title: Hepatitis B virus infections among children and adolescents in Germany: migration background as a risk factor in a low seroprevalence population.
abstract: BACKGROUND
  Data on hepatitis B (HB) infection prevalence among children and adolescents in Germany are scarce. We estimated seroprevalence of HB infection and assessed determinants for HB infection among children and adolescents in Germany from a representative population sample.
  
  
  METHODS
  From 2003 to 2006, the Robert Koch Institute conducted a nationwide cross-sectional Health Interview and Examination Survey for Children and Adolescents in Germany. Data on age, gender, migration background, and socioeconomic status were collected through questionnaires. A child was defined as having a 2-sided migration background if both parents, or the child and 1 parent, immigrated, and a 1-sided migration background if only 1 parent immigrated. Among children with migration background, a first-generation migrant was defined as born outside Germany; a second-generation migrant was born in Germany. Information on HB vaccination status was obtained from vaccination cards. Serologic samples from participants were tested for anti-hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen. We performed weighted univariable and multivariable logistic regression analyses to assess determinants for HB infection.
  
  
  RESULTS
  Of 13,065 participants (3-17 years), 0.5% (95% confidence interval [CI], 0.4-0.7) were anti-HBc positive, among whom 38.7% (95% CI, 20.0-57.5) were hepatitis B surface antigen positive. Two-sided migration background and being a first- or second-generation migrant were significantly associated with anti-HBc positivity (odds ratio [OR]: 8.3, 95% CI: 4.0 –17.4; OR: 11.0, 95% CI: 3.5-35.0; OR: 3.0, 95% CI: 1.2-7.3). No further determinants were found.
  
  
  CONCLUSIONS
  HB infection is rare among children and adolescents in Germany. First- and second-generation migrant children can be considered to be at risk for HB infection, 2-sided migration background or being a first-generation migrant carried the greatest risk. Targeted testing for HB infection and early HB vaccination should be provided to immigrants' children.
authors.affiliation: Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
authors.forename: Christina
authors.initials: C
authors.lastname: Poethko-Müller
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.forename: Doris
authors.initials: D
authors.lastname: Radun
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009313:National Health Programs; D011159:Population Surveillance; D012044:Regression Analysis; D012307:Risk Factors; D016036:Seroepidemiologic Studies
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines