Hepatitis B in Albanian refugees across Southeast Europe: from epidemiology to vaccination and prevention policy

Authors K.H. Katsanos, B.F. Resuli, E.V. Tsianos.


In 1991, a serious political and socioeconomic crisis in
Albania caused a massive migration of refugees to
Northwestern Greece (Ioannina region) and to the Apulia
region of Southern Italy. Seroepidemiological data on viral
hepatitis marker distribution of among refugees indicated
a high HBV infection endemicity in these Albanian refugees.
More updated epidemiological information on hepatitis B
marker prevalence of the young, non-vaccinated Albanian
population became available through the national Greek-
Albanian collaborative study on prevention of viral hepatitis
and hepatocellular carcinoma (known with the acronym as
the HEPAGA study). This study showed that 11.89% of the
tested Albanian group was HBsAg(+) while only 21.19% of
the group were immunoprotected against HBV. A critical
point for all countries to reach or fail to reach the 1997
WHO targets is their social and political commitment to
preventive medicine and vaccines, besides their effort to
inform and educate both the general public and medical
societies. In Southeastern Europe, where acute and chronic
HBV infection is a major health problem, selected riskgroup
vaccination policy will have no impact on this
infection and will not be able to control further transmission
from this HBsAg(+) young, carrier pool. In addition, the increasing number of immigrants from high to intermediate
or low endemicity regions such as Greece and Italy
forms a new dynamic epidemiology of hepatitis B transmission.
Sustaining available vaccination programmes
against HBV is one of the greatest challenges for the near
future. Other challenges are increasing vaccine coverage,
continuous support in order to maintain a sustainable
supply of vaccine and other related facilities and, finally,
to successfully monitor the effectiveness of currently implemented
vaccination programmes.
Key words: Hepatitis B, refugees, epidemiology, vaccination,
Albania, Greece