Viral hepatitis: testing saves lives

​Every year, around 50 000 newly diagnosed cases of hepatitis B and C are reported across Europe but millions are unaware of their infection. Left untreated, hepatitis can cause irreversible liver damage. Hepatitis A is recognised as a re-emerging health threat in Europe.

”In Europe, an estimated 10 million people are chronically infected with hepatitis B and C but most  of these individuals do not know of their infection”, highlights acting ECDC Director Andrea Ammon on the occasion of World Hepatitis Day. “A quick blood test helps to check if you are infected or not. Especially those most at-risk for hepatitis should have easy access to testing, for example men who have sex with men or people who inject drugs. After the diagnosis, the actual stage of liver disease and eligibility for treatment can be assessed”, says Ammon.

Reaching and testing those at risk of infection is still a public health challenge across Europe which is why ECDC supports the efforts of the European HIV-Hepatitis testing week that now includes testing for viral hepatitis.

Hepatitis A re-emerging in Europe

Food-borne transmission of hepatitis A virus has been implicated in several outbreaks in recent years: between 2007 and 2012, ECDC and EFSA reported and assessed 14 outbreaks with strong evidence of hepatitis A as the cause. The food items were imported from areas where the virus is still circulating, both outside and inside the EU/EEA.

 

In 2013 and 2014, three large international hepatitis A outbreaks were reported in several EU/EEA countries; all were associated with consumption of frozen or fresh berries. The largest outbreak was declared over in February 2015 and affected 1500 patients, of which more than 1100 were hospitalised. Frozen berries are a potential high-risk food associated with increasing reports of norovirus and hepatitis A outbreaks and contamination events.

In 2014, hepatitis A was recognised as a re-emerging threat, with travels to endemic areas and consumption of contaminated food items as the main risk factors in Europe.

Hepatitis B and C in Europe – new data

Surveillance data from 2013 show high numbers of newly diagnosed hepatitis B and C cases notified across Europe with a reported hepatitis C rate that is more than twice the reported hepatitis B rate. Chronic cases dominate across both diseases with a marked variation between countries: in 2013, 19 930 cases of hepatitis B virus infection were reported in 28 EU/EEA Member States, a crude rate of 4.4 per 100 000 population. 26 EU/ EEA Member States recorded 32 512 cases of hepatitis C resulting in a crude rate of 9.9 per 100 000 population.

Between 2006 and 2013, more than 137 000 newly diagnosed cases of hepatitis B and over 241 000 newly diagnosed hepatitis C infections were reported in Europe – and this is known to be an underestimate of the true burden as hepatitis is largely asymptomatic, so many cases are not diagnosed.

 
Hepatitis B surveillance in Europe 2013

 
Hepatitis C surveillance in Europe 2013

 
Preventable and curable

“Viral hepatitis is preventable and curable”, stresses Ammon, “vaccination is the most effective individual measure to protect yourself against hepatitis A and B. And hepatitis C can be cured, especially if it is detected and treated early”. As a result of local vaccination campaigns, there has been a steady downward trend in the rate of reported acute hepatitis B cases across Europe (from 1.3 per 1000 000 population in 2006 to 0.7 in 2013).

 

Universal infant hepatitis B vaccination is recommended by WHO and this vaccine is included in the schedule of most European countries. Many countries also vaccinate key risk groups. In areas with local virus circulation, the hepatitis A vaccine is recommended for universal vaccination. However this is not the case for most of the EU/EEA countries.

ECDC co-ordinates the surveillance for hepatitis A, B and C to help countries to assess the hepatitis disease burden, evaluate existing prevention and control strategies, and to define epidemiological trends or transmission patterns across Europe.

 

 
What is hepatitis

Hepatitis is an inflammation of the liver and is most commonly caused by a viral infection. There are five known hepatitis viruses, referred to as types A, B, C, D and E. They can cause acute and in the case of hepatitis B and C also chronic liver disease. While infection with the hepatitis A virus is typically caused by consumption of contaminated food or water and causes an acute infection, hepatitis B and C usually occur as a result of contact with infected blood or body fluids and can develop into a life-threatening chronic infection.