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The Need for Including Hepatitis a Vaccine in Routine Childhood Immunization Programs in Europe as a Response to the Influx of Refugees from the Middle East and North Africa (MENA) Regions

Authors: S. Ramia, N. Melhem, K. Kreidieh


The world is facing an unprecedented displacement crisis. Recently, over 1.1 million asylum seekers have been granted protection status in the European Union (EU). The majority of these asylum seekers were from countries of the Middle East and North Africa (MENA) region.This influx carries with it a potential introduction of infectious diseases that have been eliminated in the EU, which poses a challenge for EU health authorities. Compared to MENA region countries where Hepatitis A Virus (HAV) endemicity is high to intermediate, member states of the EU show very low (Western Europe) to low (Eastern Europe) levels of HAV endemicity. Because of this situation, there is an ongoing public health concern in high-income countries, like members of the EU, that many adults remain susceptible to HAV outbreaks. The overwhelming majority of the EU members’ states do not include HAV vaccine in their immunization calendars. Hence, this paper urgently calls for the implementation of new policies regarding HAV in EU members’ states.

Keywords: European Union, Hepatitis A, MENA Region Refugees, Vaccine preventable diseases.

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[1] UNHCR. “UNHCR Mid-Year Trends 2015”.2015.
[2] UNHCR.”UNHCR Global Appeal 2015 Update- Europe Regional Summary”.2015.
[3] “Adapting to migration as a planetary force”, in Lancet, London, England, vol. 386, 2015, pp. 1013.
[4] Tajaldin B, Almilaji K, Langton P, Sparrow A, “Defining Polio: Closing the Gap in Global Surveillance”, Annals of Global Health, vol. 81, 2015, pp. 386-395.
[5] Djebbi A, Bahri O, Mokhtariazad T, Alkhatib M, Ben Yehyia A, Rezig D, et al., “Identification of Measles virus genotypes from recent outbreaks in countries from the Eastern Mediterranean Region”, Journal of Clinical Virology: the official publication of the Pan American Society for Clinical Virology, vol. 34, 2005, pp. 1-6.
[6] Cousins S, “Syrian Crisis: health experts say more can be done”, in Lancet, London, England, vol. 385, 2015, pp. 931-934.
[7] Matheny SC, Kingery JE, “Hepatitis A”, American family physician, vol. 86, 2012, pp. 1027-1034, quiz 10-2.
[8] Jacobsen KH, Wiersma ST, “Hepatitis A virus seroprevalence by age and world region”, Vaccine, vol. 28, 2010, pp. 6653-6657.
[9] Ciocca M, “Clinical course and consequences of Hepatitis A infection”, Vaccine, vol. 18, 2000, supplement 1, pp. 71-74.
[10] Daniels D, Grytdal S, Wasley A, “Surveillance for acute viral hepatitis –United States 2007”, Morbidity and mortality weekly report Surveillance summaries, Washington, DC, vol. 58, 2009, pp. 1-27.
[11] Jacobsen KH, Koopman JS, “Declining Hepatitis S seroprevalence: a global review and analysis”, Epidemiology and Infection, vol. 132, 2004, pp. 1005-1022.
[12] Jacobsen KH, Koopman JS, “The effects of socioeconomic development on worldwide hepatitis A virus seroprevalence patterns”, International Journal of Epidemiology, vol. 34, 2005, pp. 600-609.
[13] Luyten J, Beutels P, “Costing infectious disease outbreaks for economic evaluation: a review for hepatitis A”, PharmacoEconomics, vol. 27, 2009, pp. 379-389.
[14] Melhem NM, Talhouk R, Rachidi H, Ramia S, “Hepatitis A virus in the Middle East and North Africa region: a new challenge”, Journal of viral hepatitis, vol. 21, 2014, pp. 605-615.
[15] Mohd Hanafiah K, Jacobsen KH, Wiersma ST, “ Challenges to mapping the health risk of hepatitis A infection”, International journal of health geographics, vol. 10, 2011, pp. 57.
[16] Alkhalidi J, Alenezi B, Al-Mutfi S, Hussain E, Askar H, Kemmer N, et al., “Seroepidimiology of hepatitis A virus in Kuwait”, World journal of gastroenterology, vol. 15, 2009, pp. 102-105.
