Sandra Coenen1, Suzanne van Meer2, Jan M Vrolijk3, Clemens Richter4, Karel J van Erpecum2, Marijke C Mostert5, Irene K Veldhuijzen5, Jurriën G P Reijnders6, Hanneke van Soest7, Kees Dirksen8, Joost P H Drenth9, René P M Koene10, Maaike Bosschart11, Pieter Friederich12, Martijn J Ter Borg13, Rick H P J Daemen14, Joop E Arends15, Marc A M T Verhagen16, Christine Schout17, B W Marcel Spanier3. 1. Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands. sandracoenen80@yahoo.com. 2. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands. 4. Department of Internal Medicine and Infectious diseases, Rijnstate Hospital Arnhem, Arnhem, the Netherlands. 5. Department of Infectious Disease Control, Municipal Health Services, Rotterdam, the Netherlands. 6. Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands. 7. Department of Gastroenterology and Hepatology, Medical Center Haaglanden The Hague, The Hague, the Netherlands. 8. Department of Infectious Disease Control, Municipal Health Services, The Hague, the Netherlands. 9. Department of Gastroenterology and Hepatology, Radboudumc Nijmegen, Nijmegen, the Netherlands. 10. Department of Infectious Disease Control, Municipal Health Services, Gelderland Zuid, the Netherlands. 11. Department of Infectious Disease Control, Municipal Health Services, Gelderland Midden, the Netherlands. 12. Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands. 13. Department of Gastroenterology and Hepatology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands. 14. Departments of Infectious Disease Control, Municipal Health Services, Eindhoven, the Netherlands. 15. Department of Internal Medicine and Infectious diseases, University Medical Center Utrecht, Utrecht, the Netherlands. 16. Department of Gastroenterology and Hepatology, Diakonessen Hospital Utrecht, Utrecht, the Netherlands. 17. Departments of Infectious Disease Control, Municipal Health Services, Utrecht, the Netherlands.
Abstract
BACKGROUND & AIMS: In low-endemic countries it is debated whether first-generation migrants should be screened for chronic hepatitis B infection. We describe the clinical impact of five large-scale Dutch screening projects for hepatitis B in first-generation Chinese migrants. METHODS: Between 2009 and 2013 five independent outreach screening projects for hepatitis B targeting first-generation Chinese migrants were conducted in five main Dutch regions. To explore the relevance of our screening we defined clinical impact as the presence of an indication for: (i) antiviral therapy, (ii) strict follow-up because of high hepatitis B DNA levels and/or (iii) surveillance for hepatocellular carcinoma. RESULTS: In total, 4423 persons participated in the projects of whom 6.0% (n = 264) were HBsAg positive. One hundred and twenty-nine newly diagnosed HBsAg-positive patients were analysed in specialist care. Among these patients prevalence of cirrhosis was 6.9% and antiviral therapy for hepatitis B was started in 32 patients (25%). In patients without a treatment indication, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma was considered indicated in 64 patients (50%). CONCLUSIONS: In our screening project in first-generation Chinese migrants, antiviral treatment, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma were considered indicated in three of four analysed HBsAg-positive patients. These data show that detection of hepatitis B in Chinese migrants can have considerable impact on patient care.
BACKGROUND & AIMS: In low-endemic countries it is debated whether first-generation migrants should be screened for chronic hepatitis B infection. We describe the clinical impact of five large-scale Dutch screening projects for hepatitis B in first-generation Chinese migrants. METHODS: Between 2009 and 2013 five independent outreach screening projects for hepatitis B targeting first-generation Chinese migrants were conducted in five main Dutch regions. To explore the relevance of our screening we defined clinical impact as the presence of an indication for: (i) antiviral therapy, (ii) strict follow-up because of high hepatitis B DNA levels and/or (iii) surveillance for hepatocellular carcinoma. RESULTS: In total, 4423 persons participated in the projects of whom 6.0% (n = 264) were HBsAg positive. One hundred and twenty-nine newly diagnosed HBsAg-positive patients were analysed in specialist care. Among these patients prevalence of cirrhosis was 6.9% and antiviral therapy for hepatitis B was started in 32 patients (25%). In patients without a treatment indication, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma was considered indicated in 64 patients (50%). CONCLUSIONS: In our screening project in first-generation Chinese migrants, antiviral treatment, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma were considered indicated in three of four analysed HBsAg-positive patients. These data show that detection of hepatitis B in Chinese migrants can have considerable impact on patient care.
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