Choose a region checklist:


CCIRH Logo uOttawa logo
Bruyere logo

Global Refugees Checklist
© CCIRH 2013 All Rights Reserved

Overview of Hepatitis B

The mortality rate from chronic viral hepatitis and hepatocellular carcinoma is up to four times higher among immigrants than the Canadian born population. Hepatitis B vaccination is routinely given to all children as part of Canada's national immunization program, but there is no routine catch-up vaccination for immigrants:

Key Recommendations:

Hepatitis B: Screening

*≥ 2% HBsAg positive = Africa, Asia, Eastern Europe and parts of South America

Quality of Evidence: MODERATE

Balance of benefits and harms Values and preferences
  • Prevalence of chronic hepatitis B virus infection is higher among immigrants and refugees than among North Americans (mean 4% v. < 0.5%).
  • Screening for and then treating advanced chronic hepatitis B virus infection reduces the development of progressive liver failure (NNT 19, 95% CI 15–44).
  • Screening for hepatocellular carcinoma (by ultrasonography and serologic testing for αFP every 6 months) in certain risk groups with chronic hepatitis B virus infection decreases the risk of death from hepatocellular carcinoma (NNS 2058, 95% CI 1462–4412).
  • Toxicity varies by treatment regimen, but most therapies are well tolerated.

The committee attributed more value to:

  • preventing progressive liver failure and death from hepatocellular carcinoma

Attributed less value to:

  • the burden of screening for and treatment of adverse effects

Hepatitis B: Vaccination

Key Recommendations for Hepatitis B Vaccination:

*≥ 2% HBsAg positive = Africa, Asia, Eastern Europe and parts of South America

Quality of Evidence: MODERATE

Balance of benefits and harms Values and preferences
  • Universal perinatal and childhood vaccination in countries where chronic hepatitis B virus infection is endemic have dramatically reduced chronic infection with hepatitis B virus (NNV 12, 95% CI 11–12) and decreased mortality from hepatocellular carcinoma (RR 0.725, 95% CI 0.518–1.015) 15 yr after initiation of vaccination programs.
  • In countries with low seroprevalence of chronic hepatitis B virus infection (< 2% HBsAg positive), vaccination of adults decreases development of acute infection.
  • Adverse reactions to vaccination are minor and self limited.

The committee attributed more value to:

  • reducing transmission of hepatitis B virus infection, a potentially fatal disease, to close contacts

The committee attributed less value to:

  • the burden of screening and vaccination

Links to Other Learning Resources

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer L, Ueffing E, MacDonald N, Hassan G, McNally M, Kahn K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P and co-authors of the Canadian Collaboration for Immigrant and Refugee Health. Overview: Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183(12):E824-E925.

Design and Production: Centre for e-Learning, Teaching and Learning Support Service (TLSS), University of Ottawa