Viral hepatitis in Germany: poor vaccination coverage and little knowledge about transmission in target groups.

BACKGROUND: In Germany, vaccination against hepatitis B is recommended for infants, children and adolescents since 1995 and for specific target groups since 1982. Little is known about knowledge about viral hepatitis and attitudes toward hepatitis B vaccination-factors likely to influence vaccine uptake. METHODS: In order to estimate vaccination coverage in adult target groups and in the overall adult population and to assess knowledge and attitudes, we conducted a nationwide cross-sectional telephone survey among 412 persons in November 2004. We defined participants as being vaccinated if they reported at least one previous vaccination against hepatitis B. RESULTS: Vaccination coverage (vc) standardised for age, sex and residence was 29.6% in the general population and 58.2% in target groups for hepatitis B vaccination. Particular gaps in vaccine coverage were detected among health care workers (vc: 69.5%) and chronically ill persons (vc: 22.0%). Knowledge on risk factors and transmission was far below expectations, whereas the acceptance of vaccination in the majority of the population (79.0%) was good. CONCLUSION: We conclude that educational measures could lead to a higher vaccination uptake in adult target groups.

Hepatitis B virus infections among children and adolescents in Germany: migration background as a risk factor in a low seroprevalence population.

BACKGROUND: Data on hepatitis B (HB) infection prevalence among children and adolescents in Germany are scarce. We estimated seroprevalence of HB infection and assessed determinants for HB infection among children and adolescents in Germany from a representative population sample. METHODS: From 2003 to 2006, the Robert Koch Institute conducted a nationwide cross-sectional Health Interview and Examination Survey for Children and Adolescents in Germany. Data on age, gender, migration background, and socioeconomic status were collected through questionnaires. A child was defined as having a 2-sided migration background if both parents, or the child and 1 parent, immigrated, and a 1-sided migration background if only 1 parent immigrated. Among children with migration background, a first-generation migrant was defined as born outside Germany; a second-generation migrant was born in Germany. Information on HB vaccination status was obtained from vaccination cards. Serologic samples from participants were tested for anti-hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen. We performed weighted univariable and multivariable logistic regression analyses to assess determinants for HB infection. RESULTS: Of 13,065 participants (3-17 years), 0.5% (95% confidence interval [CI], 0.4-0.7) were anti-HBc positive, among whom 38.7% (95% CI, 20.0-57.5) were hepatitis B surface antigen positive. Two-sided migration background and being a first- or second-generation migrant were significantly associated with anti-HBc positivity (odds ratio [OR]: 8.3, 95% CI: 4.0 ­17.4; OR: 11.0, 95% CI: 3.5-35.0; OR: 3.0, 95% CI: 1.2-7.3). No further determinants were found. CONCLUSIONS: HB infection is rare among children and adolescents in Germany. First- and second-generation migrant children can be considered to be at risk for HB infection, 2-sided migration background or being a first-generation migrant carried the greatest risk. Targeted testing for HB infection and early HB vaccination should be provided to immigrants' children.

Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany--a case-control study.

OBJECTIVES: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding.

Prevention of viral hepatitis in the Nordic countries and Germany.

The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in the Nordic countries and Germany, in order to review the epidemiological situation, the surveillance systems for infectious diseases, the immunization programmes and policy, and the monitoring of adverse events after hepatitis vaccination in those countries, to evaluate prevention and control measures, and to identify the issues that arose and the lessons learnt. Considerable progress has been made in the past decades in the prevention and control of viral hepatitis in the respective countries. Vaccination programmes have been set up, blood products' safety has significantly been improved, and outbreak investigations remain the basis for the implementation of control measures. However, additional work remains to be done. Awareness of viral hepatitis among the public and professionals should further be raised, and more political support is needed regarding the value of prevention efforts and vaccination programmes.