Systematic review on hepatitis B and C prevalence in the EU/EEA
Because chronic hepatitis B and C infections are typically asymptomatic, notification data reflect national screening and testing practices and do not give accurate insights into the prevalence of infections. In order to inform prevention efforts, supplementary information such as prevalence data are needed. ECDC conducted a systematic review of the literature published between 2005–2015, with the aim to estimate the prevalence of hepatitis B and C in the general population and specific population subgroups in the EU/EEA Member States. This review is an update of an earlier review covering the period 2000–2009.
Executive summary
A new ECDC review estimates the prevalence of both hepatitis B and C infection at around 1 percent respectively in the countries of the European Union and European Economic Area. In total, it is estimated that more than 10 million Europeans may have chronic hepatitis B or hepatitis C. Chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) can cause serious liver disease such as liver cirrhosis and hepatocellular carcinoma. Unlike acute infections, that are more obvious but relatively uncommon, chronic infections are typically asymptomatic and often even the individuals themselves do not know they are infected. This means that the data derived from notifications of chronic HBV and HCV diagnoses will more reflect national screening and testing practices, rather than giving accurate insights into the true burden of the disease. Additional sources of data, such as those derived from prevalence studies, are needed in order to provide more accurate information to assist policy advisors to plan for effective prevention and control programmes.
ECDC conducted a systematic review of prevalence studies published in the literature between 2005–2015, with the aim to obtain better estimates of the prevalence of HBV and HCV infection in the general population and in specific population subgroups in the EU/EEA Member States.
Estimate: more than 10 million Europeans suffer from chronic viral hepatitis
The prevalence of HBV is estimated to be around 0.9% and of HCV about 1.1% in the EU/EEA, with an estimated total of 4.7 million chronic HBV cases and 5.6 million HCV cases. These figures are likely to be an underestimation as a result of certain assumptions in this review, such as the inclusion of the prevalence estimates among blood donors as a proxy for those in the general population, among others.
Overall, countries in the eastern and southern part of the EU/EEA were found to have a higher HBV and HCV prevalence than countries in the northern and western parts. The HBV prevalence ranged from 0.1% in Ireland to 4.4% in Romania, while the report found that the prevalence of anti-HCV ranges from 0.1% in Belgium, Ireland and the Netherlands, to 5.9% in Italy. As expected, groups at higher risk of hepatitis infection, such as people who inject drugs, prisoners and certain migrant groups were found to have higher prevalence, compared to the general population.
The report concludes that more robust prevalence estimates are needed to gain a better insight into the true extent of the burden of hepatitis B or C infections - both with regard to the general population and in specific risk groups in the different EU/EEA countries. This may be achieved by carrying out more robust and comparable seroprevalence surveys.With more accurate information, primary and secondary prevention measures (e.g. screening and linkage to care of at-risk populations to identify patients with chronic hepatitis B and C who can benefit from new treatment options) can be better targeted and evaluated.
