Hepatitis B virus infections among children and adolescents in Germany: Migrant background as a risk factor in a low seroprevalence population – Findings from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003 to 2006

Background: Data on hepatitis B (HB) infection prevalence among children and adolescents in Germany are scarce. We estimated seroprevalence of HB infection and assessed determinants for HB infection among children and adolescents in Germany from a representative population sample. Methods: From 2003–2006, the Robert Koch-Institute conducted a nationwide cross-sectional Health Interview and Examination Survey for Children and Adolescents in Germany. Data on age, gender, migrant background and socio-economic status were collected through questionnaires. A child was defined as having a two-sided migrant background if both parents, or the child and one parent, immigrated, and a one-sided migrant background if only one parent immigrated. Among children with migrant background, a first generation migrant was defined if born outside Germany; a second generation migrant was born in Germany. Information on HB vaccination status was obtained from vaccination cards. Serological samples from participants were tested for anti-HBc and HBsAg. We performed weighted univariable and multivariable logistic regression analyses to assess determinants for HB infection. Results: Of 13,065 participants aged 3–17 years, 0.5% (95%-CI: 0.4–0.7) were anti-HBc positive, among whom 38.7% (95%-CI: 20.0–57.5) were HBsAg positive. Two-sided migrant background and being first or second generation migrant were significantly associated with anti-HBc positivity (OR: 10.5, 95%-CI: 5.1–21.5; OR: 11.4, 95%-CI: 3.4–38.6; OR: 3.0, 95%-CI: 1.2–7.3). No further determinants were found. Conclusions: HB infection is rare among children and adolescents in Germany. First and second generation migrant children can be considered to be at risk for HB infection, with two-sided migrant background or being first generation migrant the most risky categories. Targeted testing for HB infection and early HB vaccination should be provided to immigrants' children.