case may be an effective approach to targeted hepatitis screening given the high risk among self-reported cases. Expanded access to voluntary testing may be needed to improve access to hepatitis treatment and care in other refugee settings.
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Noninvasive Evaluation of Liver Fibrosis in a Sample of Putative Inactive HBV Carriers in Rome, Italy. ACTA ACUST UNITED AC 2021; 2021:3068690. [PMID: 34426755 PMCID: PMC8380153 DOI: 10.1155/2021/3068690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022]
Abstract
Background Noninvasive methods are useful for investigating patients with chronic HBV infection. The severity of liver disease in inactive HBsAg carriers can be noninvasively assessed by transient elastography (TE) alone or in association with biochemical markers of fibrosis. Objectives The study evaluates the effectiveness of the TE compared to common fibrosis scores (FSs), APRI, Forns Index, and FIB4, for identifying significant fibrosis in Italian and foreigner HBsAg carriers. To investigate the risk of progression of the liver disease, liver stiffness (LS) and HBV-DNA were monitored over time. Methods Viral load, biochemical parameters, and LS have been retrospectively evaluated in 125 putative inactive HBV carriers, who visited two outpatient departments (Colleferro Hospital and INMP) from 01/03/2014 to 31/12/2019. Differences in clinical, biochemical, and demographic variables between Italians and foreigners were analyzed. 66 of 125 patients were followed up for 24 months by monitoring liver stiffness and HBV-DNA. Results Mean overall LS was 5.55 ± 1.92 kPa; 18 (14.4%) patients had a LS ≥7.5 kPa. Mean of APRI, Forns, and FIB4 was 0.29 ± 0.11, 4.15 ± 1.63, and 1.16 ± 0.59, respectively. FS did not differ between the patients with LS <7.5 kPa and those with LS ≥7.5 kPa. Italians displayed a significant lower ALT (0.53 ± 0.18 vs. 0.67 ± 0.33, p < 0.05) and AST (0.59 ± 0.16 vs. 0.70 ± 0.21, p < 0.01) value than foreigners. No differences in LS and HBV-DNA levels were observed. In 66 patients followed up for 24 months, HBV-DNA increased by ≥2000 UI/ml after 12 months in 15 individuals and remained ≥2000 UI/ml after 24 months in 10/15 individuals. 7/10 patients showed LS ≥ 7.5 kPa after 24 months, and 4 of them underwent antiviral therapy for HBV. Patients with HBV-DNA <2000 IU/ml had a significantly lower LS than those with HBV-DNA ≥2000 IU/ml (5.30 ± 1.43 vs. 7.69 ± 1.07, p < 0.0001). Conclusions Analysis shows lower effectiveness of FS vs. TE in the assessment of putative inactive HBV carriers. Furthermore, using FibroScan® and HBV-DNA can identify “false” inactive carriers.
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Charania NA, Gaze N, Kung JY, Brooks S. Interventions to reduce the burden of vaccine-preventable diseases among migrants and refugees worldwide: A scoping review of published literature, 2006-2018. Vaccine 2020; 38:7217-7225. [PMID: 33008670 DOI: 10.1016/j.vaccine.2020.09.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/21/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Disparities in vaccine-preventable disease (VPD) burden and immunisation coverage between migrants and refugees and their host populations have been described in numerous countries worldwide. Effective strategies are required to reduce the health disparities and immunisation inequities experienced by migrants and refugees. METHODS Using Arksey and O'Malley's framework, we conducted a scoping review to identify available literature on interventions aimed at reducing VPD burden among migrants and refugees worldwide. We searched for relevant empirical, peer-reviewed literature published in English between 2006 and 2018 using MEDLINE, Ovid EMBASE, CINAHL, Sociological Abstracts, and Web of Science databases. Relevant information from the studies, including intervention type, details and outcomes, were charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Seventy studies met the inclusion criteria. The number of published studies increased over the years. The majority of studies were conducted in high-income countries. More studies were conducted among migrants (not including refugees) (n = 48, 66%) than specifically among refugees (n = 25, 34%). Interventions were implemented in a variety of settings, including health care (n = 31, 42%), community (n = 29, 39%), off-shore (n = 7, 9%), national (n = 4, 5%), school (n = 2, 3%), and workplace (n = 1, 1%). Studies reported interventions focused at the individual (to facilitate uptake of health services) (n = 4, 5%), community (to raise awareness) (n = 25, 34%), provider (to offer health services) (n = 12, 16%) and/or system (to increase compliance with recommendations) (n = 33, 45%) level. To be effective, interventions were designed to overcome commonly identified barriers to accessing services related to language, culture, distance and cost. Engagement with community members and organisations was an effective way to co-design interventions that address migrants' specific needs. CONCLUSIONS Studies emphasised the importance of interventions that address the heterogeneity within and between migrant and refugee populations. Considerable variation in practice remains, therefore more evaluation of interventions is needed to inform policy and programme decision-making.
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Affiliation(s)
- Nadia A Charania
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand.
| | - Nina Gaze
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland 2025, New Zealand
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta, 2K3.28 Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta T6G 2E1, Canada
| | - Stephanie Brooks
- Department of Pediatrics, University of Alberta, 116 Street and 85 Avenue, Edmonton, Alberta T6G 2R3, Canada
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Marrone R, Baglio G, Bruscino G, Costanzo G, Cavani A, Mirisola C. Prevalence of latent tuberculosis infection, hepatitis B, hepatitis C, and syphilis among newly arrived unaccompanied minors living in reception centers in Rome. Int J Infect Dis 2020; 101:126-130. [PMID: 32947054 DOI: 10.1016/j.ijid.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to address the prevalence of infectious diseases in a population of unaccompanied immigrant minors living in reception centres of Rome, Italy. METHODS The study was carried out from January 2013 to January 2019. All unaccompanied immigrant minors were screened for hepatitis B, hepatitis C, syphilis and latent tuberculosis infection. RESULTS A total of 879 unaccompanied immigrant minors, 858 males and 21 females, aged 13-18 years old were studied. Of these, 615 were from Africa, 179 from Asia and 84 from Eastern Europe. A low prevalence of HBsAg carriage (2.5%) was observed as was very low prevalence of hepatitis C (0.72%) and latent syphilis (0.4%); latent tuberculosis, defined as tuberculin skin test (TST)+ X-ray case, was diagnosed in 102 (12%) minors. CONCLUSIONS Similar to previous studies, these data demonstrate that migrant minors are generally healthy. However, given the relatively high prevalence of hepatitis B and latent tuberculosis, systematic screening for these diseases among immigrant minors immigrants is highly recommended for early detection and treatment of potentially transmissible diseases.
