Tanja Wörmann

Changing epidemiology of Hepatitis B and migration—a comparison of six Northern and North-Western European countries

BACKGROUND Increased migration volume and different Hepatitis B prevalence between immigration and emigration countries have changed the Hepatitis B virus (HBV) epidemiology considerably in Northern and North-Western European migrants-receiving countries. Due to the difference in migration status monitoring, the HBV infection data on migrants are not easily comparable among those countries. The study aims were: to compare the migration status indicators used by the national surveillance system in six Northern and North-Western European countries (the Netherlands, Germany, Finland, Denmark, Sweden and the UK); to determine the impact of the migration status on HBV infection by comparing the available data on prevalence and transmission routes of Hepatitis B in the migration and the general population in the six countries; to recommend sensible indicators and pertinent measures for HBV infection surveillance and control in the region. METHODS Literature review, statistical data analysis on migration and HBV infection in the six countries; expert interviews to identify migration status indicators used in national surveillance systems. RESULTS Evident differences were found between the migration and the general population in Hepatitis B prevalence and transmission routes in the six countries. Migration status is monitored differently in six surveillance systems; immigrants from high/intermediate Hepatitis B endemic countries constitute a substantial proportion of HBsAg(+) and chronic cases in all six countries. CONCLUSIONS International migration has an obvious impact on Hepatitis B prevalence in the six countries. It is important to include common migration status indicators and to collect comparable data for HBV infection surveillance in different notification systems.

Migrants and hepatitis B: new strategies for secondary prevention needed

Migration of individuals with chronic hepatitis B virus (HBV) infection from endemic countries contributes substantially to the prevalence of chronic HBV infection in low-endemic countries.1 This is reflected in case notifications where chronic infections are frequently reported in first generation migrants and the high diversity of HBV genotypes found in chronic infections in The Netherlands.2,3 Consequently, the burden of illness caused by chronic HBV infection in low-endemic countries is largely carried by first generation migrants. Now that in recent years treatment for chronic HBV infection has improved with new antiviral drugs such as adefovir, entecavir …

Availability of indicators of migration in the surveillance of HIV, tuberculosis and hepatitis B in the European Union – a short note

Background and aimData regarding infectious diseases in migrant populations in Europe are scarce. We aimed to assess whether information on migration status is collected in countries of the European Union (EU) as part of their national surveillance systems for major infectious diseases (HIV/AIDS, tuberculosis (TB) and hepatitis B infection).MethodsUsing different electronic sources we collected information about whether indicators of migration status were collected in national infectious diseases surveillance systems in European countries.ResultsOf 27 EU countries, migration status was recorded in all 27 countries for TB surveillance (100%), in 22 countries for HIV (~82%) and in 23 countries for AIDS (~85%). Eight of 20 countries (40%) recorded migration status in hepatitis B surveillance systems. The most commonly recorded indicator of migration status was country of birth. Among countries which conducted migrant specific surveillance, country of birth was collected in ~82% of TB, ~86% of HIV, and ~83% of AIDS surveillance systems. Other indicators of the migration status were ethnicity (used in HIV and AIDS surveillance) and citizenship (TB surveillance).ConclusionWe showed differences in how migration status is recorded in surveillance systems from European countries. This was especially true for tuberculoses and hepatitis B, whereas data collection as part of HIV/AIDS surveillance was nearly uniform. These results suggest the need for a more uniform reporting of migration status as part of infectious disease surveillance in EU countries.

[Serological and sociodemographic differences in HBV-patients with and without migration background].

