Hepatitis and liver disease knowledge and preventive practices among health workers in Mexico: a cross-sectional study

Objectives

To assess the knowledge and preventive practices regarding hepatitis and liver disease among a sample of participants in the Mexican Health Worker Cohort Study.

Methods

The study population consisted of 892 participants from Cuernavaca, Mexico. Demographic characteristics, knowledge about hepatitis B, hepatitis C, and liver disease in general, as well as information about prevention practices were obtained from self-reported questionnaires. Participants were grouped into categories that were created using information about their professional background and patient contact status. Knowledge and prevention practices were compared within these categories.

Results

Inadequate levels of knowledge and preventive practices were found, even within the more highly educated group. Nearly 57 % of the participants had inadequate knowledge about liver disease in general, while 76 and 79 % had inadequate knowledge about Hepatitis B virus (HBV) and Hepatitis C virus (HCV), respectively. For general liver disease, the mean knowledge score increased significantly with education, history of HCV screening, and low alcohol consumption.

Conclusions

Health workers should be better educated about hepatitis and liver disease so they can reduce their own risk and share their knowledge of how to prevent liver disease with patients.

     

Strategies to prevent and control hepatitis B and C virus infections: a global perspective

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of acute and chronic liver disease worldwide. Chronic infection with these viruses often leads to chronic liver disease, including cirrhosis or primary hepatocellular carcinoma. Both HBV and HCV are bloodborne viruses; however, HBV is transmitted efficiently by both percutaneous and mucosal exposures, and HCV is transmitted predominantly by percutaneous exposures. Because the relative importance of various modes of transmission of these viruses differs by country, the choice of specific prevention and control strategies depends primarily on the epidemiology of infection in a particular country. Comprehensive hepatitis B prevention strategies should include (1) prevention of perinatal HBV transmission, (2) hepatitis B vaccination at critical ages to interrupt transmission and (3) prevention of nosocomial HBV transmission. The prevention of hepatitis C is problematic because a vaccine to prevent HCV infection is not expected to be developed in the foreseeable future. From a global perspective, the greatest impact on the disease burden associated with HCV infection will most likely be achieved by focusing efforts on primary prevention strategies to reduce or eliminate the risk for transmission from nosocomial exposures (e.g. blood transfusion, unsafe injection practices) and high-risk practices (e.g. injecting drug use).     

Knowledge of Viral Hepatitis Among Puerto Rican Adults: Implications for Prevention

Although primary prevention of HAV and HBV can be achieved through vaccination, the burden of HCV can only be reduced through behavioral interventions to reduce its risk factors. This study evaluated knowledge regarding transmission, clinical manifestations and prevention of viral hepatitis in Puerto Rico. We assessed the level of knowledge about HAV (six questions), HBV (12 questions) and HCV (eight questions) among non-institutionalized Puerto Rican adults aged 21-64?years. Demographic characteristics and self-reported knowledge of these infections were determined through a face-to-face interview. A mean knowledge score was computed by summing correct responses to each scale. Mean knowledge scores according to demographics were compared using ANOVA or the Kruskal-Wallis test. Mean knowledge scores for HAV, HBV and HCV infections were 2.6?±?1.5, 6.1?±?2.4, and 3.6?±?1.1, respectively. For HAV and HBV infections, the mean knowledge score significantly (P?相似文献   

An Analysis of Content in Comprehensive Cancer Control Plans that Address Chronic Hepatitis B and C Virus Infections as Major Risk Factors for Liver Cancer

