Epidemiology of hepatitis C virus infection in seven European Union countries: a critical analysis of the literature. HENCORE Group. (Hepatitis C European Network for Co-operative Research (original) (raw)
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The changing epidemiology of hepatitis C virus infection in Europe
Journal of Hepatology, 2008
The epidemic of hepatitis C virus (HCV) infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Four main factors contribute to such changes: increased blood transfusion safety, improvement of healthcare conditions, continuous expansion of intravenous drug use and immigration to Europe from endemic areas. As a result, intravenous drug use has become the main risk factor for HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.
The European Journal of Public Health, 1998
Background: Since the identification of the hepatitis C virus (HCV) in 1989, hepatitis C infection has been recognized as an infection of public health importance. However, the magnitude of the problem is not well estimated at the European level. In order to assess the burden of HCV infection and to analyse the prevention and management policies of this illness at the European level, we performed a survey of European Union (EU) member state health authorities. Methods: For this purpose, we collected all currently running policies regarding the surveillance, prevention and medical care of HCV infection in EU states through a questionnaire sent to the public health authorities of each member state. Results: Based on the data reported by the different member-states, we estimated that 2.4-5.0 million subjects are HCV seropositive in the EU. If we assume, in accordance with the literature, that approximately 70% of those seropositive for HCV have a viral multiplication, 1.7-3.5 million subjects are potentially infectious and most of them may need to be treated. However, the level of assessment of HCV burden is very variable from one state to another and needs to be improved. For HCV prevention and management, the current national policies and practices are very heterogeneous. The surveillance systems for HCV developed in the EU countries need to be improved and harmonized before the establishment of a European surveillance network. Conclusions: Based on these findings, there is need to promote, coordinate, support and fund European collaborations for this major public health problem.
Medical practices regarding hepatitis C virus infection in Europe
Journal of Viral Hepatitis, 1998
was funded by the Directorate General V of the European Commission to perform an inventory study on the epidemiology, the prevalence, the prevention and the surveillance of hepatitis C virus infection in the European Union (EU) member states in order to propose surveillance and public health recommendations at a
Enhanced surveillance of hepatitis C in the EU , 2006 – 2012
Journal of Viral Hepatitis, 2014
Hepatitis C is a major public health issue across Europe, and with rapidly evolving developments in the therapeutic field, it is essential that countries have access to epidemiological information. In 2011, The European Centre for Disease Prevention and Control (ECDC) introduced enhanced surveillance of hepatitis C across EU/EEA countries collecting routine data from national notification systems using standardized case definitions. Data collected from 2006 to 2012 indicate a high burden of disease with great variation in reported cases between countries. Most cases occurred among young adult males, and although injecting drug use dominated across all cases, there were increasing numbers of acute cases reported among men who have sex with men. Geographically, the reported data were the inverse of what may be expected based on findings from recent prevalence surveys in a number of EU/ EEA countries. Unexpectedly, low figures were reported through notification systems in some southern and eastern European countries where prevalence is known from surveys to be high. This discrepancy highlights the limitation of surveillance data for a disease such as hepatitis C which is largely asymptomatic until a late stage, so that notifications reflect testing practices rather than real occurrence of disease. Further improvements to the quality of the data are important to increase data utility. Improved understanding of national testing practices is necessary to allow a better interpretation of surveillance results. Additional epidemiological studies alongside routine case-based reporting in notification systems should also be considered to better estimate the true disease burden across Europe.
Clinical Microbiology and Infection, 1999
Objective: To evaluate the prevalence of anti-HCV antibodies using subjects hospitalized in surgical departments and medical wards, and out-patients; secondly, to assess the evidence for developing chronic hepatitis in subjects positive for anti-HCV when compared with those with hepatitis B virus (HBV).Methods: 21888 serum samples from 18380 subjects were investigated for anti-HCV antibodies using second and third generation immunoenzymatic assays. Some of these subjects were hospitalized patients and some were out-patients.Results: The study showed a 12.8% overall anti-HCV prevalence rate with significant differences between out-patients (16.5%) or subjects hospitalised in medical wards (16%) and in-patients in surgical departments (7.7%). The third group included asymptomatic subjects over twenty years old whose sera were tested for anti-HCV antibodies as part of routine preoperation screening and not on clinical suspicion. Hence, this group, too, can be considered as representative of the general population, and the prevalence of anti-HCV antibodies observed among them as the prevalence of anti-HCV antibodies in the general population in a northern Italian area. The data, following a confirmatory test (RIBA) on positive samples, were analysed for their positivity to different antigens (the simultaneous presence of antibodies to the C-100, C-33 and C-22 antigens), as an index of developing chronic viral activity. This was observed in 63.4% of positive patients from surgical departments.Conclusions: There is a large proportion of the asymptomatic population which could be chronically infected.
