World Health Matters: Germany: Concern over hepatitis B among refugees

by Gary Finnegan: People seeking refuge and asylum in Germany are at higher risks of liver problems due to hepatitis B, according to experts.

Many of the new arrivals are not vaccinated against the disease, particularly if they have fled unstable or fragile states such as Syria where health systems have broken down and routine immunisation has been compromised.

The study, presented at the International Liver Congress 2016 in Barcelona, looked particularly at communities in northern Germany and highlighted the need for more data as most people arrive without their health records.

“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, Vice-Secretary of the European Association for the Study of the Liver. “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.”