Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania, Via: L. Armanni 5, 80131, Naples, Italy.
Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano di Caserta, 81100, Caserta, Italy.
Infect Dis Poverty. 2019 Mar 15;8(1):17. doi: 10.1186/s40249-019-0528-6.
At present, there is a continuous flow of immigrants from the south of the world to north-western countries. Often immigrants originate from areas of high-prevalence of viral hepatitis and pose a challenge to the healthcare systems of the host nations. Aims of this study is to evaluate the prevalence and virological and clinical characteristics of hepatitis C virus (HCV) infection in immigrants and the strategies to identify and take care of the immigrants infected with HCV.
We conducted an electronic literature search in several biomedical databases, including PubMed, Google Scholar, Scopus, Web of Science, using different combinations of key words: "HCV infection; chronic hepatitis C, immigrants; low-income countries". We included studies written in English indicating the epidemiological data of HCV infection in the immigrant population, studies that assessed the clinical presentation, clinical management and treatment with directly acting antiviral agent in immigrants, HCV infection is unevenly distributed in different countries, with worldwide prevalence in the general population ranging from 0.5 to 6.5%. In Western countries and Australia this rate ranges from 0.5 to 1.5%, and reaches 2.3% in countries of south-east Asia and eastern Mediterranean regions, 3.2% in China, 0.9% in India, 2.2% in Indonesia and 6.5% in Pakistan; in sub-Saharan Africa the prevalence of HCV infection varies from 4 to 9%. Immigrants and refugees from intermediate/high HCV endemic countries to less- or non-endemic areas are more likely to have an increased risk of HCV infection due to HCV exposure in their countries of origin. Because of the high HCV endemicity in immigrant populations and of the high efficacy of directly acting antiviral agent therapy, a campaign could be undertaken to eradicate the infection in this setting.
The healthcare authorities should support screening programs for immigrants, performed with the help of cultural mediators and including educational aspects to break down the barriers limiting access to treatments, which obtain the HCV clearance in 95% of cases and frequently prevent the development of liver cirrhosis and hepatocellular carcinoma.
目前，来自世界南方的移民不断流向西北国家。这些移民通常来自高病毒肝炎流行地区，给宿主国家的医疗保健系统带来挑战。本研究旨在评估移民中丙型肝炎病毒（HCV）感染的流行率以及病毒学和临床特征，并确定和照顾感染 HCV 的移民的策略。
我们在几个生物医学数据库中进行了电子文献检索，包括 PubMed、Google Scholar、Scopus、Web of Science，并使用了不同的关键词组合：“HCV 感染；慢性丙型肝炎、移民；低收入国家”。我们纳入了以英文撰写的研究，这些研究表明了移民人群中 HCV 感染的流行病学数据，评估了 HCV 感染在移民中的临床表现、临床管理和直接作用抗病毒药物治疗的研究，HCV 感染在不同国家的分布不均，全球普通人群的感染率在 0.5%至 6.5%之间。在西方国家和澳大利亚，这一比例在 0.5%至 1.5%之间，而在东南亚和东地中海地区的国家达到 2.3%，在中国为 3.2%，在印度为 0.9%，在印度尼西亚为 2.2%，在巴基斯坦为 6.5%；在撒哈拉以南非洲，HCV 感染的流行率在 4%至 9%之间。来自丙型肝炎高流行国家的移民和难民到低流行或非流行地区，由于在原籍国接触 HCV，感染 HCV 的风险增加。由于移民人群中 HCV 流行率较高，直接作用抗病毒药物治疗效果较高，因此可以在这一环境中开展消灭感染的运动。
医疗保健当局应支持移民筛查计划，在文化调解员的帮助下进行，并包括教育方面，以消除限制治疗机会的障碍，这种治疗方法可获得 95%的 HCV 清除率，并经常预防肝硬化和肝细胞癌的发展。
