European Journal of Epidemiology 12: 297--301, !996. © 1996 Kluwer Academic Publishers. Pr'it~ted in the Netherlands. Prevalence study of different hepatitis markers among pregnant Albanian refugees in Greece A, Malamitsi-Puchner 2, S. Papacharitonos 1, D. Sotos 3, L. Tzala 4, M. Psichogiou 4, A. Hatzakis 4, A. Evangelopoulou 3 & S. Michalas 1 First and 2Second Department of Obstetrics and Gynecology, University of Athens; 3 Department of Immunology, ~Atexandra' University and State Hospital, Athens; 4 Department of Hygiene and Epidemiology, University of Athens Accepted in revised form 16 February 1996 Abstract, Aim of the study was to record the preva- lence of the various types of viral hepatitis, especially hepatitis B, in pregnant Albanian refugees in Greece. The study comprised 500 pregnant refugees of mean age 25,1 _+4,6 years. In Albania, all women had lived in overcrowded houses and had been exposed to non throw-away needles and syringes. Various indices for all hepatitis types were determined. The prevalence of HBsAg was 13.4%, of anti-HBs 53%, of total anti-HBc 70.8%, of anti-HBc IgM 0.4%, of HBeAg 1.2%, Of anti-HBe 58,6%, of anti-HAV 96.2%, of anti-HAV IgM 1%, of anti-HDV 0.4%, of anti-HCV 0.6% and of anti-HEV 2%. HBeAg was found positive in 7.5% of HBsAg carriers. Prevalence of hepatitis B markers, as determined by HBsAg and/or anti-HBs and/or total anti-HBc was significantly higher in those with a history of previous hospitalization in Albania (p = 0.01) and those with previous history of hepatitis (p = 0.02). The high prevalence of hepatitis B markers in pregnant Albanian refugees proves that HBV infection is highly endemic in Albania and the possibility of perinatal transmission to the offsprings urges for HBV vaccination programmes. On the other hand improvements in the socioeconomic conditions and the sanitation system in Albania is anticipated to reduce the incidence of HAV and HBV infections. Key words: Hepatitis, Pregnancy, Refugees, Albanians, HAV, HBV, HCV, HDV, HEV Introduction Recently Albania - a small country in the Balkans, toially isolated from the rest of Europe since the last World War, with very limited economical sources and a low standard of hygiene - was abandoned imme- diately after the fall of the former political regime arid the opening of the borders by a large number of its citizens, who seeked work and shelter in the neighbour countries, mainly Italy and Greece [1]. The I .! massive escape to the latter was more convenient due to geographical vicinity and to the ties to the land of origin of the large Greek minority, residing ever since in the region of North Epirus, comprising now South Albania. Unpublished data from various Greek hospitals, where Albanian refugees had been treated for various reasons, gave a high percentage of them being infected by hepatitis viruses. ! The aim of this study was to record the burden of illfection by the various types of hepatitis, especially h~patit!s B, in pregnant women of Albanian citizen- ship, who live as refugees in Greece. This record would help to prevent vertical transmission to their offsprings by early vaccination and would give the baseline information to formulate a health policy aiming at limiting the spread of viral hepatitis and its consequences. Subjects and methods The study comprised 500 consequetive pregnant refugees of Albanian citizenship, who had entered Greece mainly in the years 1991-1994 and were cared for their pregnancy in the 'Alexandra' Hospital. Living conditions of all women in their homeland were poor: 425/499 (85.2%) reported 5 or more persons living in the paternal house, which in 459/499 (92%) cases had 3 or less rooms altogether (kitchen and bathroom included) (persons/room: mean _+SD: 3 _+ 1, range 1-11). The conditions in the conjugal house were similar: In 329/467 (70.4%) cases 5 or more persons resided in the same house sharing in 347/467 (74.3%) cases 3 or less rooms (persons/room: mean _+ SD: 4 _+_+ 3, range 1-11). All women had been vaccinated against tetanus, diphteria and pertussis by non throw-away syringes and needles, as reported. Of the total number only 92/499 (18.4%) had been treated in a hospital in Albania and 22/497 (4.4%) of them reported a liver disease. Also 50/499 (10%) had been operated on, 35/499 (7%) had