Chronic hepatitis B and hepatitis C virus (HBV and HCV) infections are among the leading causes of preventable death worldwide. Chronic viral hepatitis is the cause of most primary liver cancer, which is the third leading cause of cancer deaths globally and the ninth leading cause of cancer deaths in the United States. The extent to which comprehensive cancer control (CCC) programs in states, tribal governments and organizations, territories, and Pacific Island jurisdictions address chronic hepatitis B and/or hepatitis C infections as risk factors for liver cancer or recommend interventions for liver cancer prevention in their CCC plans remains unknown. We searched CCC plans for this information using the search tool at http://www.cdc.gov/cancer/ncccp/ to access the content of plans for this information. A combination of key search terms including "liver cancer", "hepatitis", "chronic alcohol", and "alcohol abuse" were used to identify potential content regarding liver cancer risk factors and prevention. Relevant content was abstracted for further review and classification. Of 66 (Although CDC funds 65 programs, one of the Pacific Island Jurisdiction grantees is the Federated States of Micronesia (FSM). This national program supports four FSM states, each of which submits a cancer plan to CDC for a total of 69 plans. During this time period, 66 plans were available on the website.) CCC plans, 27% (n?=?18) addressed liver cancer using the above-mentioned search terms. In the 23 plans that addressed HBV and/or HCV, there were 25 goals, objectives, strategies, and outcomes aimed at reducing the incidence or prevalence of HBV and/or HCV infection. While nearly a third of CCC programs identify at least one goal, objective, strategy, outcome, or prevention program to reduce cancer burden in their CCC plans, few plans discuss specific actions needed to reduce the burden of liver cancer.     

Past excessive alcohol consumption: a major determinant of severe liver disease among newly referred hepatitis C virus infected patients in hepatology reference centers, France, 2001

PURPOSE: Our study aimed to identify factors associated with the occurrence of severe liver disease in hepatitis C virus (HCV) positive patients at first referral to hepatology reference centers in France in 2001. METHODS: Patients reported through the national hospital-based hepatitis C surveillance system in 2001 were included. The definition of severe liver disease was based on clinical, biological, and morphological evaluation; cirrhosis (+/- complication) and primary liver cancer were classified as severe liver disease. Patient characteristics were compared for those with and without severe liver disease. RESULTS: Of the 3404 newly referred patients in the 26 participating centers, 391 (11.5%) had severe liver disease. Male gender (adjusted odds ratios [aOR]=1.4; 95% confidence interval [CI], 1.0-1.9), age over 39 years at referral (aOR=3.8; 95% CI, 2.7-5.3), past excessive alcohol consumption (aOR=2.6; 95% CI, 1.9-3.5), and HIV seropositivity (aOR=1.9; 95% CI, 1.1-3.3) were each independently associated with an increased risk of severe liver disease. In the subgroup of patients with known age at time of HCV exposure, age over 39 years at time of exposure (aOR=1.6; 95% CI, 1.1-2.4), duration of HCV infection over 15 years (aOR=2.6; 95% CI, 1.8-3.7), known HBs antigen positivity (aOR=2.4; 95% CI, 1.1-5.2), and past excessive alcohol consumption (aOR=2.7; 95% CI, 1.8-3.9) were each associated with increased risk of severe liver disease. CONCLUSIONS: Our findings underscore the important role of past excessive alcohol consumption on the development of severe liver disease for HCV patients.     

The relationships of chronic hepatitis and cirrhosis to alcohol intake,hepatitis B and C,and delta virus infection: a case-control study in Albania.

The present study examined the effect of hepatitis B virus (HBV) and alcohol intake, and the role of hepatitis delta virus (HDV) and hepatitis C virus (HCV) in the aetiology of chronic liver disease in Albania. A total of 106 cases of liver cirrhosis or chronic hepatitis were compared to 195 control patients without these or other liver diseases. Adjusted odds ratios were 52.7 (95% CI 22.7-122) for HBV surface antigen, 26.9 (95% CI 4.9-147) for anti-HCV, 26.2 (95% CI 3-1-221) for anti-HDV, 2.4 (95% CI 1.3-4.4) for lifetime alcohol intake and 2.3 (95% CI 1-5.5) for duration of alcohol intake. Although not significant, an interaction was suggested between HBsAg and anti-HCV and between HBsAg and alcohol intake. Our study underlines the role of hepatitis viruses in the development of chronic liver diseases. Additionally, it suggests that heavy alcohol intake may magnify the effect of HBV on these diseases. HBV vaccination and alcohol abstention appear to be important strategies to reduce the risk of liver cirrhosis and chronic hepatitis in Albania.     

