Hospital Division of Infectious Diseases, Spedali Civili General Hospital, Brescia, Italy.
J Travel Med. 2015 Mar-Apr;22(2):78-86. doi: 10.1111/jtm.12176. Epub 2014 Nov 26.
Screening migrants from areas where hepatitis B virus (HBV) infection is endemic is important to implement preventive measures in Europe. The aim of our study was to assess (1) the feasibility of point-of-care screening in a primary care clinic and (2) hepatitis B surface antigen (HBsAg) prevalence, associated risk factors, and its clinical and epidemiological implications in undocumented migrants in Brescia, northern Italy.
A longitudinal prospective study was conducted from January 2006 to April 2010 to assess HBsAg reactivity and associated risk factors among consenting undocumented migrants who accessed the Service of International Medicine of Brescia's Local Health Authority. Genotyping assay was also performed in HBV DNA-positive patients.
Screening was accepted by 3,728/4,078 (91.4%) subjects consecutively observed during the study period, 224 (6%) of whom were found to be HBsAg-positive. HBsAg reactivity was independently associated with the prevalence of HBsAg carriers in the geographical area of provenance (p < 0.001). On the contrary, current or past sexual risk behaviors (despite being common in our sample) were not associated with HBV infection. Half of the HBsAg patients (111/224) had either hepatitis B e-antigen (HBeAg)-positive or -negative chronic HBV infection with a possible indication for treatment. HBV genotypes were identified in 45 of 167 HBV-infected patients as follows: genotype D, 27 subjects; genotype A, 8; genotype B, 5; and genotype C, 5. The geographical distribution of genotypes reflected the geographic provenance.
Our results suggest that point-of-care screening is feasible in undocumented migrants and should be targeted according to provenance. Case detection of HBV infection among migrants could potentially reduce HBV incidence in migrants' contacts and in the general population by prompting vaccination of susceptible individuals and care of eligible infected patients.
在乙型肝炎病毒（HBV）感染流行地区对移民进行筛查对于在欧洲实施预防措施非常重要。我们的研究目的是评估（1）在初级保健诊所进行即时检测的可行性，以及（2）在意大利北部布雷西亚的无证移民中，HBsAg 流行率、相关危险因素及其临床和流行病学意义。
2006 年 1 月至 2010 年 4 月期间进行了一项纵向前瞻性研究，以评估同意进入布雷西亚地方卫生局国际医学服务的无证移民中 HBsAg 反应性及相关危险因素。还对 HBV DNA 阳性患者进行了基因分型检测。
在所研究期间连续观察的 4078 名受试者中，有 3728 名（91.4%）接受了筛查，其中 224 名（6%）被发现 HBsAg 阳性。HBsAg 反应性与原籍地区 HBsAg 携带者的流行率独立相关（p<0.001）。相反，当前或过去的性风险行为（尽管在我们的样本中很常见）与 HBV 感染无关。224 名 HBsAg 患者中有 111 名（50%）为 HBeAg 阳性或阴性慢性 HBV 感染，可能需要治疗。在 167 名 HBV 感染患者中鉴定出 45 种 HBV 基因型，分别为：基因型 D，27 例；基因型 A，8 例；基因型 B，5 例；基因型 C，5 例。基因型的地理分布反映了地理来源。
我们的结果表明，即时检测在无证移民中是可行的，应根据原籍国进行针对性检测。在移民中发现 HBV 感染病例，通过对易感个体进行疫苗接种和对符合条件的感染患者进行护理，有可能降低移民接触者和普通人群中 HBV 的发病率。
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