Transmission of hepatitis B in Hamburg, Germany, 1998-2002: a prospective, population-based study.
To study the pattern of transmission of HBV in a large urban community, an in-depth prospective study was performed in Hamburg between 1 January 1998 and 31 December 2002. In total, 524 patients were classified as hepatitis B cases according to the case definition of the Robert Koch Institute, comprising 197 foreign-born and 327 German-born persons. The principal risk factor was parenteral drug use, with 17.7% (n=93/524) of all documented cases of hepatitis B, followed by immigration as refugees (13.9%; n=73). Of all 524 cases, 72 (13.7%) were associated with heterosexual (n=41) or homosexual (n=31) transmission. Household contacts of HBV carriers or of patients with acute infectious disease contributed to 9.0% of the cases (n=47). Medical procedures were most probably the source in 7.4% (n=39), although only 3.2% (n=17) of all patients were health-care workers. In multivariate analysis of household contacts, male-male sexual activity was found to be the greatest risk factor for acquiring an acute HBV infection, followed by asylum-seeking status and the number of contacts. The incidence was 3.5-fold higher among foreign-born persons (16.1 per 100,000) than among German-born individuals (4.5 per 100,000) suggesting that a targeted intervention in this population group is a public-health need. The current national policy of vaccination in defined age groups should be extended to the immunization of all children of foreign-born parents as well as the screening and immunisation of susceptible foreign-born adults.
Diel
R
R
School of Public Health c/o Institute of Medical Sociology, Heinrich Heine University, Postfach 101007, 40001 Düsseldorf, Germany. Roland.Diel@uni-duesseldorf.de
Helle
J
J
Gottschalk
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018672:Community Health Planning; D018562:Disease Transmission, Infectious; D005260:Female; D005858:Germany / Q000453:epidemiology; D006509:Hepatitis B / Q000453:epidemiology* / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D007223:Infant; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012036:Refugees; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D014505:Urban Population