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

Author

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  • Daniel T Myran

    (University of Ottawa School of Epidemiology and Public Health, Ottawa, ON K1G 5Z3, Canada)

  • Rachael Morton

    (NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia)

  • Beverly-Ann Biggs

    (Department of Medicine at the Doherty Institute, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne 3000, Australia)

  • Irene Veldhuijzen

    (Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands)

  • Francesco Castelli

    (University Department of Infectious and Tropical Diseases University of Brescia and ASST Spedali Civili, Brescia 25123, Italy)

  • Anh Tran

    (NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia)

  • Lukas P Staub

    (NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia)

  • Eric Agbata

    (Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, Barcelona 08193, Spain)

  • Prinon Rahman

    (C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 7G5, Canada)

  • Manish Pareek

    (Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK)

  • Teymur Noori

    (European Centre for Disease Prevention and Control, Stockholm 169 73, Sweden)

  • Kevin Pottie

    (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.

Suggested Citation

  • Daniel T Myran & Rachael Morton & Beverly-Ann Biggs & Irene Veldhuijzen & Francesco Castelli & Anh Tran & Lukas P Staub & Eric Agbata & Prinon Rahman & Manish Pareek & Teymur Noori & Kevin Pottie, 2018. "The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review," IJERPH, MDPI, vol. 15(9), pages 1-19, September.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:9:p:1898-:d:167028
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    References listed on IDEAS

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    1. Ruggeri, Matteo & Cicchetti, Americo & Gasbarrini, Antonio, 2011. "The cost-effectiveness of alternative strategies against HBV in Italy," Health Policy, Elsevier, vol. 102(1), pages 72-80, September.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    Cited by:

    1. Osnat Keidar & David S. Srivastava & Emmanouil Pikoulis & Aristomenis K. Exadaktylos, 2019. "Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?," IJERPH, MDPI, vol. 16(8), pages 1-8, April.
    2. Lukas Kratzsch & Kayvan Bozorgmehr & Joachim Szecsenyi & Stefan Nöst, 2022. "Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities," IJERPH, MDPI, vol. 19(11), pages 1-18, May.

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