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Affiliation(s)
- Rosalia Marrone
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Giovanni Baglio
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | - Giusy Bruscino
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
| | | | - Andrea Cavani
- National Institute for Health Migration and Poverty (INMP), Rome, Italy.
| | - Concetta Mirisola
- National Institute for Health Migration and Poverty (INMP), Rome, Italy
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13
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van Dulm E, Klok S, Boyd A, Joore IK, Prins M, van Dam AP, Tramper-Stranders GA, van Duijnhoven YTHP. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among undocumented migrants and uninsured legal residents in Amsterdam, the Netherlands: a cross-sectional study. Antimicrob Resist Infect Control 2020; 9:118. [PMID: 32727560 PMCID: PMC7391596 DOI: 10.1186/s13756-020-00785-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased risk of infection. Colonization with MRSA is observed in < 1% of the general Dutch population. Increased risk for MRSA carriage is known to occur in several key groups, one of which is asylum seekers. However, little is known about MRSA carriage among undocumented migrants and uninsured legal residents. This study aimed to determine the prevalence of nasal MRSA carriage among these groups in Amsterdam, the Netherlands. METHODS In this cross-sectional study, between October 2018 and October 2019, undocumented migrants and uninsured legal residents aged 18 years or older who were able to understand one of the study languages were recruited at an NGO health care facility in Amsterdam, the Netherlands, for general practitioner (GP) consultations. Participants were asked questions on demographics, migration history, antibiotic use and other possible risk factors for MRSA carriage and were screened for nasal MRSA carriage by selective culturing e-swabs. Characteristics of MRSA-negative and MRSA-positive participants were compared using univariable logistic regression analysis with Firth's correction. RESULTS Of the 3822 eligible patients, 760 were screened for nasal MRSA carriage (19.9%). Of the 760 participants, over half were male (58%; 442/760) and originated mainly from Africa (35%; 267/760), Asia (30%; 229/760) and North or South America (30%; 227/760). In total, 705/760 participants (93%) were undocumented migrants and 55/760 (7%) were uninsured legal residents of Amsterdam. The overall prevalence of nasal MRSA carriage was 2.0% (15/760) (95%CI 1.1 to 3.2%), with no difference between undocumented migrants (14/705) (2.0, 95%CI 1.1 to 3.3%) and uninsured legal residents (1/55) (1.8, 95%CI 0.1 to 9.7%). Genotyping showed no clustering of the 15 isolates. MRSA carriage was not associated with sociodemographic, migration history or other possible risk factors. Nevertheless, this study had limited power to detect significant determinants. Three participants (3/15; 20%) harbored Panton-Valentine leukocidin (PVL)-positive isolates. CONCLUSION Even though our study population of undocumented migrants and uninsured legal residents had a higher prevalence of nasal MRSA carriage compared to the general Dutch population, the prevalence was relatively low compared to acknowledged other high-risk groups.
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Affiliation(s)
- E van Dulm
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.
| | - S Klok
- NGO health care clinic Kruispost, Amsterdam, the Netherlands
| | - A Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - I K Joore
- Department of Infectious Diseases, Public Health Service Flevoland, Lelystad, the Netherlands
| | - M Prins
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Amsterdam, the Netherlands
| | - A P van Dam
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands.,Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Y T H P van Duijnhoven
- Department of Infectious Diseases, Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018WT, Amsterdam, the Netherlands
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Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996-2016. Confl Health 2020; 14:49. [PMID: 32704307 PMCID: PMC7374653 DOI: 10.1186/s13031-020-00295-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background The United Nations Refugee Agency (UNHCR) estimates the number of forcibly displaced people increased from 22.7 million people in 1996 to 67.7 million people in 2016. Human mobility is associated with the introduction of infectious disease pathogens. The aim of this study was to describe the range of pathogens in forcibly displaced populations over time using an informal event monitoring system. Methods We conducted a retrospective analysis of ProMED, a digital disease monitoring system, to identify reports of outbreak events involving forcibly displaced populations between 1996 and 2016. Number of outbreak events per year was tabulated. Each record was assessed to determine outbreak location, pathogen, origin of persons implicated in the outbreak, and suspected versus confirmed case counts. Results One hundred twenty-eight independent outbreak events involving forcibly displaced populations were identified. Over 840,000 confirmed or suspected cases of infectious diseases such as measles, cholera, cutaneous leishmaniasis, dengue, and others were reported in 48 destination countries/territories. The average rate of outbreak events concerning forcibly displaced persons per total number of reports published on ProMED per year increased over time. The majority of outbreak events (63%) were due to acquisition of disease in the destination country. Conclusion This study found that reports of outbreak events involving forcibly displaced populations have increased in ProMED. The events and outbreaks detected in this retrospective review underscore the importance of capturing displaced populations in surveillance systems for rapid detection and response.
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Thijssen M, Lemey P, Amini-Bavil-Olyaee S, Dellicour S, Alavian SM, Tacke F, Verslype C, Nevens F, Pourkarim MR. Mass migration to Europe: an opportunity for elimination of hepatitis B virus? Lancet Gastroenterol Hepatol 2020; 4:315-323. [PMID: 30860067 DOI: 10.1016/s2468-1253(19)30014-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 02/07/2023]
Abstract
People from low-to-middle income countries have been migrating to western Europe on a large scale in recent years. Data indicate that the number of first-time asylum applications by non-EU members increased from 290 000 in 2011 to more than 1·3 million in 2015. During the peak period of migration, The Global Health Sector Strategy on Viral Hepatitis was adopted by WHO. Viral hepatitis, and particularly hepatitis B virus (HBV), is an important disease because of its high prevalence and associated mortality. In some cases, HBV can be carried by refugees arriving from regions of high and intermediate prevalence. Refugees with HBV might not show clinical symptoms and not be diagnosed in destination countries with a low prevalence, where screening is not regularly done. Although transmission to the host population is low, dedicated surveillance and tailored public health policies are required. It is important to note that some of the countries that receive many migrants do not have a universal HBV vaccination programme. In this Viewpoint, we argue that the current large-scale movement from regions with high or intermediate HBV prevalence should be taken as an opportunity to achieve viral hepatitis elimination targets, by establishing a well prepared infrastructure for HBV screening, vaccination, and treatment.
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Affiliation(s)
- Marijn Thijssen
- Department of Microbiology and Immunology, Rega Institute, Laboratory of Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium
| | - Philippe Lemey
- Laboratory of Evolutionary and Computational Virology, KU Leuven, Leuven, Belgium
| | | | - Simon Dellicour
- Laboratory of Evolutionary and Computational Virology, KU Leuven, Leuven, Belgium; Spatial Epidemiology Lab, Université Libre de Bruxelles, Brussels, Belgium
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Frank Tacke
- Department of Medicine III, Rheinisch-Westfälische Technische Hochschule-University Hospital Aachen, Aachen, Germany
| | - Chris Verslype
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Leuven Belgium
| | - Mahmoud Reza Pourkarim
- Department of Microbiology and Immunology, Rega Institute, Laboratory of Clinical and Epidemiological Virology, KU Leuven, Leuven, Belgium; Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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Coppola N, Monari C, Alessio L, Onorato L, Gualdieri L, Sagnelli C, Minichini C, Sagnelli E, Di Caprio G, Surace L, Scotto G, Macera M, Griffo G, Angelillo IF, Pisaturo M. Blood-borne chronic viral infections in a large cohort of immigrants in southern Italy: A seven-centre, prospective, screening study. Travel Med Infect Dis 2020; 35:101551. [PMID: 31945499 DOI: 10.1016/j.tmaid.2020.101551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Aim of this study was to evaluate the prevalence of blood-borne chronic viral infections in immigrants living in southern Italy and identify factors associated to viral infections. METHODS A prospective screening program was performed in seven clinical centers operating in Campania, Apulia and Calabria regions in southern Italy, in order to identify immigrants with HBV, HCV or HIV infections. RESULTS Of 4,125 immigrants observed in the study period, 3,839 (93.0%) agreed to be screened: 381 (9.9%) resulted HBsAg-positive, 136 (3.5%) anti-HCV, 62 (1.6%) anti-HIV and 1,448 (37.7%) HBsAg-negative and anti-HBc-positive. Ongoing or previous HBV infection was observed more frequently in males (p = 0.02 and p < 0.001, respectively), whereas HIV infection in females (p = 0.01). Immigrants from western Africa showed a higher rate of HBsAg positivity (p < 0.0001), HBsAg negativity/anti-HBc positivity (p < 0.0001) and anti-HIV positivity (p = 0.004) compared with those from other geographical areas. At multivariate analysis, ongoing HBV infection was associated with male sex (OR 1.49, 95% CI: 1.04-2.14) and origin from western Africa (OR 4.67, 95% CI: 1.70-12.80) and eastern Europe (OR 3.44, 95% CI: 1.17-10.08). HCV infection showed the tendency to be more frequent among males (OR 1.84, 95% CI: 0.99-3.42). HIV infection was associated with an older age (OR 1.04, 95% CI: 1.01-1.06), origin from western Africa (OR 4.09, 95% CI: 1.26-13.29) and female sex (OR 2.38, 95% CI: 1.29-4,39; p = 0.006). CONCLUSIONS The high prevalence of HBV, HCV and HIV infections in our large cohort of immigrants should definitively prompt Italian Healthcare Authorities to develop adequate cost-effective screening policies.
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Affiliation(s)
- Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.
| | - Caterina Monari
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Loredana Alessio
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy; Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
| | - Lorenzo Onorato
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Luciano Gualdieri
- Medical Center, Centro per la Tutela della Salute degli Immigrati, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Medical Center, Centro Suore Missionarie della Carità, Naples, Italy
| | - Carmine Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy
| | - Giovanni Di Caprio
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy; Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
| | - Lorenzo Surace
- Centro Medicina del Viaggiatore e delle Migrazioni ASP Catanzaro, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | | | - Margherita Macera
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
| | - Gianfranco Griffo
- Centro Medicina del Viaggiatore e delle Migrazioni ASP Catanzaro, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | | | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Italy; Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
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17
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Mason LMK, Veldhuijzen IK, Duffell E, van Ahee A, Bunge EM, Amato‐Gauci AJ, Tavoschi L. Hepatitis B and C testing strategies in healthcare and community settings in the EU/EEA: A systematic review. J Viral Hepat 2019; 26:1431-1453. [PMID: 31332919 PMCID: PMC6899601 DOI: 10.1111/jvh.13182] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023]
Abstract
An estimated 9 million individuals are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV) across the European Union/European Economic Area (EU/EEA), many of which are yet to be diagnosed. We performed a systematic review to identify interventions effective at improving testing offer and uptake in the EU/EEA. Original research articles published between 1 January 2008 and 1 September 2017 were retrieved from PubMed and EMBASE. Search strings combined terms for HBV/HCV, intervention, testing and geographic terms (EU/EEA). Out of 8331 records retrieved, 93 studies were selected. Included studies reported on testing initiatives in primary health care (9), hospital (12), other healthcare settings (31) and community settings (41). Testing initiatives targeted population groups such as migrants, drug users, prisoners, pregnant women and the general population. Testing targeted to populations at higher risk yielded high coverage rates in many settings. Implementation of novel testing approaches, including dried blood spot (DBS) testing, was associated with increased coverage in several settings including drug services, pharmacies and STI clinics. Community-based testing services were effective in reaching populations at higher risk for infection, vulnerable and hard-to-reach populations. In conclusion, our review identified several successful testing approaches implemented in healthcare and community settings, including testing approaches targeting groups at higher risk, community-based testing services and DBS testing. Combining a diverse set of testing opportunities within national testing strategies may lead to higher impact both in terms of testing coverage and in terms of reduction, on the undiagnosed fraction.
