fd02144311a64e3d7ee3b7b25c490167 pmc_30200406.pdf ca81a8c9ef0caf2ffca012895fbaf03092695e02 pmc_30200406.pdf 07a995863999e3d360e41a7781dfcfc76d03a5f22706ab74b56c5c5188df2e07 pmc_30200406.pdf Title: The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review Subject: Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention. Keywords: HBV; CHB; screening; vaccination; refugees; migrants Author: Daniel T Myran, Rachael Morton, Beverly-Ann Biggs, Irene Veldhuijzen, Francesco Castelli, Anh Tran, Lukas P Staub, Eric Agbata, Prinon Rahman, Manish Pareek, Teymur Noori and Kevin Pottie Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Sat Sep 1 05:15:59 2018 CEST ModDate: Sat Sep 1 05:15:59 2018 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 19 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 975414 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SCCVVP+URWPalladioL-Ital Type 1 Custom yes yes no 74 0 JJOVQY+URWPalladioL-Bold Type 1 Custom yes yes no 75 0 OXBKYU+TeXGyreAdventor-Bold Type 1 Custom yes yes no 76 0 TPQGQV+URWPalladioL-Roma Type 1 Custom yes yes no 77 0 PKKOBI+VnURWPalladioL Type 1 Custom yes yes 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