Background and Aim:The hepatitis B virus (HBV) prevalence study performed in2003 in Belgium is believed to be underestimating HBV prevalence due tounderrepresentation of the non‐Belgian population. Therefore, we assessed theprevalence and risk factors of HBV infection in a multi‐ethnic region situated inMiddle‐Limburg Belgium, in 2017.Methods:Between May and November 2017, blood samples and questionnaires weretaken from patients who presented at the emergency department of a large educationalhospital. Blood samples were tested for hepatitis B surface antigen (HBsAg) andhepatitis B core antibodies (anti‐HBc). A sample size of 1000 persons was required toobtain a representative sample of the general Middle‐Limburg population.Results:Of the 1131 patients screened, the overall HBsAg prevalence was 0.97%with differences between Belgians (0.67%) and first‐generation‐migrants (2.55%),(P= 0.015). Five (45.5%) of 11 HBsAg‐positive individuals were not aware of theirHBV status. All five (100%) newly diagnosed HBsAg‐positive patients had furtherclinical evaluation and all had a normal level of alanine aminotransferase (ALT). Theprevalence of anti‐HBc was 8.4%, and was significantly associated with age‐gender‐ethnicity interaction, presence of HBV‐infected household member, hepatitis C virusinfection, men who have sex with men, and hemodialysis. Conclusions:In this area with large immigrant populations, we found a higherprevalence of HBV infection compared with the nationwide study of 2003. NationalHBV screening for first‐generation migrants is needed as this high‐risk group will gounnoticed due to the possible incorrect interpretation of normal ALT values. ; Gilead Sciences, Grant/Award Number: V-2112