Risk of hepatitis B when migrating from low to high endemic areas

ABSTRACT

Prevalence of hepatitis B virus (HBV) infections varies markedly with geography and is endemic in the Arctic. Travel and migration have increased markedly while the influence of migration to high endemic areas remains unknown. We surveyed subjects migrating from an area with a low prevalence of chronic HBV infection (Denmark, 0.01%) to an endemic HBV area (West- and East Greenland, 3% and 29%) in order to describe the prevalence of HBV exposure among migrants. We included 198 Caucasian Danes that had migrated to Greenland and repeated the cross-sectional investigation after 10 years. We performed thorough serological testing for HBV. None had ongoing HBV infection. Migrants to East Greenland were more frequently exposed to HBV than those in West Greenland (34.3% vs 10.3%; p < 0.01). This difference was reduced at 10-year follow-up (8.1% vs 5.7%; ns) and the overall number of participants with past HBV infection decreased over the 10-year period from 19.4% to 6.9% (p = 0.02). In conclusion, migration from very low prevalence to endemic HBV areas associated with a markedly increased risk of exposure to HBV. Lack of vaccination among migrants from Denmark to Greenland was frequent and it poses a continuing risk. All who migrate from low to high endemic HBV areas should be vaccinated.

Abbreviations

HBV: Hepatitis B virus; HBV-DNA: Hepatitis B virus deoxyribonucleic acid; HBsAg: Hepatitis B surface antigen; Anti-HBs: Antibodies against hepatitis B surface antigen; Anti-HBc: Antibodies against hepatitis B core antigen; BMI: Body mass index

KEYWORDS:

• Hepatitis B
• migration
• low endemic
• high endemic
• arctic
• vaccination

Acknowledgments

We gratefully acknowledge the invaluable support from Queen Ingrid’s Healthcare Center in Nuuk and staff at the hospital and nursing stations in East Greenland.

Disclosure statement

This study poses no conflicts of interest.

Contribution by the individual authors:

HBK: Conception of idea, study design, raising of funds, analysis and interpretation of data, and writing of the manuscript.

KFR: Conception of idea, data collection, analysis and interpretation of data, and reviewing of the manuscript.

SA: Conception of idea, study design, raising of funds, data collection, analysis and interpretation of data, and writing of the manuscript.

Additional information

Funding

This study was supported by grants from: Greenland Government; Karen Elise Jensen Foundation; Northern Jutland Research Foundation.