Hepatitis B and hepatitis C represent a threat to global and European public health, with about 4,7 million people living with chronic hepatitis B virus infection (HBV) and 3.9 million with chronic hepatitis C virus infection (HCV) in EU countries.
Both infections are one of the main causes of cirrhosis, liver cancer, and mortality. Available information indicates that many people living with chronic HBV and HCV infections in the EU area remain undiagnosed and unaware of their infection.
Testing for HBV and HCV is critical to diagnose those living with the infection and allow them access to treatment, leading to better health outcomes.
In line with the United Nations Sustainable Development Goals, the World Health Organization (WHO) has set global and regional targets for the elimination of hepatitis B and hepatitis C. The WHO regional office for Europe has developed a hepatitis action plan for the European region with targets for 2020 using specific steps along the continuum of care: testing, treatment and cure/viral suppression. The goal related to testing is for 50 percent of people living with chronic infections, from HBV and HCV, to be diagnosed and then made aware of their condition.
Among the twelve countries that reported sufficient data, there were about 1,597,377 estimated people with chronic HBV infection, of whom only 20.3% were diagnosed.
Of the fifteen countries that reported data on both the estimated number of people living with HCV infection and the number diagnosed by RNA testing, there were approximately 1,422,285 people with chronic HCV infection, of whom only 26.8% had already been diagnosed.
It is important to note that estimating the percentage of chronically HBV and HCV cases diagnosed is currently very challenging because reliable data on both the numerator (number diagnosed) and denominator (current numbers infected) are lacking. Although there are gaps and limitations in the available data, they indicate that, as of 2017, the European region was far from reaching the WHO's 2020 target of 50 percent of people diagnosed. There is a need and urgency to increase resources in monitoring and implementation strategies.
Target populations for screening
.There are several routes of transmission for HBV and HCV. HBV is transmitted via blood, semen, and other body fluids through the following routes: sexual transmission, exposure of patients and health care workers in health care settings, injection drug use, and vertical transmission (mother-to-child). Although vertical transmission is rare within the European region, it occurs more frequently in regions of the world with a higher prevalence of HBV.
HCV is transmitted through blood, most commonly through injection drug use, but also sexually, mainly between men who have sex with men. HBV and HCV can also be transmitted between patient and health care provider in a hospital setting, through accidental puncture with infected blood or blood products or transplantation of unscreened organs/tissues.
The HCV is also transmitted through blood, most commonly through the use of injecting drugs.
Hindrances to screening
From the level of the individual patient, to the broader policy and structural levels, there are several important barriers to performing hepatitis screening tests. In general, there are low levels of knowledge and awareness of HBV / HCV infections and also of the need to screen for these sometimes latent infections among patients, the general public, and health care providers. The asymptomatic nature of much of the course of chronic HBV and HCV probably prevents people living with these infections from actively seeking testing.
The lack of training, education, support, and promotion of testing can often be a barrier to the provision of screening by physicians and administrators in health care institutions. In addition, many populations at risk of hepatitis B and hepatitis C are socially marginalized. Poverty, unstable or unstructured lives, other health, social problems, and fear and/or experience of stigma and discrimination may prevent members of some of the most vulnerable groups from seeking and accessing testing.
Priority Areas for Action
- The scarcity and incompleteness of data regarding HBV and HCV infections both globally and in the European Region present a major challenge in monitoring progress toward WHO and Sustainable Development Goals goals for the elimination of hepatitis as a public health threat. In order to guide national responses toward these goals, countries need to prioritize improving the collection and reporting of high-quality data;
- A high percentage of people living with hepatitis B and C infection are undiagnosed. There is an urgent need for countries to prioritize improving the supply and coverage of screening tests, particularly for the most vulnerable populations.
