BACKGROUND: Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019. METHODS: Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature. FINDINGS: The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs. INTERPRETATION: Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID. FUNDING: ECDC.

7 A 11 Communicable Diseases and Disease Control Federal Ministry of Social Affairs Health Care and Consumer Protection Vienna Austria

Addiction Competence Center Austrian National Public Health Institute Vienna Austria

Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven the Netherlands

Centro Hospitalar Universitário Lisboa Norte Medical School of Lisbon Directorate General of Health Ministry of Health Lisbon Portugal

Clinic for Infectious Diseases University Medical Centre Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Clinic of Infectious Diseases and Dermatovenerology Institute of Clinical Medicine Medical Faculty Vilnius University Vilnius Lithuania

Clinical Institute University of Southern Denmark Odense Denmark

Communicable Disease Epidemiology Department Andrija Stampar Teaching Institute of Public Health Zagreb Croatia

Department for HIV Sexual and Blood Transmitted Diseases Reference Center of the Epidemiology of the Ministry of Health Croatian Institute of Public Health Zagreb Croatia

Department of Biostatistics National Institute of Public Health Prague Czech Republic

Department of Epidemiology and Public Health Sciensano Brussels Belgium

Department of Epidemiology Regional Authority of Public Health in Banská Bystrica Banská Bystrica Slovakia

Department of Gastroenterology and Hepatology University Hospital Antwerp Antwerp Belgium

Department of Health Studies University of Split Split Croatia

Department of Infection and Immunity Luxembourg Institute of Health Esch sur Alzette Luxembourg

Department of Infectious Disease Epidemiology and Prevention Statens Serum Institut Copenhagen Denmark

Department of Infectious Disease Epidemiology and Surveillance National Institute of Public Health NIH National Research Institute Warsaw Poland

Department of Infectious Disease Epidemiology Robert Koch Institute Berlin Germany

Department of Infectious Diseases Hospitais da Universidade de Coimbra Directorate General of Health Coimbra Portugal

Department of Infectious Diseases Odense University Hospital Odense Denmark

Department of Infectious Diseases Public Health Service of Amsterdam Amsterdam the Netherlands

Department of Internal Medicine Division of Infectious Diseases Amsterdam Institute for Infection and Immunity Amsterdam University Medical Centers University of Amsterdam Amsterdam the Netherlands

Division for HIV STI Viral Hepatitis and Tuberculosis Control Ministry of Health Madrid Spain

European Centre for Disease Prevention and Control Stockholm Sweden

European Monitoring Centre for Drugs and Drug Addiction Lisbon Portugal

Faculty of Medicine School of Health Sciences University of Iceland Reykjavík Iceland

Finnish Institute for Health and Welfare Helsinki Finland

HSE Health Protection Surveillance Centre Dublin Ireland

Infectious Disease Prevention and Control Unit Health Promotion and Disease Prevention Directorate Department of Health Regulation Ministry for Health Gwardamangia Malta

Institute for Surveillance and Infectious Disease Epidemiology Austrian Agency for Health and Food Safety Vienna Austria

Landspitali University Hospital Reykjavík Iceland

Medical School University of Cyprus Nicosia Cyprus

Ministry of Health Nicosia Cyprus

National AIDS Unit Department of Infectious Diseases Istituto Superiore di Sanità Rome Italy

National Center for Global Health Istituto Superiore di Sanità Rome Italy

National Center for Public Health and Pharmacy Budapest Hungary

National Centre for Surveillance and Control of Communicable Diseases National Institute of Public Health Romania Bucharest Romania

National Centre of Epidemiology Carlos 3 Health Institute CIBER in Infectious Diseases Madrid Spain

National Institute of Health Development Tallinn Estonia

National Institute of Public Health Ljubljana Slovenia

National Public Health Organization Marousi Greece

National Reference Laboratory for Viral Hepatitis National Institute of Public Health Prague Czech Republic

Public Health Agency of Sweden Solna Sweden

Santé Publique France The National Public Health Agency Saint Maurice France

Scientific Research Institute Medical University Pleven Bulgaria

Section for Respiratory Blood borne and Sexually Transmitted Infections Department of Infection Control and Vaccines Norwegian Institute of Public Health Oslo Norway

stichting hiv monitoring Amsterdam the Netherlands

Teaching Institute of Public Health Split and Dalmatia County Split Croatia

The Centre for Disease Prevention and Control Riga Latvia

UniCamillus Saint Camillus International University of Health and Medical Sciences Rome Italy

Viral Hepatitis Oncovirus and Retrovirus Disease Unit Department of Infectious Diseases Istituto Superiore di Sanità Rome Italy

Viral Hepatitis Research Group Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerp Belgium

Zobrazit více v PubMed

Polaris Observatory Collaborators Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. 2022;7:396–415. PubMed

Page K., Melia M.T., Veenhuis R.T., et al. Randomized trial of a vaccine regimen to prevent chronic HCV infection. N Engl J Med. 2021;384:541–549. PubMed PMC

European Association for the Study of the Liver EASL recommendations on treatment of hepatitis C: final update of the series. J Hepatol. 2020;73:1170–1218. PubMed

World Health Organization (WHO) WHO; Geneva: 2016. Global health sector strategy on viral hepatitis, 2016–2021.https://www.who.int/publications/i/item/WHO-HIV-2016.06

Lombardi A., Mondelli M.U. ESCMID study group for viral hepatitis (ESGVH). Hepatitis C: is eradication possible? Liver Int. 2019;39:416–426. PubMed

