University of Oulu

Tiittala et al. BMC Infectious Diseases (2018) 18:137

Missed hepatitis b/c or syphilis diagnosis among Kurdish, Russian, and Somali origin migrants in Finland : linking a population-based survey to the national infectious disease register

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Author: Tiittala, Paula1,2; Ristola, Matti3; Liitsola, Kirsi2;
Organizations: 1Doctoral Programme in Population Health, University of Helsinki, Helsinki, Finland
2Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
3Inflammation Center, Helsinki University Hospital, Helsinki, Finland
4Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
5Oulu University Hospital, Biobank Borealis of Northern Finland, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2018-04-26


Background: Migrants are considered a key population at risk for sexually transmitted and blood-borne diseases in Europe. Prevalence data to support the design of infectious diseases screening protocols are scarce. We aimed to estimate the prevalence of hepatitis B and C, human immunodefiency virus (HIV) infection and syphilis in specific migrant groups in Finland and to assess risk factors for missed diagnosis.

Methods: A random sample of 3000 Kurdish, Russian, or Somali origin migrants in Finland was invited to a migrant population-based health interview and examination survey during 2010–2012. Participants in the health examination were offered screening for hepatitis B and C, HIV and syphilis. Notification prevalence in the National Infectious Diseases Register (NIDR) was compared between participants and non-participants to assess non-participation. Missed diagnosis was defined as test-positive case in the survey without previous notification in NIDR. Inverse probability weighting was used to correct for non-participation.

Results: Altogether 1000 migrants were screened for infectious diseases. No difference in the notification prevalence among participants and non-participants was observed. Seroprevalence of hepatitis B surface antigen (HBsAg) was 2.3%, hepatitis C antibodies 1.7%, and Treponema pallidum antibodies 1.3%. No cases of HIV were identified. Of all test-positive cases, 61% (34/56) had no previous notification in NIDR. 48% of HBsAg, 62.5% of anti-HCV and 84.6% of anti-Trpa positive cases had been missed. Among the Somali population (n = 261), prevalence of missed hepatitis B diagnosis was 3.0%. Of the 324 Russian migrants, 3.0% had not been previously diagnosed with hepatitis C and 2.4% had a missed syphilis diagnosis. In multivariable regression model missed diagnosis was associated with migrant origin, living alone, poor self-perceived health, daily smoking, and previous diagnosis of another blood-borne infection.

Conclusions: More than half of chronic hepatitis and syphilis diagnoses had been missed among migrants in Finland. Undiagnosed hepatitis B among Somali migrants implies post-migration transmission that could be prevented by enhanced screening and vaccinations. Rate of missed diagnoses among Russian migrants supports implementation of targeted hepatitis and syphilis screening upon arrival and also in later health care contacts. Coverage and up-take of current screening among migrants should be evaluated.

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Series: BMC infectious diseases
ISSN: 1471-2334
ISSN-E: 1471-2334
ISSN-L: 1471-2334
Volume: 18
Article number: 137
DOI: 10.1186/s12879-018-3041-9
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
Funding: This study was funded by the National Institute for Health and Welfare of Finland (Maamu study) and by the University of Helsinki, Doctoral Programme for Population Health (PT).
Dataset Reference: The data for this study are available from the National Institute for Health and Welfare (THL), but some restrictions apply. The data were used under license for the current study, and thus, are not publicly available. They are, however, available from the authors upon reasonable request and with permission of THL.
Copyright information: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.