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Affiliation(s)
| | - Irene K. Veldhuijzen
- The Netherlands National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and ControlStockholmSweden
| | - Ayla van Ahee
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | - Eveline M. Bunge
- Pallas Health Research and Consultancy B.V.RotterdamThe Netherlands
| | | | - Lara Tavoschi
- European Centre for Disease Prevention and ControlStockholmSweden
- Present address:
University of PisaPisaItaly
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18
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Buonfrate D, Gobbi F, Marchese V, Postiglione C, Badona Monteiro G, Giorli G, Napoletano G, Bisoffi Z. Extended screening for infectious diseases among newly-arrived asylum seekers from Africa and Asia, Verona province, Italy, April 2014 to June 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29692316 PMCID: PMC5915973 DOI: 10.2807/1560-7917.es.2018.23.16.17-00527] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Management of health issues presented by newly-arrived migrants is often limited to communicable diseases even though other health issues may be more prevalent. We report the results of infectious disease screening proposed to 462 recently-arrived asylum seekers over 14 years of age in Verona province between April 2014 and June 2015. Methods: Screening for latent tuberculosis (TB) was performed via tuberculin skin test (TST) and/or QuantiFERON-TB Gold in-tube assay and/or chest X-ray. An ELISA was used to screen for syphilis. Stool microscopy was used to screen for helminthic infections, and serology was also used for strongyloidiasis and schistosomiasis. Screening for the latter also included urine filtration and microscopy. Results: Most individuals came from sub-Saharan Africa (77.5%), with others coming from Asia (21.0%) and North Africa (1.5%). The prevalence of viral diseases/markers of human immunodeficiency virus (HIV) infection was 1.3%, HCV infection was 0.85% and hepatitis B virus surface antigen was 11.6%. Serological tests for syphilis were positive in 3.7% of individuals. Of 125 individuals screened for TB via the TST, 44.8% were positive and of 118 screened via the assay, 44.0% were positive. Of 458 individuals tested for strongyloidiasis, 91 (19.9%) were positive, and 76 of 358 (21.2%) individuals from sub-Saharan Africa were positive for schistosomiasis. Conclusions: The screening of viral diseases is questionable because of low prevalence and/or long-term, expensive treatments. For opposing reasons, helminthic infections are probably worth to be targeted by screening strategies in asylum seekers of selected countries of origin.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Federico Gobbi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Valentina Marchese
- University Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.,Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Chiara Postiglione
- Prevention Department, Unità Locale Socio Sanitaria (ULSS) 9, Verona, Italy
| | | | - Giovanni Giorli
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | | | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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19
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Sagnelli C, Sagnelli E. Towards the worldwide eradication of hepatitis B virus infection: A combination of prophylactic and therapeutic factors. World J Clin Infect Dis 2019; 9:11-22. [DOI: 10.5495/wjcid.v9.i2.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples 80131, Italy
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20
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Ackermann N, Marosevic D, Hörmansdorfer S, Eberle U, Rieder G, Treis B, Berger A, Bischoff H, Bengs K, Konrad R, Hautmann W, Schönberger K, Belting A, Schlenk G, Margos G, Hoch M, Pürner F, Fingerle V, Liebl B, Sing A. Screening for infectious diseases among newly arrived asylum seekers, Bavaria, Germany, 2015. ACTA ACUST UNITED AC 2019. [PMID: 29536830 PMCID: PMC5850590 DOI: 10.2807/1560-7917.es.2018.23.10.17-00176] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and aimAs a consequence of socioeconomic and political crises in many parts of the world, many European Union/European Economic Area (EU/EEA) countries have faced an increasing number of migrants. In the German federal state of Bavaria, a mandatory health screening approach is implemented, where individuals applying for asylum have to undergo a medical examination that includes serological testing for HIV and hepatitis B, screening for tuberculosis, and until September 2015, stool examination for Salmonella spp. and Shigella spp.. Methods: Data from mandatory screening of all first-time asylum seekers in Bavaria in 2015 was extracted from the mandatory notification and laboratory information system and evaluated. Results: The HIV positivity and hepatitis B surface antigen (HBsAg) positivity rate of tested samples from asylum seekers were 0.3% and 3.3%, respectively, while detection rate of active tuberculosis was between 0.22% and 0.38%. The rates for HIV, hepatitis B, and tuberculosis among asylum seekers were similar to the corresponding prevalence rates in most of their respective countries of birth. Only 47 Salmonella spp. (0.1%) were isolated from stool samples: 45 enteric and two typhoid serovars. Beyond mandatory screening, louse-borne relapsing fever was found in 40 individuals. Conclusions: These results show that mandatory screening during 2015 in Bavaria yielded overall low positivity rates for all tested infectious diseases in asylum seekers. A focus of mandatory screening on specific diseases in asylum seekers originating from countries with higher prevalence of those diseases could facilitate early diagnosis and provision of treatment to affected individuals while saving resources.
