New study reveals high lifetime exposure to hepatitis B and C in Ukraine

A study just published on Eurosurveillance has found evidence of substantial lifetime exposure to hepatitis B and C viruses in Ukraine in a 2021 nationwide, representative sample of the population, with findings also suggesting significant ongoing circulation of these viruses.

Ahead of World Hepatitis Day 2025, viral hepatitis remains a major global health concern, and is one of the priority infectious diseases under the United Nations' Sustainable Development Goal 3. The World Health Organization (WHO) Global Hepatitis report 2024 estimated an overall hepatitis B virus (HBV) prevalence of 1.2% for the WHO European Region and identified Ukraine as one of six focus countries in the region for its viral hepatitis response.

Diagnostic tests to detect Hepatitis C virus (HCV) core antigen (HCcAg) in the study were interrupted by the Russian invasion of Ukraine. With the war still ongoing and the disruption in public health infrastructure and surveillance, it is difficult to estimate its inevitably negative effect on global efforts to reach the goal of eliminating viral hepatitis as a public health threat by 2030. This was the first population-based serological study in Ukraine to assess HBV and HCV prevalence among the general adult population, despite the pressing need for such data.

Men and older adults more likely to test positive for hepatitis B and C

Researchers from the Public Health Centre of the Ministry of Health of Ukraine and the medical laboratory DILA used blood samples collected in mid-2021 through a nationwide and representative cross-sectional, household-based SARS-CoV-2 serosurvey. The samples from the adult population were tested for hepatitis C virus (HCV) antibodies, total antibodies against hepatitis B virus (HBV) core antigen (HBc), hepatitis B surface antigen (HBsAg) and hepatitis D virus (HDV) antibodies. Researchers then calculated crude and weighted proportions for anti-HCV, anti-HBc and HBsAg positivity, adjusting the data to ensure it reflected actual Ukrainian demographics. Weighted regional estimates and proportions positive for anti-HDV were also calculated among HBsAg-positive cases.

The study found a 3.3% prevalence of hepatitis C antibodies and 11.6% of hepatitis B antibodies, which indicate current or past infection for these viral infections. A prevalence of 0.9% was found for HBsAg, which indicates a current, mainly chronic HBV infection. Among those with HBsAg, 7.5% were anti-HDV positive.

Odds of having anti-HBc increased with age and was highest among those over 60. The prevalence of anti-HCV, anti-HBV and HBsAg was found to be higher in southern regions of Ukraine. Anti-HCV markers were more prevalent among men, in urban areas, and in the eastern and southern regions.

Significant challenges in Ukraine to achieve viral hepatitis elimination targets

These findings emphasise the need of hepatitis B virus (HBV) vaccination among infants and risk groups as well as regular HBV and hepatitis C virus (HCV) screening, treatment, and awareness raising to decrease transmission.

Ukraine joined the WHO's Global Strategy for the Elimination of HBV and HCV in 2019 [4], and has since expanded HBV screenings in primary care, ensured public funding for diagnosis and treatment, and decentralized care by involving family and non-infectious disease doctors. It has also improved access to HBV services.

Ukraine introduced HBV vaccination in the national childhood immunisation schedule in 2002, achieving vaccination coverage of 88% in 2024. However, the vaccination rate remains below the WHO target of 90% and national surveillance is not fully established. Ukraine's strategy to eliminate viral hepatitis includes reducing new cases and associated deaths, which requires effective surveillance.

The war on Ukraine has resulted in large-scale internal displacement as well as refugee migration to neighboring countries, disrupted treatment for Ukrainians in the occupied territories, and hampered healthcare infrastructure, adding to existing challenges in addressing viral hepatitis.