Understanding the burden of chronic hepatitis B in Europe and UK and the role of migration

Abstract

Chronic hepatitis B (CHB) remains a significant public health concern globally, with a disproportionate burden among migrant populations in low-endemic countries such as the UK. This thesis used multiple data sources to evaluate evidence on hepatitis B virus (HBV) distribution and HBV prevalence among different population groups, including migrants.
Initially, I undertook a systematic review to update and evaluate HBV prevalence estimates in the EU/EEA/UK general population and key risk groups. In the EU/EEA/UK, HBV prevalence remains low (≤2%) in the general population but is considerably higher among migrants and people in prison, ranging between 5.8%-8.3%.
Live births data for the UK, linked to maternal country of birth, was used to examine the contribution of non-UK born persons to the UK HBV burden. This analysis demonstrated that while HBV prevalence among UK-born women was low (0.02%), it was 30 times higher among non-UK-born pregnant women. The highest HBV prevalence (≥2%) was observed among women from Eastern Europe, Eastern and Southeast Asia, and Western Africa. The extrapolation of live births data to the 2021 UK Census revealed a lower HBV burden estimate (n=119,896) than expected.
I then developed and used a dynamic compartmental modelling framework to combine published country-level HBV prevalence estimates with UK incoming migration data to simulate the expected inflow of CHB among migrants to the UK from 2000 to 2019. This dynamic model estimates an average CHB prevalence of 3.2% among incoming UK migrants. The burden is concentrated among migrants aged ≥15yrs. In 2019, the expected vaccination coverage was high (70-80%) among young (0-14yrs) migrants and low (≤10%) among older (≥15yrs) migrants.
This thesis provides valuable insights into the epidemiology of CHB in the UK and Europe, targeted screening of the non-UK-born population aged 15 years and above may improve case-finding and reduce the undiagnosed HBV burden.

Date of Award	17 Jun 2025
Original language	English
Awarding Institution	University of Bristol
Supervisor	Anna McNaughton (Supervisor), Josephine G Walker (Supervisor), Aaron G Lim (Supervisor) & Hannah Fraser (Supervisor)