Public health concern as data reveals high prevalence of hepatitis B among refugees in Germany

A new study presented today demonstrates the potential challenge posed to public health systems across Europe as a result of the prevalence of Hepatitis B among new refugee populations. The study was presented at The International Liver Congress 2016 in Barcelona, Spain.

With nearly one million asylum applications lodged in Germany alone last year,1 the European Union (EU) is experiencing an unprecedented wave of immigration by refugees and asylum seekers.2 With many coming from unstable and fragile states like Syria where health systems have broken down and routine immunisation has been severely compromised,3 health authorities in the EU face serious challenges in responding to the spread of communicable diseases among both refugee and native populations.

"Recording data amongst transient and displaced populations can be extremely challenging," said Dr Philipp Solbach from the Department of Gastroenterology, Hepatology and Endocrinology of the Medizinsche Hochschule Hannover, Germany and lead author of the study. "The prevalence data we have recorded, alongside decreased levels of immunity and non-immunisation, reveals the true extent of the public health challenge that Europe is facing with regard to Hepatitis B."

The study was conducted by testing 793 patients from all age groups for serological markers of Hepatitis B virus infection (HBsAg and anti-HBc), and liver enzyme tests (ALT, AST, bilirubin, gGT, alkaline phosphatase) were performed in refugee reception centres in northern Germany throughout August 2015. 258 patients were tested for anti-HBs antibodies.

The presence of Hepatitis B, as measured by HBsAg, was found in 2.3% of people tested and anti-HBc in 14% of people tested, indicating higher levels of Hepatitis B infection than in the German controls, but not higher than other migrant populations working in Germany. Prevalence of HBsAg was found to be higher overall in male patients (2.5%) and middle-aged to older patients (3.1%) compared to female and younger patients. Male patients were also more likely to exhibit anti-HBc than female patients (14.5% compared to 13.5%) however the highest levels were found amongst the over 50s age group (38%).

With regard to liver enzymes, elevated ALT and AST were recorded in 15.9% and 5.8% respectively of those refugees studied. The study further revealed that more than half of patients studied (62%) had no immunity to Hepatitis B altogether and only 18.6% had been vaccinated against the disease.

"This new research demonstrates the potential impact of health policy across Europe," said Professor Tom Hemming Karlsen, EASL Vice-Secretary. "Understanding the potential health implications of large scale migratory trends like the one Europe is currently experiencing can be challenging, however it is urgently needed. While this study looks at Hepatitis B markers in isolation, there are potential implications for surveillance of communicable diseases across the board."