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Affiliation(s)
- Nikolaus Ackermann
- These authors contributed equally to the paper.,LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Durdica Marosevic
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,These authors contributed equally to the paper.,LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Stefan Hörmansdorfer
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Ute Eberle
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Gabriele Rieder
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Bianca Treis
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Anja Berger
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Heribert Bischoff
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Katja Bengs
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Regina Konrad
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Wolfgang Hautmann
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Katharina Schönberger
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Anne Belting
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Gisela Schlenk
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Gabriele Margos
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Martin Hoch
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Friedrich Pürner
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Volker Fingerle
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Bernhard Liebl
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
| | - Andreas Sing
- LGL Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit Oberschleißheim, Oberschleißheim, Germany
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21
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Greenaway C, Castelli F. Infectious diseases at different stages of migration: an expert review. J Travel Med 2019; 26:5307656. [PMID: 30726941 DOI: 10.1093/jtm/taz007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Human migration is increasing in magnitude and scope. The majority of migrants arriving in high-income countries originate from countries with a high prevalence of infectious diseases. The risk and burden of infectious diseases are not equally distributed among migrant groups and vary with migration stage. METHODS A broad literature review was conducted on the drivers for infectious diseases and associated health outcomes among migrants across different stages of migration. The aim was to provide practitioners with an overview of the key infectious disease risks at each stage to guide health promotion strategies. RESULTS A complex interaction of factors leads to infectious diseases and associated poor health outcomes among migrants. The most important drivers are the epidemiology of infectious diseases in their countries of origin, the circumstances and conditions of the migration journey and barriers accessing healthcare post-arrival. During the recent large waves of forced migration into Europe, the primary health concerns on arrival were psychological, traumatic and chronic non-communicable diseases. In the early settlement period, crowded and unhygienic living conditions in reception camps facilitated outbreaks of respiratory, gastrointestinal, skin infections and vaccine preventable diseases. After re-settlement, undetected and untreated latent infections due to tuberculosis, viral hepatitis, HIV, chronic helminthiasis and Chagas' disease led to poor health outcomes. Migrants are disproportionally affected by preventable travel-related diseases such as malaria, typhoid and hepatitis due to poor uptake of pre-travel prophylaxis and vaccination. Infectious diseases among migrants can be decreased at all migration stages with health promotion strategies adapted to their specific needs and delivered in a linguistically and culturally sensitive manner. CONCLUSIONS Tailored health promotion and screening approaches and accessible and responsive health systems, regardless of legal status, will be needed at all migration stages to limit the burden and transmission of infectious diseases in the migrant population.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada.,JD MacLean Centre for Tropical Diseases at McGill, McGill University Health Centre, McGill University, Montreal, Canada
| | - Francesco Castelli
- JD MacLean Centre for Tropical Diseases at McGill, McGill University Health Centre, McGill University, Montreal, Canada.,University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy.,UNESCO Chair 'Training and Empowering Human Resources for Health Development in Resource-Limited Countries', University of Brescia, Brescia, Italy
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22
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Myran DT, Morton R, Biggs BA, Veldhuijzen I, Castelli F, Tran A, Staub LP, Agbata E, Rahman P, Pareek M, Noori T, Pottie K. The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091898. [PMID: 30200406 PMCID: PMC6164421 DOI: 10.3390/ijerph15091898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
Abstract
Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention.
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Affiliation(s)
- Daniel T Myran
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON K1G 5Z3, Canada.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Beverly-Ann Biggs
- Department of Medicine at the Doherty Institute, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne 3000, Australia.
| | - Irene Veldhuijzen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands.
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases University of Brescia and ASST Spedali Civili, Brescia 25123, Italy.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Lukas P Staub
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Eric Agbata
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, Barcelona 08193, Spain.
| | - Prinon Rahman
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 7G5, Canada.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm 169 73, Sweden.
| | - Kevin Pottie
- Bruyere Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1R 7G5, Canada.
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23
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Sagnelli C, Ciccozzi M, Alessio L, Cella E, Gualdieri L, Pisaturo M, Minichini C, Di Caprio G, Starace M, Onorato L, Capoprese M, Occhiello L, Angeletti S, Scotto G, Macera M, Sagnelli E, Coppola N. HBV molecular epidemiology and clinical condition of immigrants living in Italy. Infection 2018; 46:523-531. [PMID: 29796738 DOI: 10.1007/s15010-018-1153-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We investigated 170 HBsAg-positive immigrants living in Italy for 1-7 years to ascertain whether they may have become infected in the host country. METHODS Of 2032 adult immigrants interviewed, 1727 (85%) voluntarily adhered to a screening program for bloodborne or sexually transmitted infections. HBsAg was detected in 170 (9.8%) screened immigrants who completed the diagnostic, clinical and therapeutic process at the nearest clinic of infectious diseases. HBV molecular biology was performed applying a homemade technology. Phylogenetic signal of the datasets was obtained by a likelihood-mapping analysis using TreePuzzle. RESULTS Of the 170 HBsAg-positive immigrants, 133 were inactive carriers, 29 had chronic hepatitis and 8 compensated cirrhosis. HBV genotype was identified in 109 of the 113 HBV-DNA-positive immigrants and HBV-genotype-E predominated (68.9%). Of these 109, 6 (5.5%) subjects showed an HBV genotype absent or extremely rare in their native country: HBV-genotype-E in three from Eastern Europe and in one from Sri Lanka, possibly acquired from other immigrants from sub-Saharan countries, HBV-genotype-D1 in one from Burkina Faso and one from Senegal, possibly acquired in Italy. CONCLUSION The data suggest that immigrants may acquire HBV infection in Italy and, therefore, HBV vaccination programs should be extended to all immigrants living in Italy.
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Affiliation(s)
- Caterina Sagnelli
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
- Medical Center, Centro Suore Missionarie della Carità, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Loredana Alessio
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luciano Gualdieri
- Medical Center, Centro per la Tutela della Salute degli Immigrati, Naples, Italy
| | - Mariantonietta Pisaturo
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Carmine Minichini
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Giovanni Di Caprio
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Mario Starace
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Lorenzo Onorato
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Mara Capoprese
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Laura Occhiello
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Margherita Macera
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza "La tenda di Abramo", Caserta, Italy
| | - Evangelista Sagnelli
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
| | - Nicola Coppola
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
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24
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Zampino R, Capoluongo N, Boemio A, Macera M, Vitrone M, Adinolfi LE, Filippini P, Sagnelli E, Sagnelli C, Durante-Mangoni E, Coppola N. Effect of a Cooperation Strategy between Primary Care Physicians and Hospital Liver Units on HBV Care in Campania, Italy. Can J Gastroenterol Hepatol 2018; 2018:5670374. [PMID: 30148123 PMCID: PMC6083479 DOI: 10.1155/2018/5670374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/30/2018] [Accepted: 07/08/2018] [Indexed: 12/18/2022] Open
Abstract
AIMS This study is aimed at assessing the efficacy of an active search and treat strategy for HBV-infected subjects in an endemic area (Campania, Italy). To do this, we created a cooperation bundle between 24 General Practitioners (GPs) and 3 Hospital Liver Units (HLU). We assessed whether this strategy improved the detection of HBV infection in patients at risk and the overall quality of care, with the aim of reducing liver disease progression. METHODS We estimated that, among about 20,000 patients cared for by the 24 GPs, approximately 280 patients unaware of or underestimating HBV infection would be found. Identified patients were to be referred to the HLU for clinical evaluation and treatment from February 2016 for 12 months. RESULTS Unexpectedly, screening and enrolment were poor (48 patients only). GP workloads, patient financial difficulties, and patients' refusal were the major causes of enrolment failure according to GPs. All patients referred to HLU completed the program; most of them were HBV inactive carriers. CONCLUSIONS This program failed to scavenge chronic HBV-infected patients in an endemic area and establish a successful clinical collaboration between GPs and HLU. Underlying reasons are diverse and call for new strategies to implement cooperation between primary care providers and hospital specialists.
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Affiliation(s)
- Rosa Zampino
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “L. Vanvitelli”, Italy
- Unit of Infectious & Transplant Medicine, “V. Monaldi” Hospital, AORN dei Colli, Naples, Italy
| | - Nicolina Capoluongo
- Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Adriana Boemio
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “L. Vanvitelli”, Italy
| | - Margherita Macera
- Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Martina Vitrone
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “L. Vanvitelli”, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “L. Vanvitelli”, Italy
| | - Pietro Filippini
- Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Evangelista Sagnelli
- Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Caterina Sagnelli
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Emanuele Durante-Mangoni
- Unit of Infectious & Transplant Medicine, “V. Monaldi” Hospital, AORN dei Colli, Naples, Italy
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “L. Vanvitelli”, Italy
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25
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Fougère Y, El Houss S, Suris JC, Rouvenaz-Defago S, Miletto D, Von der Weid L, Willen F, Williams-Smith JA, Gehri M, Crisinel PA. High coverage of hepatitis B vaccination and low prevalence of chronic hepatitis B in migrant children dictate a new catch-up vaccination strategy. Vaccine 2018; 36:4501-4506. [PMID: 29907480 DOI: 10.1016/j.vaccine.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Worldwide coverage of hepatitis B (HB) vaccination is increasing. This should be considered when determining the best strategy for catch-up HB vaccination in migrant children, who rarely have written proof of past immunizations. This study aimed to estimate HB vaccine protection, chronic HB prevalence and to identify determinants of vaccine protection. METHODS Newly arrived migrant children at Lausanne University Hospital from October 2014 to July 2017 were prospectively enrolled. Children and adolescents aged 1-18 years were approached for inclusion if they had no proof of past vaccinations and accepted a single dose of injected HB vaccine. HB surface antibody (anti-HBs) serology was performed after 4-6 weeks. Anti-HBs ≥100 IU/L were considered consistent with a booster-type antibody response. Patients with anti-HBs <100 IU/L received additional dose(s) of HB vaccine, after exclusion of chronic HB in children with anti-HBs <10 IU/L. Potential determinants of vaccine response were compared between children with and without booster-type response. RESULTS Two hundred children were available for analysis. Median age was 8.9 years (IQR 4.8-12.9), and 97 (49%) were female. The majority (n = 124, 62%) came from the region classified by the WHO as eastern Mediterranean. One hundred and sixty-one children (81%) had a booster-type antibody response. Only 1 patient (<1%) had chronic HB. In the multivariate analysis, younger age (OR per decreasing-year, 1.28; 95%CI, 1.05-1.57; p = 0.017) and migration from an urban area (OR 1.16; 95%CI, 1.01-1.33; p = 0.043) were the only significant determinants of booster-type response. CONCLUSION Post-vaccine serology may be used to identify a high proportion of individuals in our pediatric migrant population with previous immunization for HB. Our study also showed extremely low prevalence of chronic HB. No variable could definitively determine the results of serology. Post-vaccine serology represents the most effective strategy in this context of high vaccine coverage.
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Affiliation(s)
- Yves Fougère
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland.
| | - Samir El Houss
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Joan-Carles Suris
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Sylvie Rouvenaz-Defago
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Damien Miletto
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Lucie Von der Weid
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Fanny Willen
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | | | - Mario Gehri
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
| | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital, Switzerland
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Immunization Offer Targeting Migrants: Policies and Practices in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050968. [PMID: 29757209 PMCID: PMC5982007 DOI: 10.3390/ijerph15050968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 04/12/2018] [Accepted: 05/07/2018] [Indexed: 12/27/2022]
Abstract
The unprecedented flow of migrants over the last three years places Italy in front of new issues regarding medical care from the rescue phase up to the integration into the national health services, including preventive actions. We used online questionnaires to investigate the Italian national and regional policies for immunization offer targeting asylum seekers, refugees, irregular migrants and unaccompanied minors. Another questionnaire was used to assess how these policies are translated into practice in migrant reception centres and community health services. Questionnaires were filled out at the national level, in 14 out of 21 Regions/Autonomous Provinces, and in 36 community health services and 28 migrant reception centres. Almost all responders stated that all vaccinations included in the National Immunization Plan are offered to migrant children and adolescents. The situation concerning adults is fragmented, with most of the Regions and local centres offering more vaccines than the national offer—which include polio, tetanus and measles–mumps-rubella. Data on immunized immigrants is archived at the regional/local level with different methods and not available at the national level. Further efforts to ensure consistency in vaccine provision and adequate mechanisms of exchanging data are needed to guarantee a complete vaccination offer and avoid unnecessary health actions, including unnecessary re-vaccination.
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Lai A, Sagnelli C, Presti AL, Cella E, Angeletti S, Spoto S, Costantino S, Sagnelli E, Ciccozzi M. What is changed in HBV molecular epidemiology in Italy? J Med Virol 2018; 90:786-795. [PMID: 29315661 DOI: 10.1002/jmv.25027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/25/2017] [Indexed: 12/13/2022]
Abstract
Hepatitis B virus (HBV) infection represents the most common cause of chronic liver diseases worldwide. Consequently, to the introduction of the universal HBV vaccination program, the prevalence of hepatitis B surface antigen was markedly reduced and less than 1% of the population of Western Europe and North America is chronically infected. To date, despite great advances in therapeutics, HBV chronic infection is considered an incurable disease. Ten hepatitis B virus genotypes (A-J) and several subgenotypes have been identified so far, based on intergroup divergences of 8% and 4%, respectively, in the complete viral genome. HBV-D genotype has been found throughout the world, with highest prevalence in the Mediterranean area. In the present review, several articles concerning HBV epidemiology, and phylogeny in Italy have been analyzed, mainly focusing on the changes occurred in the last decade.
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Affiliation(s)
- Alessia Lai
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandra L Presti
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit, Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health, Rome, Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science, University of Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University of Campus Bio-Medico of Rome, Rome, Italy
| | - Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Clinical Laboratory Science, University of Campus Bio-Medico of Rome, Rome, Italy
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Hepatitis B Virus Genotypes, Epidemiological Characteristics and Clinical Presentation of HBV Chronic Infection in Immigrant Populations Living in Southern Italy. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Sagnelli E, Alessio L, Sagnelli C, Gualdieri L, Pisaturo M, Minichini C, Di Caprio G, Starace M, Onorato L, Macera M, Scotto G, Coppola N. Hepatitis B Virus Genotypes, Epidemiological Characteristics, and Clinical Presentation of HBV Chronic Infection in Immigrant Populations Living in Southern Italy. HEPATITIS MONTHLY 2017; 17. [DOI: 10.5812/hepatmon.13260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
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30
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Castelli F, Sulis G. Migration and infectious diseases. Clin Microbiol Infect 2017; 23:283-289. [PMID: 28336382 DOI: 10.1016/j.cmi.2017.03.012] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 03/14/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Infectious diseases still represent an important cause of morbidity and mortality among foreign-born individuals. The rising migration flows towards Europe throughout the last few years are raising renewed concerns about management issues and the potential associated risk for the native population. AIMS To discuss the health implications and challenges related to the four phases of migration, from first arrival to stable resettlement. SOURCES Scientific literature and relevant statistical reports. CONTENT Although infectious diseases are not a health priority at first arrival, a syndromic screening to identify the most common communicable conditions (pulmonary tuberculosis above all) should be promptly conducted. Reception centres where asylum seekers are gathered after arrival may be crowded, so favouring epidemic outbreaks, sometimes caused by incomplete vaccine coverage for preventable diseases. After resettlement, the prevalence of some chronic infections such as human immunodeficiency virus, viral hepatitis or tuberculosis largely reflects the epidemiological pattern in the country of origin, with poor living conditions being an additional driver. Once resettled, migrants usually travel back to their country of origin without seeking pre-travel advice, which results in a high incidence of malaria and other infections. IMPLICATIONS Although infectious diseases among migrants are known to have a negligible impact on European epidemiology, screening programmes need to be implemented and adapted to the different stages of the migratory process to better understand the trends and set priorities for action. Appropriate access to care regardless of the legal status is crucial to improve the health status and prevent the spread of contagious conditions.
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Affiliation(s)
- F Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy; UNESCO Chair 'Training and empowering human resources for health development in resource-limited countries', University of Brescia, Brescia, Italy.
| | - G Sulis
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
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31
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Fedeli U, Grande E, Grippo F, Frova L. Mortality associated with hepatitis C and hepatitis B virus infection: A nationwide study on multiple causes of death data. World J Gastroenterol 2017; 23:1866-1871. [PMID: 28348493 PMCID: PMC5352928 DOI: 10.3748/wjg.v23.i10.1866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/16/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy.
METHODS Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups.
RESULTS HCV infection was mentioned in 1.6% (n = 27730) and HBV infection in 0.2% (n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV.
CONCLUSION Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.
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Mipatrini D, Stefanelli P, Severoni S, Rezza G. Vaccinations in migrants and refugees: a challenge for European health systems. A systematic review of current scientific evidence. Pathog Glob Health 2017; 111:59-68. [PMID: 28165878 DOI: 10.1080/20477724.2017.1281374] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The decline of immunization rates in countries of origin of migrants and refugees, along with risky conditions during the journey to Europe, may threaten migrants' health. We performed a systematic review of the scientific literature in order to assess the frequency of vaccine preventable diseases, and vaccination coverage among migrants and refugees in Europe. To this end, Medline and Cochrane databases were considered. After the screening and the selection process, 58 papers were included in the review. We focused on the following vaccine-preventable diseases: hepatitis B, measles, rubella, mumps, tetanus, poliomyelitis, pertussis, diphtheria, meningitis, and varicella. The results were presented as a qualitative synthesis. In summary, several studies highlighted that migrants and refugees have lower immunization rates compared to European-born individuals. Firstly, this is due to low vaccination coverage in the country of origin. Then, several problems may limit migrants' access to vaccination in Europe: (i) migrants are used to move around the continent, and many vaccines require multiple doses at regular times; (ii) information on the immunization status of migrants is often lacking; (iii) hosting countries face severe economic crises; (iv) migrants often refuse registration with medical authorities for fear of legal consequences and (v) the lack of coordination among public health authorities of neighboring countries may determine either duplications or lack of vaccine administration. Possible strategies to overcome these problems include tailoring immunization services on the specific needs of the target population, developing strong communication campaigns, developing vaccination registers, and promoting collaboration among public health authorities of European Countries.
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Affiliation(s)
- Daniele Mipatrini
- a Department of Public Health and Infectious Diseases , Sapienza University , Rome , Italy
| | - Paola Stefanelli
- b Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Santino Severoni
- c Division of Policy and Governance for Health and Well-being European Office for Investment for Health and Development , WHO European Office , Copenhagen , Denmark
| | - Giovanni Rezza
- b Department of Infectious Diseases , Istituto Superiore di Sanità , Rome , Italy
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Wendland A, Ehmsen BK, Lenskjold V, Astrup BS, Mohr M, Williams CJ, Cowan SA. Undocumented migrant women in Denmark have inadequate access to pregnancy screening and have a higher prevalence Hepatitis B virus infection compared to documented migrants in Denmark: a prevalence study. BMC Public Health 2016; 16:426. [PMID: 27216405 PMCID: PMC4877804 DOI: 10.1186/s12889-016-3096-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 05/04/2016] [Indexed: 01/05/2023] Open
Abstract
Background Pregnant residents of Denmark are tested by their GP for current infections with Hepatitis B virus (HBV), HIV and syphilis through the Danish pregnancy screening programme to identify infections and initiate interventions to prevent mother-to-child transmission. Documented migrants (DM) have access to this screening but undocumented migrants (UM) do not, instead relying on ad-hoc care from clinics run by non-governmental organisations. We aimed to assess screening frequency in UM and to compare prevalence of infection in UM with DM. Methods We obtained individual-level information on HBV, HIV and syphilis testing frequency and results for pregnant women attending three clinics specialising in care for UM between August 2011 and August 2014. We obtained aggregate data on the prevalence of the three infections for documented migrants from the Danish pregnancy screening programme and birth register between January 2011 and January 2014. Planned abortions were excluded from the study. We described demographic features of pregnant UM and estimated the screening frequency for HIV, HBV and syphilis. We compared prevalence of current infections in UM and DM by calculating standardised prevalence ratios (SPR). Results The three UM clinics registered 219 pregnancies qualifying for screening. Overall 43, 58 and 60 % of pregnant UM had a test result recorded for HBV, Syphilis and HIV respectively, compared to >99 % in the general Danish population including DM. The prevalence of HBV was higher in UM than in DM (SPR: 2.4; 95 % CI: 1.1–5.3). The SPR of 2 (95 % CI: 0.5–8.0) for HIV was not statistically significant, potentially due to small sample size of UM. None of the pregnant UM tested positive for Syphilis. Conclusions Pregnant UM have a poorer chance of being tested for HIV, HBV and syphilis, despite having a higher prevalence of HBV than DM. We recommend giving systematic access to routine pregnancy screening to all UM to prevent mother-to-child transmission and to address the observed health care inequity.
