Epidemiology

An aim of the HEPscreen project was to understand and estimate the burden of viral hepatitis among people who migrated to the study countries from endemic areas. The methods we developed and what we found out is presented in this section. An interactive map shows this data for the study countries – the UK, Germany, the Netherlands, Hungary, Italy and Spain. We also developed an epidemiological tool to assist others to estimate the burden of chronic viral hepatitis in other areas.

Learn more about the epidemiology of viral hepatitis including the natural history and global burden of disease below:

  Natural history

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Infection with hepatitis B (HBV) and C (HCV) virus affects the liver and results in a broad spectrum of disease outcomes. An HBV infection can spontaneously resolve (the most common outcome if infected as an adult) and lead to protective immunity, result in a chronic infection (the most common outcome if infected as an infant or child) and, in rare cases, cause acute liver failure with a high risk of death. In contrast to HBV, an HCV infection becomes chronic in most (>80%) cases. Chronic infections are mostly asymptomatic and have a long latency period (20-30 years). If untreated, people with chronic hepatitis B and/or C virus infection remain infectious to others and are at risk of serious liver disease such as cirrhosis or hepatocellular cancer (HCC) later in life. Antiviral treatment can prevent a large proportion of this burden through early identification.

Further reading about the natural history of viral hepatitis

Global burden of viral hepatitis

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Worldwide, between 480 and 520 million people are estimated to be chronically infected with hepatitis B or C but there are strong regional differences in burden of disease. The largest burden of HCV is found in Central and Eastern Asia and the Middle East. The highest HBV prevalence rates are found in Sub-Saharan Africa, Asia and the Pacific Islands. In areas where it is very common, HBV is mostly acquired perinatally or in childhood. HCV transmission is generally via unsterile medical or dental procedures (such as vaccination or blood transfusions) or from unsterile shaving equipment. The two maps (sourced from the CDC) give an overview of high, high-intermediate, intermediate and low prevalence countries, as well as countries (highlighted grey) where there is no data available.

Further reading about global viral hepatitis prevalence

Global burden of liver cancer and mortality attributable to viral hepatitis

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In 2010, infection with hepatitis B was responsible for an estimated 786,000 deaths, ranking 15th in the global causes of death rankings. Infection with hepatitis C ranks 25th in global causes of death and was responsible for around half a million deaths in 2010. Taken together, viral hepatitis is estimated to be responsible for 1.29 million deaths, ranking 9th in all cause mortality rankings, comparable to Tuberculosis, HIV and Malaria. Chronic viral hepatitis infection is responsible for 78% of cases of primary liver cancer and 57% of cases of cirrhosis. However, these are suspected to be under-estimations because liver disease or cancer are the common end point for many different diseases and are often listed as primary causes without viral hepatitis listed as an underlying cause.

Further reading about the global burden of liver disease and the contribution of viral hepatitis