The finding:
Compared to controls, patients with schizophrenia had a three-fold increase in the odds of hepatitis C, and two-fold increase for hepatitis B. The prevalence of hepatitis C and B in this population were 6 and 7 % respectively. These findings were not influenced by age, sex, or importantly, by geography.

Strength and weaknesses:
The strengths of this study included well-defined inclusion criteria, and the use of standardized protocols and statistical tools. The sample size was large, and the authors appropriately accounted for moderating factors with meta-regression analyses. Data about acute viremia, and relevant confounding behavior such as substance use and sexual practices were not available.

Relevance:
This study presents evidence for increased prevalence of infectious hepatitis, namely hepatitis B and C, in patients with schizophrenia. Geographical location did not appear to modify the association between schizophrenia and hepatitis, which is interesting, considering that the prevalence of infectious hepatitis otherwise varies by region, although the geographical diversity of the included studies is limited. Screening for infectious hepatitis may be thought of as an intuitive step in the care of these patients. However, given that an abnormal immune response is only one of the putative mechanisms of infection, psychiatrists can still work with the other major modifiable sources of risk. There is evidence for at-risk sexual behavior in schizophrenia, including increased lifetime risk of sexually transmitted disease, using drugs during sex, trading sex and lack of condom use. Patients with schizophrenia also have increased prevalence of substance use disorders and injection drug use. Screening, offering education and treatment in cases of substance use, and not side-stepping discussions about sexual health still remain important tools in our arsenal.

Type of Study:
Systematic review and meta-analysis