Population-based comparative epidemiological survey of hepatitis B, D, and C among Inuit migrated to Denmark and in high endemic Greenland

Abstract

Objective. Infection with hepatitis B virus (HBV) is endemic among Arctic populations where it may have a benign course. However, the relation of HBV to migration to low endemic areas is unknown, as it is for hepatitis D and C, and details on the influence of delta virus at a population level are lacking. Material and methods. Population-based investigation of Greenlanders living in Denmark (n = 136) and in Greenland (n = 441). We tested for HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe, HBV-DNA, HBV genotypes, anti-HDV, HDV-RNA, anti-HCV, HCV-Elisa test, HCV-RNA, aspartate aminotransferase, gamma-glutamyl transferase, bilirubin, and albumin, and performed a physical examination. Results. Participation rate was 52/95% in Denmark/Greenland. Half of participants in Denmark had lived more than half of their lives in Denmark, and 54.5% had been exposed to HBV. This was similar to 53% among Greenlanders living in West Greenland (p = 0.76). HBsAg was positive in 4.4% of Greenlanders in Denmark (n = 6), who all were anti-HBe positive and had low viral load. Serological signs of HBV infection associated with having both parents born in Greenland (p = 0.007) and with IV drug use (p = 0.03). We found serological signs of HDV exposure among participants in Denmark/Greenland in 0.7/1.1% (n = 1/5) and HCV exposure in 1.5/0.0% (n = 2/0). Liver biochemistry was elevated in Greenlanders exposed to HDV. Conclusions. Hepatitis B, D, and C occurrences among Greenlanders in Denmark mirrored that of Greenland. Importantly, previously undetected exposure to delta virus associated with elevated liver biochemistry, and the introduction of delta virus is a liability to Greenlanders and to Greenland.

Key Words::

• arctic Greenland
• Denmark
• Greenland Inuit
• health
• hepatitis B virus infection
• hepatitis C virus infection
• hepatitis D virus infection
• migration
• viral load

Acknowledgements

Supported by grants from Greenland Homerule; the Aalborg City Christmas Lottery; the Obel Family Foundation; the Northern Jutland Research Foundation; the Danish Hospital Foundation for Medical Research region of Copenhagen, the Faroe Islands, and Greenland.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.