Risk factors associated with hepatocellular carcinoma notified to the Anti–Cancer Council of Victoria in 1991–1992

Abstract: The study aimed to estimate the prevalence of risk factors for liver disease, particularly hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, in a population–based series of hepatocellular carcinoma, and to assess the feasibility of retrospective surveys in determining risk factors for hepatocellular carcinoma. A survey of all cases of hepatocellular carcinoma diagnosed in 1991 and 1992 documented the high contribution of alcoholic cirrhosis, particularly in Australian–born men. Low levels of testing for HBV and HCV made their contribution to hepatocellular carcinoma uncertain. No cases of hepatocellular carcinoma due to HBV or HCV were reported in Australian–born subjects. Higher rates of HBV carriage in those tested were found in Asian and Mediterranean immigrants. Testing for HCV was known to have occurred for less than a quarter of subjects, and assessment for multiple aetiological risk factors was rare. The burgeoning epidemic of HCV will require improved surveillance for the sequelae of long–term infection. Satisfactory surveillance will require cooperation from clinicians in regard to the completeness of medical records and adequate resources for cancer registries to supplement their passive reporting system with exposure data. (Aust N Z J Public Health 1997; 21: 626–30)     

Multiple infections and associated risk factors among non-injecting cocaine users in Argentina

The aim of this study was to estimate the seroprevalence rates of human immunodeficiency virus (HIV), hepatitis B virus (HBV, core antibody), hepatitis C virus (HCV), and syphilis infections and analyze associated risk factors among 504 non-injecting cocaine users (NICU) in Buenos Aires, Argentina. Participants were interviewed in face-to-face sessions through a short structured questionnaire. Using venipuncture, 10 mL of blood was collected. Seroprevalence rates were: HIV (6.3%), HBV (9%), HCV (7.5%), and VDRL (4.2%). The risk of being infected with HIV, HBV, and HCV was significantly associated with having had a sex partner who was either a drug injector or who was known to be HIV positive. HIV and HCV infections were associated with former imprisonment, and HCV was associated with having been tattooed. Because of the rising number of NICU and the multiple infections detected, it is essential to implement prevention strategies focused on this population.     

Hepatitis B and C among Berlin dental personnel: incidence, risk factors, and effectiveness of barrier prevention measures

A study of 215 Berlin dentists and 108 dental assistants recruited at the 1997 Berlin Dental Society meeting assessed their occupational risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HBV vaccine coverage, and barrier prevention methods used. Among dentists, 7% (95% CI 4-11) and 0.5% (95% CI 0-3) had serological evidence of previous HBV and HCV infection, respectively. Similar figures for dental assistants were 1% (95% CI 0-5) and 0% (95% CI 0-4). Only 74% of dentists and 63% of dental assistants reported HBV vaccination. Approximately half always used gloves, eye glasses, or face masks. HBV unvaccinated dentists whose patients had HBV risk factors had a greater risk of HBV infection; those who always wore face masks were at lower risk (OR 0.2, 95% CI 0.02-0.98). These data indicate that among Berlin dentists, the HCV risk was lower than that of HBV and that face masks may have lowered the risk of HBV. The use of eye glasses or gloves did not appear to lower the risk of HBV acquisition in this population.     

Knowledge of Hepatitis B Risk Factors and Prevention Practices among Individuals Chronically Infected with Hepatitis B in San Francisco, California

Asian/Pacific Islanders (A/PIs) in the United States are disproportionately affected by the hepatitis B virus (HBV), which can cause a lifelong liver infection that may result in cirrhosis, liver failure, liver cancer, or death. Although previous studies have measured knowledge of hepatitis B transmission and prevention practices in A/PI communities, we present results from the first population-based study of this type, which specifically focuses on A/PIs who are chronically infected with HBV. Through telephone interviews, we assessed the HBV risk factor knowledge and prevention practices of a population-based, random sample of persons with chronic HBV who were reported to the San Francisco Department of Public Health between October 2007 and July 2009. Among 829 respondents, 67% were foreign born A/PIs of Chinese ethnicity who did not speak English as their primary language. Among all respondents, 75% were unable to identify how they acquired HBV, and 41% said that they do nothing to prevent transmission of HBV to their close contacts. Knowledge of HBV risk factors and recommended prevention practices was poor among A/PIs who are chronically infected with HBV and who may transmit the infection to others.     

