Next Article in Journal
Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning
Next Article in Special Issue
Pregnancy Related Health Care Needs in Refugees—A Current Three Center Experience in Europe
Previous Article in Journal
Spatial Distribution and Contamination Assessment of Surface Heavy Metals off the Western Guangdong Province and Northeastern Hainan Island
Previous Article in Special Issue
Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland
Open AccessReview

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

University of Ottawa School of Epidemiology and Public Health, Ottawa, ON K1G 5Z3, Canada
NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia
Department of Medicine at the Doherty Institute, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne 3000, Australia
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands
University Department of Infectious and Tropical Diseases University of Brescia and ASST Spedali Civili, Brescia 25123, Italy
Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, Barcelona 08193, Spain
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 7G5, Canada
Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK
European Centre for Disease Prevention and Control, Stockholm 169 73, Sweden
Bruyere Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1R 7G5, Canada
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(9), 1898;
Received: 28 June 2018 / Revised: 17 August 2018 / Accepted: 27 August 2018 / Published: 1 September 2018
(This article belongs to the Special Issue Refugee, Migrant and Ethnic Minority Health)
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. View Full-Text
Keywords: HBV; CHB; screening; vaccination; refugees; migrants HBV; CHB; screening; vaccination; refugees; migrants
Show Figures

Figure 1

MDPI and ACS Style

Myran, D.T.; Morton, R.; Biggs, B.-A.; Veldhuijzen, I.; Castelli, F.; Tran, A.; Staub, L.P.; Agbata, E.; Rahman, P.; Pareek, M.; Noori, T.; Pottie, K. The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 1898.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

Back to TopTop