Estimating the impact of displacement from Ukraine on HBV and HCV prevalence among migrants in the European Union, 2024: a modeling study

Abstract

Background: In countries with low baseline burdens of hepatitis B and C viruses (HBV, HCV), high levels of migration can impact the burden of viral hepatitis. The screening and treatment of migrants requires different methods and sensitivities than broad-based programs. We aimed to estimate the prevalence of HBV and HCV among migrants in EU-27 countries in 2024. The Ukrainian Refugee Crisis was also quantified.

Methods: Using the United Nations 2024 migrant stock data, we estimated the migrant population for each EU-27 country by five-year age and sex cohorts by country of birth. These distributions were multiplied by five-year age and sex prevalence estimates in the country-of-birth models maintained by the Polaris Observatory. The difference between the 2024 and 2020 Ukrainian migrant stock was quantified to estimate the impact of the Ukrainian Refugee Crisis.

Findings: In 2024, there were an estimated 1.73 million (UI: 1.04-2.66 million) migrants living with HBV and 1.03 million (UI: 757,000-1,559,000) living with anti-HCV in the EU-27, corresponding to migrant prevalences of 2.73% (UI: 1.6-4.2%) and 1.53% (UI: 1.2-2.5%) respectively. The Ukrainian Refugee Crisis is estimated to have resulted in an additional 43,000 (UI: 28,700-60,900) migrants living with HBV, and 154,000 (UI: 12,500-202,000) with HCV in the EU-27.

Interpretation: The burden of HBV and HCV among migrants and which communities are most affected in the EU-27 at the national level are vastly heterogeneous. These data provide evidence for policy makers to better understand the burden their community faces so that they can be better poised to develop culturally appropriate materials and outreach. While there is a great deal of uncertainty regarding the number of migrants by country, as well as the prevalence among these groups, this work provides direction towards which groups are most likely impacted at the EU-27 and national level.

Funding: John C Martin Foundation.

Keywords: Epidemiology; European Union; Hepatitis B; Hepatitis C; Migration; Modeling; Prevalence.

Fig. 1

Prevalence of HBV and HCV among immigrants in the EU-27 in 2024. HBV—HBsAg+, HCV—anti-HCV+. Microsoft Excel for Mac Version 16.99.2 screen shots reprinted with permission from Microsoft Corporation, Powered by Bing ©GeoNames, Microsoft, OpenStreetMap, TomTom.

Fig. 2

Top 23 countries of birth for migrants living with HBV or HCV in the EU-27, 2024. HBV—HBsAg+, HCV—anti-HCV+.

Fig. 3

a. Prevalence of HBV among immigrants in the EU-27 by region and country of birth in 2024. HBV—HBsAg+. Sub-Saharan Africa: SEN-Senegal, OTH-Other Countries, CIV-Côte d'Ivoire, AGO-Angola, NGA-Nigeria, GIN-Guinea, MLI-Mali, GHA-Ghana, CMR-Cameroon, CPV-Cabo Verde, SOM-Somalia, ERI-Eritrea, COM-Comoros, ETH-Ethiopia, GNB-Guinea-Bissau, MDG-Madagascar, MOZ-Mozambique, ZAF-South Africa, TGO-Togo, COG-Congo, Republic of the, COD-Democratic Republic of Congo, M …-Mauritania, GMB-Gambia, MUS-Mauritius. West Asia & North Africa: SYR-Syria, TUR-Türkiye, TUN-Tunisia, DZA-Algeria, IRQ-Iraq, MAR-Morocco, OTH-Other Countries, GEO-Georgia, EGY-Egypt, LBN-Lebanon, SDN-Sudan, A …-Armenia. Eastern Europe: ROU-Romania, UKR-Ukraine, POL-Poland, RUS-Russia, MDA-Moldova, BGR-Bulgaria, OTH-Other Countries, BLR-Belarus. Southern Europe: ALB-Albania, BIH-Bosnia and Herzegovina, SRB-Serbia, PRT-Portugal, GRC-Greece, ITA-Italy, MKD-North Macedonia, OTH-Other Countries, ESP-Spain. East and South East Asia & Oceania: CHN-China Mainland, VNM-Vietnam, PHL-The Philippines, IDN-Indonesia, OTH-Other Countries, THA-Thailand, KOR-Republic of Korea, KH …-Cambodia, M …-Mongolia. Central and Southern Asia: KAZ-Kazakhstan, IND-India, AFG-Afghanistan, BGD-Bangladesh, PAK-Pakistan, IRN-Iran, KGZ-Kyrgyzstan, LKA-Sri Lanka, TJK-Tajikistan, UZB-Uzbekistan, OTH-Other Countries. Americas: VEN-Venezuela, OTH-Other Countries, COL-Colombia, DOM-Dominican Republic, SUR-Suriname, BRA-Brazil, ECU-Ecuador. Northern Europe: GBR-United Kingdom, OTH-Other Countries. Western Europe: OTH-Other Countries, CHE-Switzerland, DEU-Germany, FRA-France. b. Prevalence of HCV among immigrants in the EU-27 by region and country of birth in 2024. HCV—anti-HCV+. Eastern Europe: UKR-Ukraine, RUS-Russia, ROU-Romania, POL-Poland, BGR-Bulgaria, MDA-Moldova, BLR-Belarus, CZE-Czechia, HUN-Hungary, S …-Slovakia. West Asia & North Africa: SYR-Syria, DZA-Algeria, EGY-Egypt, MAR-Morocco, GEO-Georgia, TUR-Türkiye, IRQ-Iraq, ARM-Armenia, TUN-Tunisia, OTH-Other Countries, AZE-Azerbaijan, SDN-Sudan, LBY-Libya. Central and Southern Asia: PAK-Pakistan, KAZ-Kazakhstan, IND-India, AFG-Afghanistan, UZB-Uzbekistan, KGZ-Kyrgyzstan, BGD-Bangladesh, LKA-Sri Lanka, TJK-Tajikistan, IRN-Iran, Blank-Other Countries. Southern Europe: ALB-Albania, BIH-Bosnia and Herzegovina, PRT-Portugal, SRB-Serbia, OTH-Other Countries, GRC-Greece, HRV-Croatia. Americas: USA-United States, COL-Colombia, VEN-Venezuela, OTH-Other Countries, ECU-Ecuador, ARG-Argentina, BRA-Brazil, DOM-Dominican Republic, HND-Honduras, CUB-Cuba, SUR-Suriname, MEX-Mexico, C …-Canada, PER-Peru. Sub-Saharan Africa: OTH-Other Countries, SEN-Senegal, CMR-Cameroon, COM-Comoros, GHA-Ghana, CIV-Côte d'Ivoire, SOM-Somalia, ZAF-South Africa, GAB-Gabon, ERI-Eritrea, NGA-Nigeria, MLI-Mali, AGO-Angola, GIN-Guinea, COD-Democratic Republic of Congo, CPV-Cabo Verde, MDG-Madagascar, BDI-Burundi, ETH-Ethiopia, GMB-Gambia. East and South East Asia & Oceania: VNM-Vietnam, CHN-China Mainland, OTH-Other Countries, PHL-The Philippines, MNG-Mongolia, THA-Thailand, KHM-Cambodia, AUS-Australia, IDN-Indonesia. Western Europe: DEU-Germany, FRA-France, OTH-Other Countries, CHE-Switzerland. Northern Europe: GBR-United Kingdom, OTH-Other Countries, LTU-Lithuania, EST-Estonia.