Key Messages

Natural history

  • Chronic infection with hepatitis B or C is mostly asymptomatic and can progress over a course of 20-30 years towards cirrhosis and liver cancer

  • Hepatitis B is vaccine preventable and the risk of developing a chronic infection is associated with the age of the immune system. Most people (90%) infected at birth (perinatally) or as children will go on to develop a chronic hepatitis B infection.

  • There is as yet no vaccine against HCV and infection with hepatitis C becomes chronic in most (>75%) cases.

  • Effective antiviral treatment is available for both chronic hepatitis B and C.

Global burden of viral hepatitis worldwide

  • HBV endemic areas are mostly in Sub-Saharan Africa and Asia.

  • The most common form of HBV transmission in these areas is perinatally (from mother to child at birth) or as children in the household.

  • HCV endemic areas are in Central and East Asia, and North Africa/the Middle East.

  • Common HCV transmission routes here are via unsterile medical/dental procedures, including vaccination and blood transfusion and via unsterile shaving equipment.

  • 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.

Viral hepatitis in europe

  • Public health measures, including a safe blood supply, HBV vaccination and antenatal screening (for HBV), have successfully halted transmission in most European countries

  • Yet there remains a large, undiagnosed burden of chronic viral hepatitis.

  • There are differences within Europe – prevalence is lower in the north-westerly region and higher in the south-eastern, Mediterranean region.

  • Most chronic hepatitis B infections are now detected among people who migrated to Europe from endemic areas

Estimating the burden among migrants to Europe

  • Migrants to Europe from these areas are therefore most affected by chronic viral hepatitis although European estimates of burden of disease are largely lacking

  • Estimates of the burden among the five most affected migrant groups have been produced for the UK, Germany, the Netherlands, Hungary, Italy and Spain.

  • There is also a ‘How to…. Guide’ to enable others to make similar estimates.

  • Two factors are important for these estimates – expected prevalence and population size.

  • Screening among populations that have a low prevalence but are large in size will not lead to many detected cases. This is likely to cause minor but unnecessary harm to the majority who screen negative and makes ineffective use of scarce health care resources.

  • Screening among population groups that have a larger expected prevalence but are smaller in size increases the chances of finding positive cases. This makes better use of health care resources and minimises harm among people screened negative.