An estimated 4.7 million Europeans are living with chronic hepatitis B and almost 4 million (3.9) with chronic hepatitis C infection. However, large numbers of them are not even aware of their infection as they have not yet been tested and diagnosed. On the occasion of World Hepatitis Day on 28 July, ECDC Director Andrea Ammon highlights the need for Europe to scale-up coverage of testing, prevention interventions and linkage to suitable treatment services in order to achieve the target of eliminating viral hepatitis as a public health issue by 2030.
According to ECDC estimates, the prevalence of hepatitis B (HBV) across the European Union and European Economic Area (EU/EEA) is around 0.9% and about 1.1% for hepatitis C (HCV) - and these figures are likely to be an underestimation of the true burden as hepatitis infection often shows no symptoms.
European Commissioner for Health and Food Safety Vytenis Andriukaitis underlined the importance of increasing testing that leads to higher detection rates: ''Greater efforts are needed to reduce both the suffering and the costs that hepatitis inflicts across Europe. The Commission is fully committed to helping Member States achieve the Sustainable Development goal of ending HIV/AIDS and tuberculosis and reducing viral hepatitis by 2030. Together, we will scale up our prevention and testing programmes and reach out to the most vulnerable to reduce health inequalities. In order to tackle the underlying causes of the hepatitis epidemic we need to combine health instruments with social instruments and work together across health, social, and education policies.''
In 2015, the countries of the EU/EEA reported almost 60 000 newly diagnosed cases of these two infections - with 24 573 cases of hepatitis B and 34 651 of hepatitis C. For hepatitis C, this constitutes an increase of 4% compared to 2014 and follows the overall trend in Europe which saw a 26% rise of diagnosed and reported cases between 2006 and 2015. While the overall rise in diagnosed hepatitis cases indicates a general increase in testing practices across Europe, this does not apply to all of the European countries. A recent ECDC survey showed great variations across the countries and the proportion of undiagnosed infections ranges between 45-85% for HBV and between 20-89% for HCV, highlighting gaps in national testing programmes.
"There are highly effective drugs available to treat people infected with hepatitis B and C but the main bottleneck we see in Europe is the actual case detection: too many infections with viral hepatitis remain undiagnosed", says ECDC Director Andrea Ammon. "An ECDC study showed that less than half of the responding EU/EEA countries have dedicated hepatitis B or C testing guidance in place and even fewer countries could provide estimates on their undiagnosed infected population", Ammon continued. "There is also a clear need for countries to improve the quality and completeness of surveillance data, especially on the route of transmission. ECDC is currently working on an evidence-based testing guidance to support EU countries in their attempt to achieve the elimination target by 2030".
More testing allows treatment of those infected and reduces transmission
Across Europe, there has been a downward trend in the rate of acute HBV notifications especially among young people - most likely reflecting the positive impact of national vaccination programmes on incidence. Trends in the notifications of acute HCV provide a less reliable proxy for incidence as the disease is largely asymptomatic and cases of acute infection are difficult to diagnose.
In order to achieve elimination of hepatitis by 2030, prevention and control practices need to be scaled up to interrupt existing transmission chains. Those who might be unknowingly infected with viral hepatitis need to be identified through more testing both for their own benefit but also to be able to reduce further transmission in the community.