BACKGROUND It is estimated that 0.5 to 1 % of the total German population is chronically infected with the hepatitis B virus (HBV). This means that approximately 500 000 chronically infected individuals live in Germany and that around 10 % of them need antiviral treatment. According to an epidemiological calculation, around 42 % of them are migrants. The aim of our study was to gather more information on socio-demographic features of HBV patients and the sero-epidemological status and treatment of these patients. METHODS Data collection was carried out in hepatological practices and outpatient clinics in Germany. We collected data from adult patients with chronic hepatitis B by studying their patient records and interviewing the patients and the responsible physicians. RESULTS Data of 160 patients from 20 different facilities could be collected. 57.5 % of them were male, mean age was 43.7 (range: 19 - 81 years). 61 (38.1 %) were Germans without a migration background, 82 (51.3 %) were first generation migrants and 17 (10.6 %) second generation migrants. We detected significant differences in the level of professional training and employment status between participants with and without migration background. Only 3 % of migrants had a university degree compared to 36.1 % of patients without migration background. In addition, more migrants were unemployed (38.9 % vs. 19.6 %). From all participants 72.4 % were HBeAg-negative. 111 (69.4 %) of all patients received a hepatitis B specific treatment at the time they were interviewed, most of them adefovir (41.5 %) or lamivudin (35.4 %) alone. DISCUSSION The estimated high HBV prevalence in migrants from countries with intermediate to high prevalence is reflected in the high number of patients with migration background in hepatological practices and outpatient clinics. To avoid further HBV infections in this population group and to reduce the HBV prevalence in Germany, the effect of further interventions, like a general HBV screening of all new incoming migrants from intermediate or high endemic areas, their vaccination and if necessary treatment, have to be tested.Background: It is estimated that 0.5 to 1% of the total German population is chronically infected with the hepatitis B virus (HBV) This means that approximately 500 000 chronically infected individuals live in Germany and that around 10% of them need antiviral treatment According to an epidemiological calculation, around 42% of them are migrants The aim of our study was to gather more information on socio-demographic features of HBV patients and the sero-epidemological status and treatment of these patients. Methods: Data collection was carried out in hepatological practices and outpatient clinics in Germany We collected data from adult patients with chronic hepatitis B by studying their patient records and interviewing the patients and the responsible physicians Results: Data of 160 patients from 20 different facilities could be collected. 57 5% of them were male, mean age was 43.7 (range. 19-81 years). 61 (38.1%) were Germans without a migration background, 82 (51.3%) were first generation migrants and 17 (10 6%) second generation migrants. We detected significant differences in the level of professional training and employment status between participants with and without migration background. Only 3% of migrants had a university degree compared to 36.1% of patients without migration background. In addition, more migrants were unemployed (38.9% vs 196%) From all participants 72 4% were HBeAg-negative. 111 (69 4%) of all patients received a hepatitis B specific treatment at the time they were interviewed, most of them adefovir (41 5%) or lamivudin (35.4%) alone. Discussion: The estimated high HBV prevalence in migrants from countries with intermediate to high prevalence is reflected in the high number of patients with migration background in hepatological practices and outpatient clinics. To avoid further HBV infections in this population group and to reduce the HBV prevalence in Germany, the effect of further interventions, like a general HBV screening of all new incoming migrants from intermediate or high endemic areas, their vaccination and if necessary treatment, have to be tested

Klimawandel, Überschwemmungen, Gesundheitskonsequenzen und Bewältigungsstrategien: Der Fall Bangladesch

Bangladesch ist eines der Lander auf der Welt, die am meisten durch den Klimawandel gefahrdet sind und es ist fast jedes Jahr Naturkatastrophen ausgesetzt. Uberschwemmungen sind die haufigste Naturkatastrophe in diesem Land und in letzter Zeit treten diese immer haufiger auf. Uberschwemmungen konnen sowohl als Folge des Klimawandels (z. B. Anstieg des Meeresspiegels und von Niederschlagen) als auch aufgrund von anthropogenen Faktoren (z. B. Anderung in der Landnutzung, Abholzung, Aufschutten von Wasserflachen, um neue Behausungen zu errichten) auftreten. Uberschwemmungen haben Auswirkungen auf fast alle Bereiche wie Wohnungsbau, Infrastruktur, Landwirtschaft, Fischerei, Wasser, sanitare Anlagen, Ernahrung, Migration und Gesundheitsversorgung. Ein groser Anteil von armen Menschen, die von einer Flut betroffen sind, migrieren in stadtische Gebiete, um der Armut zu entfliehen und um dort ihren Lebensunterhalt zu sichern. Stadte und Kustengebiete im Allgemeinen und insbesondere arme Migranten sind stark von Uberschwemmungen betroffen. Durch Uberschwemmungen hervorgerufene Probleme wie Umweltschaden, Wohnungsmangel, Ernahrungsunsicherheit und ungeplante Verstadterung verstarken die Gesundheitsprobleme in Bangladesch deutlich. Um die durch Klimawandel und Uberschwemmungen hervorgerufenen Belastungen in Bangladesch zu reduzieren, ist die Umsetzung von sowohl strukturellen wie auch nicht strukturellen Masnahmen und Strategien dringend erforderlich.

Klimawandel und Gesundheit: Grundlagen und Herausforderungen für den Public Health-Sektor

Der Klimawandel kann an verschiedenen Ereignissen wie z. B. der zunehmenden Erderwarmung, dem Anstieg von Extremwetterereignissen, Starkniederschlagen, Trockenperioden etc. festgemacht werden. Diese haben direkte bzw. indirekte Folgen sowohl fur die Gesundheit einzelner Menschen, als auch fur die gesamte Bevolkerung. Insbesondere bei der Krankheitslast durch Infektionskrankheiten und nicht-infektiose Erkrankungen lassen sich klimawandelbedingte Veranderungen erkennen, aber auch die Krankheitslast durch Verletzungen, Migrationen und gewaltsame Konflikte wird durch den Klimawandel beeinflusst. Das Ausmas und die Art der Klimawandelfolgen hangen stark von der Vulnerabilitat einer Region, eines Systems oder einer Bevolkerungsgruppe ab. Diese ist bei der Planung und Umsetzung von Masnahmen zur Anpassung an den Klimawandel zu berucksichtigen. Flankierend dazu sollten auch in Zukunft Masnahmen des Klimaschutzes vorangetrieben werden. Auf all die genannten Aspekte wird in diesem Kapitel einfuhrend eingegangen und es werden die Herausforderungen fur den Public Health- Bereich herausgearbeitet.