Hepatitis B virus prevalence, susceptibility and care engagement among vulnerable migrant populations in Rome

Hepatitis B virus (HBV) remains a leading cause of morbidity and liver-related mortality globally. Vulnerable migrant populations often experience challenges with accessing testing, vaccination and care, both before and after arrival.

Asylum seekers and undocumented migrants hosted in six reception facilities in metropolitan Rome were prospectively offered screening for hepatitis B surface antigen (HBsAg), surface antibodies (anti-HBs) and core antibodies (anti-HBc). Individuals with HBsAg positivity were assisted in accessing a specialist referral service, with support available throughout the screen-and-link pathway to reduce administrative, linguistic and logistic barriers.

Between February 2024 and August 2025, 435 individuals from 38 countries underwent screening (median age 28 years; 86.7% male). Most (273; 62.8%) were non-immune (HBsAg/anti-HBc/anti-HBs negative), 88 (20.2%) had prior infection (HBsAg negative/anti-HBc positive, usually with anti-HBs), and 51 (11.7%) had vaccine-induced immunity (anti-HBs positive only). HBsAg was detected in 23 (5.3%; 95% CI 3.6-7.8), including 16/149 (10.7%) participants from the African region and 7/160 (4.4%) from South-East Asia (all from Bangladesh); none had hepatitis delta, hepatitis C or HIV coinfection. Overall, 20/23 (87.0%) were successfully engaged in care; 5/20 (25%) met immediate treatment indications based on virological, biochemical and/or liver fibrosis criteria.

This study highlights the dual public health challenge of chronic HBV infection and lack of HBV immunity among asylum seekers and undocumented migrants in Rome. The initially high linkage to care demonstrates the effectiveness of integrated screen-and-link approaches. Strengthened HBV testing, vaccination and care pathways should be proactively embedded within health services for vulnerable migrant populations.