International Journal of Environmental Research and Public Health
Volume 15, Issue 9, 2018

The effectiveness and cost-effectiveness of screening for and vaccination against hepatitis B virus among migrants in the EU/EEA: A systematic review (Review) (Open Access)

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.*
  • a University of Ottawa School of Epidemiology and Public Health, Ottawa, ON K1G 5Z3, Canada
  • b NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 2006, Australia
  • c Department of Medicine at the Doherty Institute, University of Melbourne, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, 3000, Australia
  • d Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, 3720, Netherlands
  • e University Department of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, Brescia, 25123, Italy
  • f NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 2006, Australia
  • g NHMRC Clinical Trials Centre, The University of Sydney, Sydney, 2006, Australia
  • h Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, Barcelona, 08193, Spain
  • i C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 7G5, Canada
  • j Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, LE1 7RH, United Kingdom
  • k European Centre for Disease Prevention and Control, Stockholm, 169 73, Sweden
  • l Bruyere Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1R 7G5, Canada

Abstract

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. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

Author Keywords

CHB Screening Migrants HBV Vaccination Refugees

Index Keywords

patient care clinical outcome refugee Cost benefit analysis mass screening economics Europe human strategic approach morbidity Hepatitis B virus program effectiveness screening health care cost infectivity Humans migrant Review high risk population European Union health services immunology prevalence hepatitis disease transmission infection prevention program evaluation migration mortality rate chronic hepatitis B Transients and Migrants vaccination disease burden hepatitis B disease incidence cost-benefit analysis practice guideline systematic review evidence based medicine program cost effectiveness immigrant population
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85052855845&doi=10.3390%2fijerph15091898&partnerID=40&md5=37f7a23ce72fef5f542a19c0b5dc047c
DOI: 10.3390/ijerph15091898
ISSN: 16617827
Cited by: 4
Original Language: English