Background: Since 1991, thousands of refugees from southern Albania have entered north-western Greece, an area with low-to-moderate endemicity for infection with hepatitis viruses. We examined the prevalence of several markers of viral infection in this population in order to ascertain the likely impact of its presence on the epidemiology of hepatitis infections in north-western Greece. Design: Consecutive unselected serum samples were obtained from refugees resident in three different reception camps. Setting: A university hospital. Study population: One thousand and twenty-five refugees (662, males and 363 females, age range 0-81 years) and 1984 healthy controls (1293 males and 691 females, age range 0-80 years). Interventions: None. Results: We found a significantly greater prevalence of markers of infection with hepatitis A virus (prevalence of antibodies to hepatitis A virus 98.2%), hepatitis B virus (HBV; prevalence of HBV s antigen 22.2%, prevalence of HBV c antibody 70.6%, prevalence of HBV s antibody 40.5%, prevalence of HBV e antigen 21.1%, prevalence of HBV e antibody 46.2%), hepatitis C virus (prevalence of antibodies to hepatis C virus 1.75%) and hepatitis D virus (prevalence of antibodies to hepatis D virus 12.7%) among refugees from southern Albania than in healthy Greek controls. These markers were found with significantly greater frequency among younger refugees (< 30 years of age) than in older members of the same population. Conclusions: We conclude that refugees from southern Albania are a new immigrant population characterized by a high incidence of infection with hepatitis A, B and D viruses. This finding may reflect the low socioeconomic status of the immigrant population and the poor hygienic conditions experienced by its members. The high incidence of HBV and HDV infections in the population from Albania will probably increase the prevalence of infection with these viruses in Ioannina and subsequently in the whole of the Epirus region. We therefore believe that rigorous adherence to general precautions and the initiation of hepatitis B vaccination programmes will be necessary in future, both in our area and in Albania.

Hepatitis B vaccination Hepatitis A virus Hepatitis D virus Hepatitis B virus Hepatitis C virus

immigrant refugee Albania human Refugees hepatitis A controlled study priority journal comparative study Aged Hepatitis B virus hygiene school child social status Adolescent Infant, Newborn male preschool child Aged, 80 and over Infant Child, Preschool newborn female Greece prevalence hepatitis B(e) antibody Incidence Article major clinical study adult hepatitis B surface antibody hepatitis delta virus hepatitis a virus delta agent hepatitis hepatitis C antibody Hepatitis D hepatitis B hepatitis A antibody Seroepidemiologic Studies hepatitis B core antibody Biological Markers Middle Age hepatitis B antibody hepatitis C Child