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New wave of immigration blamed for doubling of hepatitis B cases in UK
  Nov 21, 2007
Nigel Hawkes, Health Editor
Soaring rates of infection by hepatitis B, fuelled by large-scale immigration, pose a serious health threat that is not being addressed properly, a report has said.
The Hepatitis B Foundation estimates that the numbers infected by the disease in Britain have almost doubled in the past five years, to 326,000. More than half of these people are immigrants from Africa, Asia, Russia and the new EU nations.
Hepatitis B has few symptoms. If untreated it can lead to serious liver disease including liver cancer, and death, decades after infection. World-wide, 500,000 to 700,000 people die every year as a result of infection by the virus.
Britain, unlike 85 per cent of countries, does not have the universal vaccination against hepatitis B that is recommended by the World Health Organisation. Instead, the policy is to vaccinate selectively, attempting to prevent the spread of the disease from mothers to children, for example.
The report cautions that growing levels of undetected infections are a health time bomb that needs to be defused urgently. It calls on the Government to develop a strategy for dealing with the problem.
"Much more needs to be done," the report says. "There is a serious risk that in the future, while chronic hepatitis B virus (HBV) infection declines in countries which have implemented universal vaccination, the UK - that great pioneer of public health - will continue to harbour an ever-increas-ing pool of chronic HBV infection."
Damian Green, the Conservative immigration spokesman, said: "This is an alarming report and it is reasonable to expect from the Government an urgent response about testing those people coming into the country."
Hepatitis B is transmitted in many of the same ways as HIV - through sex, shared needles, blood, from mother to baby at birth, or from person to person by contact with skin grazes. The difference is that hepatitis B is ten times as easy to transmit as HIV.
David Mutimer, a reader in medicine at the University of Birmingham, who treats liver disease at Queen Eliza-beth Hospital in the city, said: "It's pretty obvious that the number of patients is increasing exponentially year on year and it is quite clear the effect that migration is having on the numbers. The report doesn't come to definite conclusions about what needs to be done, but my opinion is that universal vaccination is the best answer."
Since most cases of infection are unknown, even to the individuals concerned, the report by the Hepatitis B Foundation, a charity that raises awareness of the disease, estimates the numbers by using the prevalence rate in each country and multiplying that by the numbers of people from that country now living in Britain. By working through all the national groups, the report comes up with a total of 326,000 cases in Britain, almost double the 180,000 estimated by Sir Liam Donaldson, the Chief Medical Officer, in his 2002 report Getting Ahead of the Curve.
The 326,000 figure is almost certainly an underestimate because only countries that have contributed more than 60,000 people to the population were included. The numbers originating from each country came from the Labour Force Survey and are themselves probably underestimates.
Eddie Chan, the director of the Chinese National Healthy Living Centre, said: "With a surge of migration from countries with a high HBV prevalence rate we are not surprised by these figures. Britain needs migrant workers and in return Britain must set in place the infrastructure to deal with the changing health demographics."
The report calls for a public education campaign, a reappraisal of the vaccination policy, action to identify and treat those who are infected and a mapping exercise to find how services for HBV infection are distributed across the country.
The Department of Health responded to the report by saying that Britain had one of the lowest prevalence rates of hepatitis B in the world and that the incidence of acute infection remained relatively stable and low. A range of measures was in place to control it.
- A report in the Journal of the American Medical Association reported last month that since immunisation against HBV was introduced in the US in the 1980s, cases had fallen by 80.1 per cent and deaths by 80.2 per cent.
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