title: Hepatitis C in the general population of various ethnic origins living in the Netherlands: should non-Western migrants be screened?
abstract: OBJECTIVE
  Little is known about the HCV prevalence in non-Western migrant populations. To determine whether targeted HCV screening and prevention programs for migrants are needed, we examined HCV prevalence and determinants among non-Western, Western migrants, and the native Dutch population in the Netherlands.
  
  
  METHODS
  Data were obtained from four surveys: (1) 3895 heterosexual visitors recruited during biannual surveys at the STI-clinic Amsterdam, 2007-2009; (2) random sample of 4563 pregnant women in Amsterdam, 2003; (3) population-based random sample of 1309 inhabitants of Amsterdam, 2004; (4) population-based random sample of 4428 people living in the Netherlands, 2006-2007. Characteristics associated with HCV-positivity were examined and phylogenetic analysis was used to obtain insight in the geographical origin of HCV strains.
  
  
  RESULTS
  HCV seroprevalence in the four surveys was low (0.3-0.6%). In total 4860/14,195 (34%) were non-Western and 9329/14,195 (66%) Western participants (including Dutch). First-generation non-Western migrants were more likely to be HCV-positive (0.7-2.3%) than Western participants (0.1-0.4%). Except for survey 3, second-generation non-Western migrants had a lower HCV prevalence than first-generation migrants, comparable to Western migrants and the Dutch population. Phylogenetic analysis showed that the majority of the HCV-positive, first-generation non-Western non-European migrants were infected with endemic strains which are rarely observed in Europe.
  
  
  CONCLUSIONS
  First-generation non-Western migrants are at increased risk for HCV. Phylogenetic analysis suggests that transmission likely took place in the country of origin, causing introduction but no further transmission of endemic HCV strains in the Netherlands. HCV screening and prevention programs should target first-generation, but not second-generation, non-Western migrants.
authors.affiliation: Cluster of Infectious Diseases, Amsterdam Public Health Service, Amsterdam, The Netherlands. aurbanus@ggd.amsterdam.nl
authors.forename: Anouk T
authors.initials: AT
authors.lastname: Urbanus
authors.forename: Thijs J W
authors.initials: TJ
authors.lastname: van de Laar
authors.forename: Anneke
authors.initials: A
authors.lastname: van den Hoek
authors.forename: Freke R
authors.initials: FR
authors.lastname: Zuure
authors.forename: Adrianus G C L
authors.initials: AG
authors.lastname: Speksnijder
authors.forename: Gijs G G
authors.initials: GG
authors.lastname: Baaten
authors.forename: Titia
authors.initials: T
authors.lastname: Heijman
authors.forename: Henrike J
authors.initials: HJ
authors.lastname: Vriend
authors.forename: Eline L M
authors.initials: EL
authors.lastname: Op de Coul
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D004641:Emigration and Immigration; D005006:Ethnicity; D005260:Female; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult