Hepatitis B and C surveillance in Europe 2012

Surveillance report
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European Centre for Disease Prevention and Control. Hepatitis B and C surveillance in Europe. 2012. Stockholm: ECDC; 2014.

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This is the second report on the enhanced surveillance of hepatitis B and C viral infections. It describes basic epidemiological features and trends of both diseases across countries in the European Union and European Economic Area for 2012.

Executive summary

This is the second report from the European Centre for Disease Prevention and Control (ECDC) on the enhanced surveillance of hepatitis B and C viral infections. It aims to describe basic epidemiological features and trends of both diseases across countries in the European Union and European Economic Area (EU/ EEA) for 2012. The data collected, using the updated EU 2012 case definition for hepatitis B and C1, include both acute and chronic infections. The previous EU case definitions for hepatitis B defined only acute cases, and as a consequence some countries still only collect acute viral hepatitis case data on a national level.

In 2012, 17 329 cases of hepatitis B were reported in 29 EU/ EEA Member States, resulting in an overall crude rate of 3.5 per 100 000 population. Of these cases, 2 798 (16.1%) were reported as acute, 12 306 (71.0%) as chronic and 1 865 (10.8%) as unknown, and 360 cases (2.1%) could not be classified as data were provided in an incompatible format. The rates of reported acute infections were considerably lower than those for chronic infections and varied between countries. The overall rates of reported acute cases continue to decline, which has been observed in several European countries and attributed to the widespread implementation of vaccination programmes. For chronic cases, there has been an on-going increase in the overall numbers and rates of reported cases over time, which probably reflects increased testing. Rates of reported chronic cases showed great variation between countries and these differences are likely to be related to differential levels of screening and diagnostic testing, as well as differences in migration patterns. Hepatitis B was more commonly reported among men than women, with an overall rate of 4.2 cases per 100 000 for men and 2.8 for women. The most affected age group were those between 25 and 34 years old, accounting for 33.3% of cases.

The reported modes of transmission differed between acute and chronic hepatitis B cases. For acute infection, heterosexual transmission and nosocomial transmission were the most commonly reported routes of transmission. For chronic infections, mother-to-child transmission continues to be the most common reported transmission route and this is probably related to a high proportion of imported cases. Although the data provided for variables relating to migration are incomplete, data from countries with relatively good reporting indicate that many of the chronic cases are classified as imported and infection was acquired through mother-to-child transmission.

Hepatitis C is reported to cause a greater disease burden in terms of numbers of reported cases than hepatitis B. In 2012, 30 607 cases of hepatitis C were reported in 27 EU/ EEA Member States, representing an overall notification rate of 7.8 cases per 100 000 population. Of these cases, 509 (1.7%) were reported as acute, 3 905 (12.8%) as chronic and 23 712 (77.5%) as unknown, and 2 481 cases (8.1%) could not be classified due to the format of the data provided. Although five countries were only able to report acute cases, the majority of all reported cases were classified as chronic or unknown. In countries able to report acute and chronic cases, most of these unknown cases are likely to be chronic cases, as acute cases are difficult to diagnose clinically or serologically. There is variation between countries in the rates of reported infections, especially for chronic cases and this variation is most likely to be related to differences in local testing practices.

Hepatitis C is also more commonly reported among men than women, with an overall rate ratio of 2:1. Just over half (54.0%) of all hepatitis C cases reported were aged between 25 and 44 years, and 9.5% of cases were aged under 25 years. The notification rate was highest for both males and females in the 25 to 34 age group, at 22.3 per 100 000 in males and 13.3 per 100 00 in females.

Injecting drug use was the most commonly reported route of transmission accounting for 76.7% of all hepatitis C cases with complete information. There has been a continued rise in the proportion of acute cases among men who have sex with men (MSM), from 0.8% in 2006 to 14.6% in 2012.

Data provided on the outcome of these infections were incomplete but available information from the published literature suggests that the disease-related burden of cirrhosis and hepatocellular carcinoma is considerable, and associated with high levels of mortality across the EU. Further work to collate available information on hepatitisassociated morbidity and mortality at the European level would help augment the notification data.

Data completeness varied considerably across variables and countries, and a small proportion of countries were not able to provide data as defined by the new EU 2012 case definitions. Heterogeneity in surveillance systems and reporting practices in EU/ EEA Member States remain a problem, and findings in both hepatitis B and C must be interpreted with caution.

The enhanced surveillance of hepatitis B and C has highlighted a significant burden of disease across Europe and differences in their distribution across countries. Enhanced surveillance of hepatitis B and C in Europe is important to provide information to help monitor the distribution of these diseases and evaluate the public health response to control the transmission of infections. To achieve this goal, further work is necessary to improve the quality of the surveillance data and to understand further the differences between countries, and the discrepancy between surveillance and sero-prevalence surveys.