Should Slovak Roma patients be screen routinely for Hepatitis B in primary care?

Author: Ann Gregory, Practice Nurse, Page Medical Centre - anngregory@nhs.net

Published Date: March 2014

Date to Review: September 2024

Partners: Page Hall Medical Centre

Dr. D.C.BRINKLEY Dr. M.C.AINGER 101, Owler Lane

Dr. H.P.EVANS Dr. C.J.BRONSDON Sheffield. S4 8GB

Dr. K.M BELLINGHAM Telephone 0114 261 7245 Fax : 0114 261 1643

Associate Principles:

Dr. P. EVANS Dr. D. LEHANE

Dr. K. VAN DER REIT

Should Slovak-Roma patients be screened routinely for hepatitis B in primary care? Report of unexpected high prevalence in a cohort in Sheffield.

Ann Marie Gregory 1 Alicia Vedio 2 Benjamin Stone 2 Stephen Green 2 Christopher Bronsdon 1

1 Page Hall Medical Centre, Sheffield, UK 2 Sheffield Teaching Hospitals NHS Foundation Trust

Introduction

In Slovakia, Roma constitute 10% of the population, and indeed the Roma are the largest minority ethnic population in the European Union, making up around 2% of the 450 million inhabitants of the EU.

Since 2004, when Slovakia joined the EU many Roma chose to leave Slovakia for Canada and the UK, and in Sheffield the City Council has estimated that currently there are approximately 3,000 Slovak-Roma residing in the City. Page Hall Medical Centre (“Page Hall”) is an inner city General Practice in Sheffield caring for a large number of migrants from many countries, including increasing numbers of people identifying themselves as Slovak-Roma.

Aim

In January 2007, Page Hall established a specialised nurse-led Slovak clinic with the objective of addressing the particular health issues of Slovak-Roma patients and minimising the potential consequences of a culture of diminished healthcare access.

Attendance at an appointment at this clinic was made an essential requisite for being allowed to register with the practice, and the assessment process was facilitated by ensuring that Slovak interpreters were present both in the reception and in the clinic. All new patients underwent a full general health check and were also offered screening for blood borne viruses, including hepatitis B.

Method

Retrospective case study. Numbers of asymptomatic patients screened in Page Hall were examined, grouping together those identified as Slovak. Children are among those reported, but only adults are screened in the practice. Prevalence of HBsAg reactivity is reported as chronic infection, and those with anti-HBcore reactivity but without HBsAg were reported as past infection.

Results

From January 2007 to December 2012, 1114 patients were screened for blood born viruses including Hepatitis B, and of these 57 were found to be HBsAg (+); showing an overall prevalence of chronic infection with hepatitis B of 5.1%.

Of these, 341 identified themselves as Slovak-Roma, of which 32 were HBsAg (+) therefore prevalence of chronic infection in this group was 9.4%. Furthermore past infection as determined by HBcoreAb (+) without evidence of HBsAg reached 28%. This contrasts with an estimated low prevalence of Hepatitis B in Slovakia as reported by WHO.

Follow-up for these patients and contact tracing proved very difficult due to their very high mobility and low health seeking behaviour. A third of those identified as chronically infected left the area without a forwarding address.

Conclusion

In line with the recent NICE guidelines, Slovak-Roma patients should be a considered a priority for screening for hepatitis B, most importantly with provision of enhanced programmes of vaccination for and patient education about hepatitis B.

An additional but related issue for consideration is how an effective contact tracing programme might best be established for a group with recognised very high mobility.

submitted on: 10/06/2013

last updated on: 04/07/2013