[17] Almuneef MA, Memish ZA, Balkhy HH, Qahtani M, Alotaibi B, Hajeer A, et al., “Epidemiologic shift in the prevalence of Hepatitis A virus in Saudi Arabia: a case for routine Hepatitis A vaccination”, Vaccine, vol. 24, 2006, pp. 5599-5603.
[18] Bener A, Al-Kaabi S, Derbala M, Al-Marri A, Rikabi A, “The epidemiology of viral hepatitis in Qatar”, Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, vol. 20, 2009, pp. 300-306.
[19] Sharar ZA, Rajah J, Parsons H, “Childhood seoprevalence of hepatitis A in the United Arab Emirates”, Tropical doctor, vol. 38, 2008, pp. 65-66.
[20] Hayajneh WA, Balbeesi A, Faouri S, “Hepatitis A virus age-specific sero-prevalence and risk factors among Jordanian Children”, Journal of medical virology, vol. 87, 2015, pp. 569-574.
[21] Letaief A, Kaabia N, Gaha R, Bousaadia A, Lazrag F, Trabelsi H, et al., “Age-specific seroprevalence of hepatitis A among school children in central Tunisia”, The American journal of tropical medicine and hygiene, vol. 73, 2005, pp. 40-43.
[22] Melhem NM, Jaffa M, Zaatari M, Awada H, Salibi NE, Ramia S, “The changing pattern of hepatitis A in Lebanese adults”, International Journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases, vol. 30, 2015, pp. 87-90.
[23] Castkova J, Benes C, “Increase in hepatitis A cases in the Czech Republic in 2008- an update”, Euro surveillance: bulletin European sur les maladies transmissibles = European communicable diseases bulletin, vol. 14, 2009.
[24] Perevoscikovs J, Lucenko I, Magone S, Brila A, Curikova J, Vennema H, “Community-wide outbreak of hepatitis A in Latvia in 2008- an update”, Euro surveillance: bulletin European sur les maladies transmissibles = European communicable diseases bulletin, vol. 14, 2009.
[25] Arie S, “Polio outbreak leads to calls for a “vaccination ceasefire” in Syria”, BMJ, Clinical Research edition, vol. 347, 2013, pp. 6682.
[26] World Health Organization UCsF, “Over 20 million children to be vaccinated in Syria and neighboring countries against polio, say WHO and UNICEF”, 2013.
[27] Eichner M, Brockmann SO, “Polio emergence in Syria and Israel endangers Europe”, in Lancet, London, England, vol. 382, 2013, pp. 1777.
[28] Hives-Wood S, “Syrian refugees could bring polio to Europe, experts warn”, BMJ, Clinical Research Edition, vol. 347, 2013, pp. 6778.
[29] Northdurft HD, “Hepatitis A vaccines”, Expert review of vaccines, vol. 7, 2008, pp. 535-545.
[30] Kohl I, Nemecek V, Summerova M, Chlibek R, Nad’ova K, Minarikova O, “Long-term protective effect of post-exposure Havrix administration during viral hepatitis Type A outbreaks”, European Journal of epidemiology, vol. 21, 2006, pp. 893-899.
[31] Lopez EL, Contrini MM, Mistchenko A, Debbag R, “Long-term immunity after two doses of inactivated hepatitis A vaccine, in Argentinean Children”, The Pediatric infectious disease journal, vol. 29, 2010, pp. 568-570.
[32] Van Herck K, Van Damme P, “Prevention of hepatitis A by Harvix: a review”, Expert review of vaccines, vol. 4, 2005, pp. 459-471.
[33] Van Herck K, Jacquet JM, Van Damme P, “Antibody persistence and immune memory in healthy adults following vaccination with a two-dose inactivated hepatitis A vaccine: long-term follow-up at 15 years”, Journal of medical virology, vol. 83, 2011, pp. 1885-1891.
[34] Bovier PA, Bock J, Loutan L, Farinelli T, Glueck R, Herzog C, “Long-term immunogenicity of an inactivated virosome hepatitis A vaccine”, Journal of medical virology, vol. 68, 2002, pp. 489-493.
[35] Brundage SC, Fitzpatrick AN, “Hepatitis A”, American family physician, vol. 73, 2006, pp. 2162-2168.
[36] Organization WH, “WHO vaccine-preventable diseases: monitoring system”, 2015 global summary, 2015.
[37] Severi E, Tavoschi L, Carillo Santisteve P, Bonfigli S, Westrell T, Arnheim Dahlstrom L, et al., “Hepatitis A incidence in the EU: what can we learn from the available data?”, Journal of viral hepatitis, vol. 22, 2015, pp. 1-18.