title: Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis.
abstract: BACKGROUND
  International migrants experience increased mortality from hepatocellular carcinoma compared to host populations, largely due to undetected chronic hepatitis B infection (HBV). We conducted a systematic review of the seroprevalence of chronic HBV and prior immunity in migrants arriving in low HBV prevalence countries to identify those at highest risk in order to guide disease prevention and control strategies.
  
  
  RESULTS
  Medline, Medline In-Process, EMBASE and the Cochrane Database of Systematic Reviews were searched. Studies that reported HBV surface antigen or surface antibodies in migrants were included. The seroprevalence of chronic HBV and prior immunity were pooled by region of origin and immigrant class, using a random-effects model. A random-effects logistic regression was performed to explore heterogeneity. The number of chronically infected migrants in each immigrant-receiving country was estimated using the pooled HBV seroprevalences and country-specific census data. A total of 110 studies, representing 209,822 immigrants and refugees were included. The overall pooled seroprevalence of infection was 7.2% (95% CI: 6.3%-8.2%) and the seroprevalence of prior immunity was 39.7% (95% CI: 35.7%-43.9%). HBV seroprevalence differed significantly by region of origin. Migrants from East Asia and Sub-Saharan Africa were at highest risk and migrants from Eastern Europe were at an intermediate risk of infection. Region of origin, refugee status and decade of study were independently associated with infection in the adjusted random-effects logistic model. Almost 3.5 million migrants (95% CI: 2.8-4.5 million) are estimated to be chronically infected with HBV.
  
  
  CONCLUSIONS
  The seroprevalence of chronic HBV infection is high in migrants from most world regions, particularly among those from East Asia, Sub-Saharan Africa and Eastern Europe, and more than 50% were found to be susceptible to HBV. Targeted screening and vaccination of international migrants can become an important component of HBV disease control efforts in immigrant-receiving countries.
authors.affiliation: Centre for Clinical Epidemiology and Community Studies of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada. carmine.rossi@mail.mcgill.ca
authors.forename: Carmine
authors.initials: C
authors.lastname: Rossi
authors.forename: Ian
authors.initials: I
authors.lastname: Shrier
authors.forename: Lee
authors.initials: L
authors.lastname: Marshall
authors.forename: Sonya
authors.initials: S
authors.lastname: Cnossen
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Guido
authors.initials: G
authors.lastname: Schwarzer
authors.forename: Chris
authors.initials: C
authors.lastname: Greenaway
mesh_terms: D017954:Africa South of the Sahara; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000821:virology; D054242:Emigrants and Immigrants; D005061:Europe, Eastern; D005202:Asia, Eastern; D005843:Geography; D006515:Hepatitis B virus / Q000378:metabolism*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications / Q000821:virology*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D012036:Refugees; D012044:Regression Analysis; D016036:Seroepidemiologic Studies