L’ Epatite Virale B nel Migrante

XIII Convegno dell’INFP

Roma, 17 febbraio 2015

Maria Chiara Pezzoli

Malattie Infettive –Brescia

Profilo sanitario del migrante e aree critiche di assistenza

Ambito materno infantile • abortività spontanea • mortalità perinatale • basso peso alla nascita • mortalità neonatale • mortalità materna • ricorso all’IVG • evasione calendario vaccinale

Ambito dell’infortunistica in particolare incidenti sul lavoro

Ambito disagio psico-sociale • prostituzione • detenzione

• emarginazione grave

• Fallimento del progetto migratorio

Ambito malattie infettive: Tubercolosi

Malattie sessualmente trasmesse Epatiti virali Parassitosi intestinali Malaria

La normativa nazionale in

tema di assistenza sanitaria

agli immigrati in Italia

1. The prevalence of chronic hepatitis B and of hepatitis

B carriers across Europe is actually changing, with

migration causing significant increases in prevalence

rates.

Background

Andamento dell’incidenza di nuove diagnosi di epatite B in Italia dal 1995 al 2005

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

5

1995 1997 1999 2001 2003 2005

nuovi casi/100.000ab

Sorveglianza dell’epatite B in Europa Rantala M, Van de Laar MJ

European Centre for Disease Control and Prevention, Stockholm, Sweden. Eurosurveillance, vol.13. issues 4-6. Apri-Jun 2008

3. The incidence of hepatitis B amongst immigrants,

particularly those from countries of high or

intermediate HBV endemicity, is much higher than

among ‘national’ populations in most European

Union (EU) countries.

Background

1. Beutels et al. Eur J Epidemiol 1997;13:275-80; 2. Roudot-Thoraval et al. Gastroenterol Clin Biol 1989;13:353-6; 3. Vall Mayans et al. Enfern Infecc Microbiol Clin 2002;20:154-6; 4. Panagopoulos et al. J Matern Fetal Neonatal Med 2004;16:106-10; 5. Stroffolini T, et al. Vaccine 2003;7:1246-9

Beutels

(1997)

Roudot-Thorval

(1989)

Vall Mayans

(2002)

Panagopoulos

(2004)

Stroffolini

(2003)

0

5

10

Belgium1 France2 Spain3 Greece4 Italy5

HB

sA

g p

revale

nc

e (

%)

Host population Newcomer population

The Prevalence of Hepatitis B Surface Antigen (HBsAg)

is Higher in Newcomer vs. Host Populations in Western

Europe

In press on J of Travel Medicine

Prevalenza di HBV in migranti a Brescia

931 women of childbearing age

Caratteristiche demografiche

Marocco Marocco

http://www.medfor.net/special/infettiv/epatiti/epidem.htm#2

Fattori di rischio per l’infezione da HBV

1

0.479

1

Fattori di rischio per l’infezione da HBV

Distribuzione geografica dei genotipi

1) Six per cent of immigrants are HBsAg+ with the same

prevalence observed in countries of birth, thus HBV

infection has probably been acquired during their first years

of life.

2) 50% of them show data suggestive of a potentially

progressive disease.

3) Determination of HBV genotype might be useful in the

menagement of hepatitis B in immigrants in our countries.

Conclusions - 1

4) 50% of immigrants are naive for HBV and international

vaccination policies seems not to have a significant impact on

HBV prevalence in this population

5) screening for HBV of immigrants coming from areas with

high prevalence of HBV infection is essential for early

identification and treatment of those infected and for vaccination

and health education of those non infected: preventive

campaigns and vaccination programmes could be the key

success factor in reducing the incidence rates within these

populations.

Conclusions - 2