(P37) Viral Hepatitis Prevalence and Crises-Driven Migration: Shifting Disease Landscapes in Northern Europe
Kenneth Valles [1,2], Andres Inzunza [1,3], Kritika Prasai , Lewis R Roberts 
1-Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester 2- The Johns Hopkins Bloomberg School of Public Health 3- Tecnologico de Monterrey, School of Medicine
Background: Hepatitis B and C viruses causes chronic inflammation of the liver and can lead to cirrhosis, liver failure, and hepatocellular carcinoma. The World Health Organization’s goal of eliminating hepatitis B and C by 2030 requires strategic screening and treatment in each nation. Crises-driven mass migrations from high-prevalence nations to Northern Europe likely increased viral hepatitis burdens. In order for policy and practice to effectively address the increase in disease, the magnitude of the burden must be determined. We aimed to generate an estimate of recent changes in hepatitis B and C prevalence for the five Northern European countries of Iceland, Norway, Sweden, Denmark, and Finland resulting from migration from six high-crises nations.
Methods: Total migrant population from 2013-2017 was obtained from respective national databases. Demographics including country-of-origin, sex, and age distributions were used to determine migrant contributions to HBV and HCV prevalence where available. Country-of-origin HBV and HCV burden magnitudes were obtained for Syria, Iraq, Afghanistan, Pakistan, Nigeria and Somalia from the Polaris Observatory and systematic reviews. Disease outcomes were estimated using population-wide HBV and HCV outcome data from Northern Europe.
Results: Between 2013 and 2017, a total of 340,671 documented migrants arrived to the five host nations. 208,973 migrants were from Syria, 34,185 from Iraq, 39,631 from Afghanistan, 13,986 from Pakistan, 5,268 from Nigeria, and 38,628 from Somalia. An estimated 21,964 migrants were HBV positive, and 9,594 were HCV positive. The most significant increases in total hepatitis case number (HBV 14,502 and HCV 6,396) and percent increases in national prevalence (HBV 73.9% and HCV 16.3%) were seen in Sweden. The average HBV increase without Sweden was 9.96%, and HCV was 5.9%.
Conclusions: Crises-driven migration has significantly changed HBV and HCV disease burden in Northern Europe over the past 5 years. Consequently, long-term outcomes of cirrhosis and HCC are also expected to increase. These increases are likely to disproportionally impact individuals of the migrant and refugee communities. Viral hepatitis surveillance and management programs must strategically focus on individuals from high-burden age cohorts and nations. Screening and treatment would aid WHO elimination efforts while benefiting both the vulnerable individuals and host nations through reduction of morbidity, mortality, and associated healthcare expenses.