Hepatology, 1997
In 1996 the prevalence, risk factors, and genotype distribu-subject (0.7%), type 2c in 66 subjects (44.6%), type 3a in 4 subjects (2.7%), and type 4 in two subjects (1.3%). These tion of hepatitis C virus (HCV) infection were assessed in the general population of a town in southern Italy. The sample figures differ from those of Italian patients with chronic liver disease in whom genotype 2 is more rare. None of the individ-was selected from the census by a systematic 1:4 sampling procedure. The participation rate was 96.6%. Among the uals was infected with more than one genotype. The distribution of the two most common HCV viral types (1b and 2c) 1,352 subjects enrolled, 195 (14.4%) tested reactive to antibody to HCV (anti-HCV) with enzyme immunoassay (EIA was not statistically different in terms of mean age, sex, or risk factors and suggests that they may have had a parallel 3). When further tested with recombinant immunoblot assay (RIBA 3), 170 subjects (87.2%) tested positive, 23 subjects spread in this community. These findings provide one of the highest overall anti-HCV prevalence rates in a general popula-(11.8%) had indeterminate results, and 2 subjects (1%) tested negative. Thus, the overall anti-HCV EIA-positive RIBA-con-tion with a likely cohort effect, i.e., decreased risk of infection along generations. These observations may indicate an epi-firmed prevalence was 12.6% (170 of 1,352 subjects) and increased from 1.3% in subjects younger than 30 years to demic or focus of hepatitis C that occurred several years earlier. The majority of anti-HCV-positive subjects in the 33.1% in those ¢60 years of age. This latter age group accounted for 72.3% of all anti-HCV-positive subjects. Females oldest age group and with no clinical evidence suggests that HCV infection is a very prolonged and indolent disease. tested positive more frequently than males (14.1% vs. 10.5%; P õ .05). Alanine transaminase (ALT) concentrations were (HEPATOLOGY 1997;26:1006-1011.) abnormal in only 4.1% (7/170) of anti-HCV EIA-positive RIBA-confirmed subjects. This suggests that ALT screening Hepatitis C virus (HCV) infection represents a major is not useful in the detection of anti-HCV-positive subjects health problem in Italy. It has been found to be highly prevain a general population. The results of multiple logistic regreslent in subjects with chronic liver disease 1-2 and strongly sion analysis showed that an age of less than 45 years, the associated with hepatocellular carcinoma. 3-4 use of glass syringes, and dental therapy were all independent General population surveys in different countries that depredictors of anti-HCV positivity. HCV RNA was detected by termined the prevalence of hepatitis C virus antibodies (antipolymerase chain reaction in 75.9% of the 195 anti-HCV EIA-HCV) have mainly consisted of voluntary or paid blood positive subjects: in 84.7% (144/170) of the RIBA-confirmed donors. Because these populations usually have special charsubjects; in 17.4% (4/23) tested as RIBA indeterminate; and acteristics regarding age, sex, socioeconomic level and selecin neither of the two subjects who tested RIBA negative. HCV tive procedures, they are not representative of the general type 1b was detected in 75 subjects (50.7%), type 2b in 1 population. Few studies using valid sampling procedures have provided reliable figures for anti-HCV prevalence in given areas. 5-12 Abbreviations: HCV, hepatitis C virus; anti-HCV, hepatitis C virus antibodies; HBV, On the basis of the phylogenetic analysis of the viral gehepatitis B virus; ALT, alanine transaminase; RIBA, immunoblot assay; anti-HBc, hepatinome, Okamoto et al. 13 classified HCV into four genotypes. tis B core antigen antibodies; RT-PCR, reverse-transcription polymerase chain reaction; Similarly, Simmonds et al. 14 classified the virus into six major OR, odds ratio; CI, confidence interval. types and a series of subtypes. The characteristics of HCV
The state of hepatitis B and C in Europe: report from the hepatitis B and C summit conference*
Journal of Viral Hepatitis, 2011
Worldwide, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause, respectively, 600 000 and 350 000 deaths each year. Viral hepatitis is the leading cause of cirrhosis and liver cancer, which in turn ranks as the third cause of cancer death worldwide. Within the WHO European region, approximately 14 million people are chronically infected with HBV, and nine million people are chronically infected with HCV. Lack of reliable epidemiological data on HBV and HCV is one of the biggest hurdles to advancing policy. Risk groups such as migrants and injecting drug users (IDU) tend to be under-represented in existing prevalence studies; thus, targeted surveillance is urgently needed to correctly estimate the burden of HBV and HCV. The most effective means of prevention against HBV is vaccination, and most European Union (EU) countries have universal vaccination programmes. For both HBV and HCV, screening of individuals who present a high risk of contracting the virus is critical given the asymptomatic, and
Enhanced surveillance of hepatitis C in the EU, 2006 - 2012
Journal of Viral Hepatitis, 2014
Hepatitis C is a major public health issue across Europe, and with rapidly evolving developments in the therapeutic field, it is essential that countries have access to epidemiological information. In 2011, The European Centre for Disease Prevention and Control (ECDC) introduced enhanced surveillance of hepatitis C across EU/EEA countries collecting routine data from national notification systems using standardized case definitions. Data collected from 2006 to 2012 indicate a high burden of disease with great variation in reported cases between countries. Most cases occurred among young adult males, and although injecting drug use dominated across all cases, there were increasing numbers of acute cases reported among men who have sex with men. Geographically, the reported data were the inverse of what may be expected based on findings from recent prevalence surveys in a number of EU/ EEA countries. Unexpectedly, low figures were reported through notification systems in some southern and eastern European countries where prevalence is known from surveys to be high. This discrepancy highlights the limitation of surveillance data for a disease such as hepatitis C which is largely asymptomatic until a late stage, so that notifications reflect testing practices rather than real occurrence of disease. Further improvements to the quality of the data are important to increase data utility. Improved understanding of national testing practices is necessary to allow a better interpretation of surveillance results. Additional epidemiological studies alongside routine case-based reporting in notification systems should also be considered to better estimate the true disease burden across Europe.
A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel
Liver International, 2011
Background and Aim: Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. Methodology: Data references were identified through indexed journals and non-indexed sources. In this work, 13 000 articles were reviewed and 860 were selected based on their relevance. Results: Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence ( 0.5%) estimates were from northern European countries and the highest (Z3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with wellestablished HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and