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. 2018 Sep 1;15(9):1898.
doi: 10.3390/ijerph15091898.

The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

Daniel T Myran  1 , Rachael Morton  2 , Beverly-Ann Biggs  3 , Irene Veldhuijzen  4 , Francesco Castelli  5 , Anh Tran  6 , Lukas P Staub  7 , Eric Agbata  8 , Prinon Rahman  9 , Manish Pareek  10 , Teymur Noori  11 , Kevin Pottie  12
Affiliations

The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

Daniel T Myran et al. Int J Environ Res Public Health. .

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.

Keywords: CHB; HBV; migrants; refugees; screening; vaccination.

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Conflict of interest statement

Dr. Pareek is supported by the National Institute for Health Research (NIHR Post-Doctoral Fellowship, PDF-2015-08-102). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. Dr Pareek reports an institutional grant (unrestricted) for project related to blood-borne virus testing from Gilead Sciences outside the submitted work. RL Morton is supported by an Australian National Health and Medical Research Council, Sidney Sax Public Health Fellowship #1054216. All other authors report no conflicts of interest. Dr Pottie led the consultant team that received funding from the European Centre for Disease Control to conduct systematic reviews for the Guidelines for Newly Arriving Migrants to EU/EEA. Francesco Castelli is a UNESCO Chair and the choice and presentation of views contained in this article and for opinions expressed therein, are not necessarily those of UNESCO and do not commit the Organization.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram for Effectiveness of HBV screening and vaccination programs * No randomized control studies on screening were identified. Included studies were on topics relevant to the evidence chain (testing, prevalence, vaccination, and treatment).
Figure 2
Figure 2
PRISMA Flow Diagram for Cost-Effectiveness of HBV screening.
See this image and copyright information in PMC

References

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    1. World Health Organization . WHO Guidelines on Hepatitis B and C Testing. World Health Organization; Geneva, Switzerland: 2017.
    1. European Centre for Disease Prevention and Control (ECDC) Epidemiological Assessment of Hepatitis B and C among Migrants in the EU/EEA. ECDC; Stockholm, Sweden: 2016.
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    1. European Centre for Disease Prevention and Control . Hepatitis B and C in the EU Neighbourhood: Prevalence, Burden of Disease and Screening Policies. ECDC; Stockhlom, Sweden: 2010.

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