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Affiliation(s)
- Annika Wendland
- Statens Serum Institut, Artillerivej 5, 2300, København S, Denmark. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Boje K Ehmsen
- Danish Research Centre for Migration, Ethnicity and Health (MESU), Øster Farimagsgade 5, Postboks 2099, 1014, København K, Denmark
| | - Vibeke Lenskjold
- Røde Kors Sundhedsklinikken, Blegdamsvej 27, 2100, København Ø, Denmark
| | | | - Marlene Mohr
- Reden International, Colbjørnsensgade 12 st.tv, 1652, København V, Denmark
| | - Christopher J Williams
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Public Health Wales, Temple of Peace and Health, Cathays Park, Cardiff, CF10 3AP, UK
| | - Susan A Cowan
- Statens Serum Institut, Artillerivej 5, 2300, København S, Denmark
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Coppola N, Alessio L, Pisaturo M, Macera M, Sagnelli C, Zampino R, Sagnelli E. Hepatitis B virus infection in immigrant populations. World J Hepatol 2015; 7:2955-2961. [PMID: 26730274 PMCID: PMC4691698 DOI: 10.4254/wjh.v7.i30.2955] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/04/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
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 (HBsAg) 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 HBsAg-positive 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.
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Affiliation(s)
- Nicola Coppola
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Loredana Alessio
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Mariantonietta Pisaturo
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Margherita Macera
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Caterina Sagnelli
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Rosa Zampino
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
| | - Evangelista Sagnelli
- Nicola Coppola, Loredana Alessio, Mariantonietta Pisaturo, Margherita Macera, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
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Villano U, Lo Presti A, Equestre M, Cella E, Pisani G, Giovanetti M, Bruni R, Tritarelli E, Amicosante M, Grifoni A, Scarcella C, El-Hamad I, Pezzoli MC, Angeletti S, Silvia A, Ciccaglione AR, Ciccozzi M. Molecular epidemiology and phylogenetic analysis of Hepatitis B virus in a group of migrants in Italy. BMC Infect Dis 2015. [PMID: 26209519 PMCID: PMC4514992 DOI: 10.1186/s12879-015-0994-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Hepatitis B virus infection (HBV) is widespread and it is considered a major health problem worldwide. The global distribution of HBV varies significantly between countries and between regions of the world. Among the many factors contributing to the changing epidemiology of viral hepatitis, the movement of people within and between countries is a potentially important one. In Italy, the number of migrant individuals has been increasing during the past 25 years. HBV genotype D has been found throughout the world, although its highest prevalence is in the Mediterranean area, the Middle East and southern Asia. We describe the molecular epidemiology of HBV in a chronically infected population of migrants (living in Italy), by using the phylogenetic analysis. Methods HBV-DNA was amplified and sequenced from 43 HBV chronically infected patients. Phylogenetic and evolutionary analysis were performed using both maximum Likelihood and Bayesian methods. Results and conclusion Of the 43 HBV S gene isolates from migrants, 25 (58.1 %) were classified as D genotype. Maximum Likelihood analysis showed an intermixing between Moldavian and foreigners sequences mostly respect to Italian ones. Italian sequences clustered mostly together in a main clade separately from all others. The estimation of the time of the tree’s root gave a mean value of 17 years ago, suggesting the origin of the tree back to 1992 year. The skyline plot showed that the number of infections softly increased until the early 2005s, after which reached a plateau. Comparing phylogenetic data to the migrants date of arrival in Italy, it should be possible that migrants arrived in Italy yet infected from their country of origin. In conclusion, this is the first paper where phylogenetic analysis and genetic evolution has been used to characterize HBV sub genotypes D1 circulation in a selected and homogenous group of migrants coming from a restricted area of Balkans and to approximately define the period of infection besides the migration date. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0994-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Umbertina Villano
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Alessandra Lo Presti
- Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy.
| | - Eleonora Cella
- Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Giulio Pisani
- Center for Immunobiologicals Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy.
| | - Marta Giovanetti
- Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Roberto Bruni
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Elena Tritarelli
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Massimo Amicosante
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
| | - Alba Grifoni
- Department of Biology, University of Rome "Tor Vergata", Rome, Italy.
| | - Carmelo Scarcella
- Department of Infectious Diseases, Spedali Civili General Hospital, Brescia, Italy.
| | - Issa El-Hamad
- Department of Infectious Diseases, Spedali Civili General Hospital, Brescia, Italy. .,Brescia Local Health Authority, Brescia, Italy.
| | - Maria Chiara Pezzoli
- Department of Infectious Diseases, Spedali Civili General Hospital, Brescia, Italy.
| | | | - Angeletti Silvia
- Clinical Pathology and Microbiology Laboratory, University hospital Campus Biomedico, Rome, Italy.
| | - Anna Rita Ciccaglione
- Viral Hepatitis Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Massimo Ciccozzi
- Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy. .,Clinical Pathology and Microbiology Laboratory, University hospital Campus Biomedico, Rome, Italy.
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36
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Petersen E. Should we offer screening for hepatitis B and other infections to immigrants--legal or illegal? J Travel Med 2015; 22:73-5. [PMID: 25753020 DOI: 10.1111/jtm.12188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Eskild Petersen
- Department of Infectious Diseases and Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
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