Seroprevalence of antibodies and antigens against hepatitis A–E viruses in refugees and asylum seekers in Germany in 2015

Jablonka, Alexandra; Solbach, Philipp; Wöbse, M.; Manns, Michael P.; Schmidt, Reinhold; Wedemeyer, Heiner; Cornberg, Markus; Behrens, Georg; Hardtke, Svenja

doi:10.1097/meg.0000000000000889

Cited by 39 publications

(47 citation statements)

References 28 publications

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“…Still, the overall range of anti‐HEV frequencies is in line with other studies from Europe and North America, which suggests similar HEV reservoirs and modes of transmission across different regions and countries. Even when refugees were evaluated, similar rates were found …”

Section: Discussionsupporting

confidence: 56%

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Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil

Hardtke

Rocco

Ogata

et al. 2018

Journal of Medical Virology

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Hepatitis E has always been related to morbidity in pregnant women. Its epidemiology is not well understood in Brazil. Therefore, we tested sera from 209 pregnant women and 199 female blood donors, collected at a single center in Curitiba, Brazil. The Wantai assay was used for testing the anti-hepatitis E virus (anti-HEV), immunoglobulin G (IgG), and an in-house polymerase chain reaction process for testing HEV RNA. Anti-HEV was detected in 22.5% of the total group, 19% in the pregnant women group, and 26% in the blood donor group (P = 0.11), a much higher prevalence when compared with other studies in Brazil. Demographical analysis showed that 92.4% were born in the South Region of Brazil, 4.9% in the Southeast, and 2.7% were distributed over other regions of the country. With respect to their origin, 99% were from the South, 0.7% from the Southeast, and 0.2% from the Central-West regions. Income, education, race, number of pregnancies, and abortion did differ significantly when comparing both the groups (P < 0.001). Age >30 (P = 0.012) and the number (>3) of pregnancies (P = 0.008) were related to anti-HEV positivity. All anti-HEV IgG-positive females were HEV RNA negative. In conclusion, HEV positivity was found in one out of five young women, which showed an urgent need for further epidemiological studies in Brazil.

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Section: Discussionsupporting

confidence: 56%

“…Even when refugees were evaluated, similar rates were found. 31 More important, HEV RNA was negative in all anti-HEV positive women. Hence, as no positive PCR samples were found, anyone could reason that the samples that were frozen in a −80°C freezer for a long period would denature the HEV RNA.…”

Section: Geographical Differencesmentioning

confidence: 96%

Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil

Hardtke

Rocco

Ogata

et al. 2018

Journal of Medical Virology

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“…Like us, Rein et al found the prevalence of HBsAg to be lowest among refugees from the Middle East and highest among those from Africa and Asia . Male asylum seekers in Germany were almost twice as likely as females to be positive for HBsAg . Foreign born Asians attending college in the United States had an 81% prevalence of HBsAb and a 16% rate of susceptibility to hepatitis B, similar to the 77% and 22%, respectively, found among the adult refugees presented here .…”

Section: Discussionsupporting

confidence: 84%

“…85% of Syrian and 100% of Eritrean asylum seekers in the Netherlands had HAV Ab, and immunity increased with age . Among refugees being held in detention in Germany, 91.2% were positive for HAV Ab . Like us, Rein et al found the prevalence of HBsAg to be lowest among refugees from the Middle East and highest among those from Africa and Asia .…”

Section: Discussionmentioning

confidence: 69%

Hepatitis A and B among newly arrived refugees: Vaccinate all, or test first for immunity?

Einterz¹

2018

Int J Clin Pract

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Summary Aim When screening newly arrived refugees, physicians must decide whether to vaccinate against hepatitis A and B at first encounter, thereby minimising missed opportunity, or to test for immunity and vaccinate only the susceptible, minimising unnecessary intervention. Better knowledge of hepatitis A and B immunity in refugee populations from different parts of the world is needed. Method Overseas and domestic medical records of refugees from Africa, Asia, and the Middle East who entered Marion County (Indiana) between 1 September 2016 and 31 December 2017 were reviewed. Results Of 1191 refugees, 1163 and 1153 were tested for immunity to hepatitis A and B respectively. Among <19 year‐olds, immunity to hepatitis A ranged from 52.1% to 79.6%, and immunity to hepatitis B ranged from 75.5% to 87.6%. Among ≥19 year‐olds, immunity to hepatitis A was greater than 90% for each of the three regions, whereas immunity to hepatitis B ranged from 19.3% to 94.4%. 96% of refugees in the subset of Burmese ≥19 years old were immune to hepatitis B. Of individuals immune to hepatitis B, immunity was due to vaccination in 94.1% of <19 year‐olds and 57.4% of ≥19 year‐olds. 10% of refugees with at least three documented doses of hepatitis B vaccine were negative for hepatitis B surface antibody. 34.1% of uninfected refugees with no documented doses of hepatitis B vaccination were positive for hepatitis B surface antibody. Conclusion It is reasonable to begin hepatitis A vaccination of <19 year‐olds in this refugee population at first encounter but to test first for hepatitis A susceptibility before vaccinating those ≥19 years old. Similarly delaying hepatitis B vaccination might be appropriate only for a subset of Burmese adults.

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“…Most children may have natural immunity from prior HAV infection acquired at their country of origin whereas others may be non-immune and candidates for vaccination against HAV. In a study in refugees and asylum seekers in Germany on the immunity against hepatitis A-E viruses, 81% of refugee minors were immune, which corresponds to the high anti-HAV seroprevalence rates in patients from Sub-Saharan and Northern Africa, and from the Middle East [64]. The U.S. CDC and AAP recommends the hepatitis A vaccine as part of the routine immunization schedule for all children aged 1 year and older without evidence of immunity [23].…”

Section: Hepatitis Amentioning

confidence: 99%

Infectious Diseases among Refugee Children

Shetty

2019

Children

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In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.

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Seroprevalence of antibodies and antigens against hepatitis A–E viruses in refugees and asylum seekers in Germany in 2015

Abstract: The prevalence of refugees with previous exposure to hepatitis viruses was higher than that in the general German population, but lower than in other migrant populations in Germany. The vaccination status against hepatitis B was poor.

Cited by 39 publications

References 28 publications

Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil

Risk factors and seroprevalence of hepatitis E evaluated in frozen‐serum samples (2002‐2003) of pregnant women compared with female blood donors in a Southern region of Brazil

Hepatitis A and B among newly arrived refugees: Vaccinate all, or test first for immunity?

Infectious Diseases among Refugee Children

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