gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Transmission of hepatitis B in Hamburg, Germany, 1998–2002: a prospective, population-based study

Meeting Abstract

Suche in Medline nach

  • Roland Diel - Institut für Medizinische Soziologie, Düsseldorf

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds077

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Veröffentlicht: 8. September 2005

© 2005 Diel.
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To study the pattern of transmission of HBV in a large urban community, an in-depth prospective study – the first of its kind in Germany – was undertaken to evaluate possible risk factors for HBV infection and to compare the transmission pattern of HBV among foreign and German people in Hamburg between 1 January 1998 and 31 December 2002. The city of Hamburg (one of the German federal states and, with 1.7 million residents, the second largest city in Germany) is particularly affected. An overall incidence of 12.8 cases per 100,000 inhabitants was documented in Hamburg in 1998 this represents – as well as in the preceding years – the highest incidence rate among all 16 German federal states. Hamburg has also the highest proportion of foreign residents, 15.2%, compared with a German national average of 8.9% reported for 31 December 1998.

In total, 524 patients were classified as hepatitis B cases according to the case definition of the Robert Koch Institute, comprising 197 foreign-born and 327 German-born persons. The principal risk factor was parenteral drug use, with 17.7% (n=93/524) of all documented cases of hepatitis B, followed by immigration as refugees (13.9%; n=73). Of all 524 cases, 72 (13.7%) were associated with heterosexual (n=41) or homosexual (n=31) transmission. Household contacts of HBV carriers or of patients with acute infectious disease contributed to 9.0% of the cases (n=47). Medical procedures were most probably the source in 7.4% (n=39), although only 3.2% (n=17) of all patients were health-care workers. In multivariate analysis of household contacts, male–male sexual activity was found to be the greatest risk factor for acquiring an acute HBV infection, followed by asylum-seeking status and the number of contacts.

The incidence was 3.5-fold higher among foreign-born persons (16.1 per 100,000) than among German-born individuals (4.5 per 100,000) suggesting that a targeted intervention in this population group is a public-health need. As the results of our study clearly demonstrate, nearly twice as many foreign-born than German-born household contacts are HBsAg carriers. Thus, not only unprotected children are exposed to a risk of HBV infection transmitted by sexual or non-sexual contact with family members, e.g. sharing of toothbrushes and other toiletry articles, bed and bedding.

The mean latency period for immigrants (other than asylum-seekers) of 453 weeks between the date of entry to Hamburg and their onset of acute hepatitis B is remarkably long, indicating that this effect persists many years after the immigrants have arrived. In conclusion, foreign-born adolescents and adults should be screened on a voluntary basis, and should be immunised if they are found not to be carrying protective antibodies.

If these complementary measures are implemented by public health policy in our area, then a further reduction in the incidence of HBV cases among foreign-born individuals and in the dissemination of HBV by recent transmission may be achieved.

The observations made in this study should provide useful information for other European urban centres with similar population structures.