Effect of alcohol consumption on the progression of hepatitis C virus infection and risk of hepatocellular carcinoma in Japanese patients

Chronic hepatitis C virus (HCV) infection is associated with a spectrum of liver diseases and a proportion of chronic cases progress through cirrhosis to hepatocellular carcinoma (HCC). The viral and host factors that are important in the clinical and histological progression of HCV infection are unclear. We investigated the effect of moderate (<80 g/day) and heavy (>80 g/day) alcohol intake on the histological and clinical progression of HCV infection and their associated risk of hepatic cancer in a group of Japanese patients. A number of other variables were assessed to evaluate their impact on disease progression. We recruited 120 patients with HCV infection and categorized them into four groups, based on alcohol consumption pattern. All clinical and biochemical profiles were collected from recorded files. Liver biopsies were analysed for the degree of fibrosis, presence of cirrhosis and histological activity of necroinflammation. Hepatic tumours were detected by the follow-up imaging analysis. There was no difference in the age, length of exposure to HCV infection and HCV RNA serum levels in the alcohol and alcohol-free groups. The histological grading of necroinflammation, serum levels of alanine aminotransferase and HCV RNA did not have any correlation with each other in the alcohol and alcohol-free group. There was a 1.5-2. 5-fold greater risk of liver cirrhosis and hepatocellular carcinoma in the alcohol intake group compared to the alcohol-free group. Kruskal-Wallis analysis among four groups demonstrated a significant transition to fibrosis (P < 0.05) for alcoholics with HCV infection. The increased risk of liver cancer in the alcohol group is independent of size and growth of tumours. The clinical manifestations of gastro-oesophageal variceal bleeding, ascites, and encephalopathy were also higher in the alcohol intake group. Alcohol consumption is an important risk factor in the histological and clinical progression of HCV infection and has no relation with HCV replication. Chronic HCV carriers should avoid excessive alcohol intake to reduce the acceleration of liver disease and risk of liver cancer.     

Sexual risk for hepatitis B virus infection among hepatitis C virus-negative heroin and cocaine users

Hepatitis C virus (HCV) and hepatitis B virus (HBV) are highly prevalent, often co-occurring infections among drug users. We examined HBV prevalence and risk behaviour patterns among a group of HCV-negative heroin and/or cocaine users in order to understand HBV risk and prevention opportunities among this unique group. Of 164 people enrolled, 44% had injected drugs. Overall, 24% of participants tested positive for exposure to HBV; drug injectors (28%) were only slightly and not significantly (P=0.287) more likely to test positive than those who had never injected drugs (21%). HBV exposure was significantly associated with multiple indicators of greater sex risk. HBV status was not associated with any demographic characteristic, but participants who reported longer duration of cocaine use were significantly less likely to test positive to exposure for HBV. It appears that HBV risk among HCV-negative drug users in this cohort is primarily due to sexual behaviour.     

原发性肝癌相关病因的探讨

原发性肝癌(PHC)是位居世界第五位的最常见恶性肿瘤,它的发生率几乎就等于其死亡率.其相关危险因素至今仍不是完全清楚.国内外早年均有文献报道了PHC与乙型肝炎病毒(HBV)之间的因果关系,并且从分子生物学角度阐述了它们两者之间的发生机制.因而,HBV导致PHC已经得到了国内外学者的一致肯定.近年来丙型肝炎病毒(HCV)与PHC之间的关系也引起了国内外学者的关注,并且也有相当多的文献报道了HCV能引起PHC.除了两种肝炎病毒可以引起PHC外,有学者研究发现,重度饮酒也会导致PHC,尤其是对已有HBV感染的病人,重度饮酒是导致其发生PHC的一个重要的危险因素.同时,流行病学还证实,PHC有家族/家庭聚集现象,提示PHC可能具有遗传学上的特点.除了上述肝脏疾病的病因外,环境致病因素在PHC的发生发展中也起着不可或缺的作用.早年就有报道黄曲霉毒素B1(AFB1)可以诱发肝癌.不仅如此,有研究表明糖尿病病人也较容易发生PHC.在基因水平上有学者发现凋亡抑制基因Survivin可以促进PHC的形成.     

