Hepatitis B and C surveillance in Europe 2006–2011
ECDC’s first collection of enhanced surveillance data for both hepatitis B and C across countries of the European Union and European Economic Area (EU/EEA) describes basic trends and epidemiological features of both diseases for the years 2006 to 2011. The findings highlight a significant burden of disease associated with chronic infections for both types of hepatitis. The overall burden is considerably greater for hepatitis C than for hepatitis B: with numbers of reported cases of hepatitis C roughly double those of hepatitis B. Early detection of infections through wider hepatitis screening and treatment of identified chronically infected patients could considerably decrease the health burden and provide opportunities for significant future savings of associated healthcare costs. Surveillance data for infections with hepatitis B virus (HBV): In 2011, 17 025 cases of hepatitis B were reported from 28 EU/EEA Member States; 2 812 (16.5%) were reported as acute, 11 557 (67.9%) of cases were chronic; 2 312 (13.6%) were classified as ‘unknown’; Across acute cases, there is a slight downward trend in rates over time, possibly reflecting the widespread implementation of hepatitis B vaccination programmes. For chronic cases, there is an increase in the number and rates of cases over time which may reflect increased testing and changes in migration. Heterosexual contacts and hospital-acquired (nosocomial) infections were the most commonly reported routes of transmission for acute infections; For chronic infections, mother-to-child transmission was the most common reported transmission route; The most affected age group was the 25–34 year-olds, accounting for 32.9% of the cases. Surveillance data for infections with hepatitis C virus (HCV): In 2011, 29 896 cases of hepatitis C were reported from 26 EU/EEA Member States; 398 cases (1.3%) were reported as acute; 2 913 (9.7%) as chronic; 24 337 (81.4%) as ‘unknown’; Trends over time are difficult to interpret due to changes in reporting practices in the use of case definitions and reporting practice; The most common route of transmission reported across all disease categories was injecting drug use, accounting in 2011 for 78.1% of all cases with complete information; Only 12 countries were able to classify cases as acute or chronic in 2011, with complete data available for only 13.3% of cases overall - reflecting the difficulty in defining cases as acute or chronic; The most affected age group was the 25–34 year-olds, accounting for 28.2% of all cases; Improved understanding of national testing and surveillance policies will help to interpret the surveillance data to provide better information to help monitor the distribution of the diseases. It can also support the evaluation of the public health response to control the transmission of HBV and HCV infections. ECDC will continue to work with the reporting countries to improve completeness of reporting and thus to facilitate a fuller analysis of the data. Surveillance of hepatitis B and C in EU/EEA The acute and chronic cases in this first hepatitis surveillance report are not equivalent to incidence and prevalence data but represent reported cases. There is a discrepancy at the country level between data reported through surveillance and results from published prevalence surveys. This discrepancy highlights the current limitations of routine surveillance data for hepatitis B and C which is often more reflective of national testing and surveillance practices rather than real disease occurrence. The report shows a high diversity in data quality across Member States and highlights the need to further improve the harmonisation of surveillance systems to be able to present comparable data across EU/EEA. World Hepatitis Day Hepatitis is an inflammation of the liver and is most commonly caused by a viral infection. The World Health Organization estimate that there are around 350 million people worldwide with chronic HBV infection, and between 120 to 170 million people with chronic infection with HCV. Both infections are prevalent across Europe but there is considerable variation in the incidence and prevalence of HBV and HCV infections between countries. What is more: 78% of liver cancer cases are linked to viral hepatitis. Transmission modes of hepatitis B and C differ and vary considerably around the world. In countries where HBV prevalence is high (defined as prevalence of HBsAg = 2%) transmission occurs mostly at birth or during childhood through transmission to close household contacts. In areas of lower prevalence, HBV transmission usually occurs later in life mostly through injecting drug use and sexual exposure. In Europe, HCV is transmitted predominantly through the sharing of contaminated needles by people who inject drugs. World Hepatitis Day on 28 July was introduced by the World Health Assembly in 2010 to raise awareness about viral hepatitis and to stimulate prevention and control measures. There are five known hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B and C are blood-borne viruses.