Report - Hepatitis B and C testing activities, needs, and priorities in the EU/EEA

ISBN 978-92-9498-065-6  doi: 10.2900/05014 

ECDC undertook a survey to assess the level and the nature of the need for guidance on testing and screening for HBV and HCV in the EU/EEA, and to update the existing evidence on the burden of HBV/HCV morbidity and mortality across EU/EEA Member States.

TECHNICAL REPORT
Hepatitis B and C testing activities, needs, and priorities in the EU/EEA

Hepatitis B and C virus infections are associated with a considerable burden of disease in Europe. In high-income countries, transmission of hepatitis B (HBV) may occur through injecting drug use, but most cases in Europe now occur through heterosexual transmission or transmission between men who have sex with men (MSM). Chronic infection with HBV is associated with an increased risk of liver cirrhosis (between 8% and 20% within five years of diagnosis) and liver failure [1]. Hepatitis C (HCV) is mainly transmitted through injecting drug use [2], with a historical contribution from transfusion of infected blood products prior to the introduction of screening in the 1990s [3,4]. Up to 24% of people infected with chronic HCV will develop liver cirrhosis within 20 years of infection, with consequent risk of liver cancer and liver failure.

A recent report commissioned by ECDC (‘Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease, and screening policies’ [5]) highlighted a wide range in HBV and HCV prevalence across Europe; for example HBV (HBsAg) prevalence was estimated to be <0.5% in Sweden and Finland, compared to 2–4% in Greece. HCV prevalence was <0.5% in Germany, compared with 1.4–2.6% in Spain. Reliable prevalence estimates were not available for nearly half of all European Union/European Economic Area (EU/EEA) Member States. The report also identified a range of testing practices and policies across Member States; for example, Ireland and Spain reported antenatal screening policies for both HBV and HCV, whereas most other countries screen for HBV alone [5]. Among people who inject drugs (PWID), testing for HCV has been supported by a number of national policies and consensus statements [6,7], but the report highlighted a lack of national-level policy on testing for HBV. There was also a lack of information from published sources on HBV and HCV testing practice among men who have sex with men and migrant populations.

An estimated 9–10 million individuals have been infected with HBV or HCV in the EU/EEA [5], with a considerable burden of undiagnosed infection likely to exist across Member States. The proportion of the HCV-infected population who remain undiagnosed is estimated to be 45% in Scotland (2013), 62% in Germany (2004), 43% in France (2004), and 88% in Italy (2004) [8]. Among PWID, data are available for only a small number of countries, of which the percentage of those undiagnosed ranges between 25% in Spain, 30% in France, and 59% in the UK [9]. Published data for HBV are not currently available, although the burden of undiagnosed infection is likely to be considerable, given the increased risk of HBV among ‘hidden’ populations such as new migrants and PWID.

Given the burden of HBV/HCV infection, and in particular the burden of undiagnosed infection, the contribution of viral hepatitis to liver-related morbidity and mortality is likely to be considerable. ECDC recently reviewed evidence on the burden of cirrhosis and liver cancer due to HBV/HCV across Member States; however, such evidence was limited as the available country-level data were not HBV/HCV-specific and included liver morbidity related to all causes, including obesity and alcohol [5].

ECDC undertook a survey to assess the level and the nature of the need for guidance on testing and screening for HBV and HCV in the EU/EEA, and to update the existing evidence on the burden of HBV/HCV morbidity and mortality across EU/EEA Member States. The purpose of this project was to provide a baseline EU/EEA situation assessment to inform the guidance development process and to update the previous work by ECDC on viral hepatitis testing practices [5]. ECDC is also exploring the possibility of complementing routine case-based surveillance of HBV/HCV using data from alternative sources. With regard to this objective, this assessment appraised the availability and feasibility of collecting additional data such as liver-related morbidity and mortality data among Member States. Finally, as a subsidiary objective, the availability of information to monitor the HBV and HCV epidemic was assessed against the core indicators defined in the WHO Regional Action Plan for viral hepatitis.

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Source - http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=1706