Hepatitis B,C, and D Virus Infections and AFP Tumor Marker Prevalence Among the Elderly Population in Mongolia: A Nationwide Survey

ObjectivesInfections with hepatitis B, C, and D virus (HBV, HCV, and HDV) are a major public health problem and lead to serious complications such as cirrhosis and hepatocellular carcinoma. We aimed to determine the seroprevalence of hepatitis B surface antigen (HBsAg), anti-HCV, anti-HDV immunoglobulin G, alpha-fetoprotein (AFP), and dual and triple hepatitis virus infections in Mongolia.MethodsA total of 2313 participants from urban and rural regions were randomly recruited for this cross-sectional study. A questionnaire was used to identify the risk factors for hepatitis virus infections, and the seromarkers were measured using immunoassay kits.ResultsAmong all participants, the prevalence of HBV, HCV, and HDV was 15.6%, 36.6%, and 14.3%, respectively. The infection rates were significantly higher in females and participants with a lower education level, rural residence, older age, and a history of blood transfusion. HBV and HCV co-infection was found in 120 (5.2%) participants and HBV, HCV, and HDV triple infection was detected in 67 (2.9%) participants. The prevalence of elevated AFP was 2.7%, 5.5%, and 2.6% higher in participants who were seropositive for HBsAg (p=0.01), anti-HCV (p<0.001), and anti-HDV (p=0.022), respectively. Elevated AFP was more prevalent in participants co-infected with HBV and HCV (5.8%, p=0.023), HBV and HDV (6.0%, p<0.001), and triple-infected with HBV, HCV, and HDV (7.5%) than in uninfected individuals.ConclusionsNearly half (49.8%) of the study population aged ≥40 years were infected with HBV, HCV, or HDV, and 22.4% had dual or triple infections.     

Hepatitis C virus infection and the development of type 2 diabetes in a community-based longitudinal study

The temporal relation of hepatitis C virus (HCV) infection to the development of type 2 diabetes remains unknown. The authors followed 4,958 persons aged > or =40 years without diabetes (3,486 seronegative, 812 anti-HCV+, 116 with hepatitis B virus/HCV coinfection, and 544 hepatitis B surface antigen (HBsAg)+) from a community-wide cohort in southern Taiwan for 7 years (1997-2003) to study the risk of diabetes associated with HCV infection. A total of 474 participants developed diabetes. The 7-year cumulative incidence was 7.5% for HBsAg+, 8.6% for seronegative, 14.3% for anti-HCV+, and 14.7% for coinfected participants. Compared with HCV- persons, HCV+ persons had a higher cumulative incidence of diabetes (log-rank test, p < 0.0001). A multivariate Cox proportional hazards model showed that anti-HCV+ (hazard ratio = 1.7, 95% confidence interval: 1.3, 2.1), coinfection (hazard ratio = 1.7), overweight, obesity, and increasing age were significantly associated with diabetes (p < 0.05). Gender, educational level, HBsAg+ status, alcohol consumption, and smoking were not significant. After stratification by age and body mass index, the risk ratio for diabetes in anti-HCV+ participants increased when age decreased and body mass index levels increased (p < 0.001). Results show that HCV infection is an independent predictor of diabetes, especially for anti-HCV+ persons who are younger or have a higher body mass index.     

