Incidence of acute hepatitis B in different ethnic groups in a low-endemic country, 1992-2009: increased risk in second generation migrants.
BACKGROUND
The Netherlands is a low-incidence country for acute hepatitis B (HBV) infection (1.2/100,000 in 2010), where it is typically acquired in adulthood through injecting drug use or homosexual exposure. Recently, the number of heterosexually acquired acute infections in the Netherlands has increased. Ethnicity may be a risk factor. We describe trends in the incidence of acute HBV among heterosexual adults in ethnic groups in Amsterdam from 1992 to 2009 and discuss future control of HBV in the Netherlands.


METHODS
We studied all cases of acute HBV acquired in heterosexuals aged ≥15 years in the Amsterdam region (1992-2009, n=238) by ethnic group. Incidence rates were estimated as the average number of cases per 100,000 per year. Using Poisson regression, we calculated univariable and multivariable incidence rate ratios (IRR) by ethnic group over calendar year, by age and gender.


RESULTS
The incidence in first generation migrants from HBV-endemic countries (FGM) was 4.1/100,000 showing no trend over time. Since 1999, incidence in Dutch-born cases in Amsterdam has increased by 13% annually from 0.2/100,000 in 1999 to 2.1/100,000 in 2009 (annual IRR 1.13, 95% CI:1.0-1.22). From 2004 to 2009, the incidence in native Dutch/Western in Amsterdam was 1.6/100,000 (reference for IRR), in FGM was 4.3/100,000 (IRR of 2.7, 95% CI:1.8-4.2) and in Dutch-born second generation migrants (SGM) was 3.7/100,000 (IRR:2.4, 95% CI:1.2-4.7).


CONCLUSIONS
Incidence of acute hepatitis B in Amsterdam in FGM and SGM is higher than in the native Dutch population. Low-endemic countries with migrant populations from HBV-endemic areas should consider offering screening and vaccination to both FGM and SGM.
Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Nieuwe Achtergracht 100, 1000 CE Amsterdam, The Netherlands. jwhelan@ggd.amsterdam.nl
Jane
J
Whelan
Gerard
G
Sonder
José
J
Heuker
Anneke
A
van den Hoek
D000293:Adolescent; D000328:Adult; D005006:Ethnicity; D006509:Hepatitis B / Q000453:epidemiology*; D020010:Heterosexuality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment; D014171:Transients and Migrants; D055815:Young Adult