Viral Hepatitis in Europe

Public health measures across Europe including antenatal screening, vaccination and a safe blood supply have successfully halted most transmission of hepatitis B and C and reduced the burden of chronic infection in the general population. But there remains a large, undiagnosed burden of disease in the European Union. Models predict that the peak mortality for HCV-related causes is ahead of us and there remains a huge undiagnosed burden of disease.

There are distinct geographical variations in the prevalence and incidence of viral hepatitis in Europe. The burden of disease is generally low in the north western countries of the EU and higher in the south eastern region. Prevalence in the general population varies from 0.4% to 5.2% for anti-HCV and from 0.1% to 5.6% for HBsAg. It is suspected that, due to a lack of representative data in higher risk populations, these are under-estimates in low prevalence countries. Estimates for liver cancer attributable to chronic hepatitis B/C in the EU also suggest regional variation; blood markers for chronic viral hepatitis infection were detected in 24% of HCC cases in Sweden compared to 82% of cases in Italy. These estimates are more limited in countries with a higher prevalence.

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Hepatitis B and C in the EU neighbourhood: Prevalence, burden of disease and screening policies: Literature review
http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_C%20_EU_neighbourhood.pdf

Hahne SJ, Veldhuijzen IK, Wiessing L, Lim TA, Salminen M, Laar M. Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening. BMC infectious diseases. 2013;13:181. http://www.ncbi.nlm.nih.gov/pubmed/23597411 FREE FULL TEXT

Migration from endemic areas

A safe blood supply, antenatal screening, HBV vaccination and other successful public health measures have significantly halted transmission of HBV and HCV in most European countries. Most chronic hepatitis B (CHB) infections in Europe are now detected among people who have migrated to the EU from areas where HBV is endemic. Differences between European countries in the proportion of chronic hepatitis C cases detected among migrants compared to people who inject drugs (PWID) are reported; in the UK, PWID account for over 90% of cases whereas migrants from endemic areas account for most infections in the Netherlands, Germany, Italy, and Spain.

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Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology 2011. http://www.ncbi.nlm.nih.gov/pubmed/22105832

Hope VD, Eramova I, Capurro D, Donoghoe MC. Prevalence and estimation of hepatitis B and C infections in the WHO European Region: a review of data focusing on the countries outside the European Union and the European Free Trade Association. Epidemiology and infection 2014;142(2): 270-286. http://www.ncbi.nlm.nih.gov/pubmed/23714072

Hepatitis B and C in the EU neighbourhood: Prevalence, burden of disease and screening policies: Literature review
http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_C%20_EU_neighbourhood.pdf

Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014. http://www.ncbi.nlm.nih.gov/pubmed/25086286

Rossi C, Shrier I, Marshall L, Cnossen S, Schwartzman K, Klein MB, et al. Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: a systematic review and meta-analysis. PloS one 2012;7(9): e44611. http://www.ncbi.nlm.nih.gov/pubmed/22957088 FREE FULL TEXT

Vriend HJ, Van Veen MG, Prins M, Urbanus AT, Boot HJ, Op De Coul EL. Hepatitis C virus prevalence in The Netherlands: migrants account for most infections. Epidemiology and infection 2013;141(6): 1310-1317. http://www.ncbi.nlm.nih.gov/pubmed/22963908

Urbanus AT, van de Laar TJ, van den Hoek A, Zuure FR, Speksnijder AG, Baaten GG, et al. Hepatitis C in the general population of various ethnic origins living in the Netherlands: should non-Western migrants be screened? J Hepatol 2011;55(6): 1207-1214. http://www.ncbi.nlm.nih.gov/pubmed/21703202

Fasano M, Saracino A, Carosi G, Mazzotta F, Marino N, Sagnelli E, et al. Hepatitis B and immigrants: a SIMIT multicenter cross-sectional study. Infection 2013;41(1): 53-59. http://www.ncbi.nlm.nih.gov/pubmed/23264094

Chu JJ, Wormann T, Popp J, Patzelt G, Akmatov MK, Kramer A, et al. Changing epidemiology of hepatitis B and migration–a comparison of six Northern and North-Western European countries. Eur J Public Health 2013;23(4): 642-647. http://www.ncbi.nlm.nih.gov/pubmed/23132874

Seedat F, Hargreaves S, Friedland JS (2014) Engaging New Migrants in Infectious Disease Screening: A Qualitative Semi-Structured Interview Study of UK Migrant Community Health-Care Leads. PLoS ONE 9(10): e108261. www.ncbi.nlm.nih.gov/pubmed/25330079 FREE FULL TEXT