Exploring the combined action of lifetime alcohol intake and chronic hepatotropic virus infections on the risk of symptomatic liver cirrhosis

Although alcohol intake and hepatitis B and C virus (HBV and HCV) infections are the major determinants of liver cirrhosis (LC) in western countries, the joint effect of these factors on LC risk has not yet been adequately studied. Data from three case-control studies performed in Italy were used. Cases were 462 cirrhotic patients admitted to Hospitals for liver decompensation. Controls were 651 inpatients admitted for acute diseases unrelated to alcohol. Alcohol consumption was expressed as lifetime daily alcohol intake (LDAI). Three approaches were used to explore the interaction structure. The Breslow and Storer parametric family of relative risk functions showed that an intermediate structure of interaction from additive to multiplicative was the most adequate one. The Rothman synergism index showed that the interaction structure between LDAI and viral status differed significantly from the additive model in particular for high levels of alcohol intake. When multiple regression additive and multiplicative models were compared after adjustment for the known confounding variables, a trend of the interaction structure towards the multiplicative model was observed at increasing levels of consumption. Better methods are needed for assessing mixed interaction structures in conditions characterized by multifactorial etiologies like cirrhosis of the liver.     

HIV and hepatitis B infection and risk behavior in young gay and bisexual men.

OBJECTIVES: To estimate the prevalence of and identify risk factors for human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections and unprotected anal intercourse among young homosexual and bisexual men. METHODS: The authors performed a cross-sectional analysis of data from a prospective cohort of 508 young gay and bisexual men ages 18-29. RESULTS: HIV-1 seroprevalence was 2.4%, with five (1.3%) of 390 college students and seven (6.0%) of 117 non-students infected. After adjusting for confounders, HIV-1 infection was associated with having a history of a sexually transmitted disease other than HIV-1 or hepatitis B. The prevalence of hepatitis B markers in unvaccinated men was 12.9%. The presence of hepatitis B markers in unvaccinated men was significantly associated with Asian ethnicity, off-campus residence, and history of a sexually transmitted disease other than HIV-1 or hepatitis B and inversely associated with recent non-intravenous drug use. Eighteen percent of the participants reported having had sex with women during the previous 12 months, and 26.4% reported a history of unprotected anal intercourse during the previous six months. Men who reported unprotected anal intercourse were more likely to have at least one steady partner, to have met their partners in anonymous settings, and to be identified as probably alcohol dependent. CONCLUSIONS: Although the prevalence of HIV-1 infection among young homosexual and bisexual men in Boston was relatively low, the high rates of unprotected anal intercourse suggest a potential for future HIV-1 and hepatitis B transmission. Interventions should focus on young men with histories of sexually transmitted diseases, alcohol abuse, and depression.     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.     

Trends in all cause and viral liver disease-related hospitalizations in people with hepatitis B or C: a population-based linkage study

Background  

Previous studies have reported an excess burden of cancer and mortality in populations with chronic hepatitis B (HBV) or C (HCV), but there are limited data comparing hospitalization rates. In this study, we compared hospitalization rates for all causes and viral liver disease in people notified with HBV or HCV in New South Wales (NSW), Australia.     

Knowledge about hepatitis and previous exposure to hepatitis viruses in immigrants and refugees from the Mekong Region

OBJECTIVE: Infection with hepatitis B (HBV) and hepatitis C (HCV) viruses is relatively common throughout South-East Asia and chronic infection can lead to severe consequences. This study assesses knowledge about HBV and HCV and estimates the seroprevalence of markers for these viruses in immigrants from Laos and Cambodia. METHODS: Ninety-five Laotian (aged 18-82 years) and 234 Cambodian (15-92 years) immigrants participated in separate community-based surveys conducted during 1998 and 2002, respectively. Participants completed a questionnaire on health status and level of knowledge about viral hepatitis. Blood samples were collected and tested for the presence of HBV and HCV markers. RESULTS: Nine per cent of Laotian and 8% of Cambodian participants were infected with HBV. While 49% of Laotian and 64% of Cambodian participants showed evidence of previous exposure to HBV, 30% and 9%, respectively, were vulnerable to infection. The seroprevalence of antibodies to HCV was 3% in the Laotian and 8% in the Cambodian participants. Between one-fifth and one-third of the Laotians and Cambodians who had heard of HBV and HCV knew of possible transmission routes for the viruses. Most of those with HBV or HCV infection were unaware they were infected. CONCLUSIONS: These findings indicate a significant prevalence of undetected HBV and HCV infections and an urgent need for the provision of culturally relevant information about viral hepatitis in immigrants of South-East Asian origin.