World Health Organization (WHO) WHO; Geneva: 2022. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030.https://www.who.int/publications/i/item/9789240053779

Sperle I., Nielsen S., Bremer V., et al. Developing and piloting a standardized European protocol for hepatitis C prevalence surveys in the general population (2016-2019) Front Public Health. 2021;9 PubMed PMC

Han R., Zhou J., François C., Toumi M. Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update. BMC Infect Dis. 2019;19:655. PubMed PMC

Koopsen J., van Steenbergen J.E., Richardus J.H., et al. Chronic hepatitis B and C infections in the Netherlands: estimated prevalence in risk groups and the general population. Epidemiol Infect. 2019;147:e147. PubMed PMC

Chromy D., Bauer D.J.M., Simbrunner B., et al. The ‘Viennese epidemic’ of acute HCV in the era of direct-acting antivirals. J Viral Hepat. 2022;29:385–394. PubMed PMC

Estirado Gomez A., Justo Gil S., Limia A., et al. Prevalence and undiagnosed fraction of hepatitis C infection in 2018 in Spain: results from a national population-based survey. Eur J Public Health. 2021;31:1117–1122. PubMed

Hofstraat S.H.I., Falla A.M., Duffell E.F., et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;145:2873–2885. PubMed PMC

Litzroth A., Suin V., Wyndham-Thomas C., et al. Low hepatitis C prevalence in Belgium: implications for treatment reimbursement and scale up. BMC Public Health. 2019;19:39. PubMed PMC

Cui F., Blach S., Manzengo Mingiedi C., et al. Global reporting of progress towards elimination of hepatitis B and hepatitis C. Lancet Gastroenterol Hepatol. 2023;8:332–342. PubMed

Sweeting M.J., De Angelis D., Hickman M., Ades A.E. Estimating hepatitis C prevalence in England and Wales by synthesizing evidence from multiple data sources. Assessing data conflict and model fit. Biostatistics. 2008;9:715–734. PubMed

McDonald S.A., Mohamed R., Dahlui M., Naning H., Kamarulzaman A. Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis. BMC Infectious Dis. 2014;14:564. PubMed PMC

Hickman M., De Angelis D., Jones H., Harris R., Welton N., Ades A.E. Multiple parameter evidence synthesis--a potential solution for when information on drug use and harm is in conflict. Addiction. 2013;108:1529–1531. PubMed

Presanis A.M., Gill O.N., Chadborn T.R., et al. Insights into the rise in HIV infections, 2001 to 2008: a Bayesian synthesis of prevalence evidence. AIDS. 2010;24:2849–2858. PubMed

Grebely J., Larney S., Peacock A., et al. Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs. Addiction. 2019;114:150–166. PubMed PMC

Micallef J.M., Kaldor J.M., Dore G.J. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. 2006;13:34–41. PubMed

Graf C., Mucke M.M., Dultz G., et al. Efficacy of direct-acting antivirals for chronic hepatitis C virus infection in people who inject drugs or receive opioid substitution therapy: a systematic review and meta-analysis. Clin Infect Dis. 2020;70:2355–2365. PubMed

Lampertico P., Carrion J.A., Curry M., et al. Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: a meta-analysis. J Hepatol. 2020;72:1112–1121. PubMed

European Centre for Disease Prevention and Control (ECDC) ECDC; Stockholm: 2016. Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA.

Stevens G.A., Alkema L., Black R.E., et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet. 2016;388:e19–e23. PubMed

The Lancet Viral hepatitis elimination: a challenge, but within reach. Lancet. 2022;400:251. PubMed

Olafsson S., Fridriksdottir R.H., Love T.J., et al. Cascade of care during the first 36 months of the treatment as prevention for hepatitis C (TraP HepC) programme in Iceland: a population-based study. Lancet Gastroenterol Hepatol. 2021;6:628–637. PubMed

GBD 2019 Europe Hepatitis B & C Collaborators Hepatitis B and C in Europe: an update from the global burden of disease study 2019. Lancet Public Health. 2023;8:e701–e716. PubMed

van Santen D.K., Sacks-Davis R., Stewart A., et al. Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: findings from a multinational cohort between 2010 and 2019. EClinicalMedicine. 2022;56 PubMed PMC

Martinello M., Solomon S.S., Terrault N.A., Dore G.J., Hepatitis C. Lancet. 2023;402:1085–1096. PubMed

Shiha G., Soliman R., Mikhail N.N.H., Easterbrook P. Reduced incidence of hepatitis C in 9 villages in rural Egypt: progress towards national elimination goals. J Hepatol. 2021;74:303–311. PubMed

Iversen J., Dore G.J., Starr M., et al. Estimating the Consensus hepatitis C Cascade of Care among people who inject drugs in Australia: pre and post availability of direct acting antiviral therapy. Int J Drug Policy. 2020;83 PubMed

European Centre for Disease Prevention and Control (ECDC) ECDC; Stockholm: 2022. Monitoring of responses to the hepatitis B and C epidemics in EU/EEA countries – 2020 data.

Malme K.B., Ulstein K., Finbråten A.K., et al. Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: a registry-based study. Int J Drug Policy. 2023;116 PubMed

Midgard H., Ulstein K., Backe Ø., et al. Hepatitis C treatment and reinfection surveillance among people who inject drugs in a low-threshold program in Oslo, Norway. Int J Drug Policy. 2021;96 PubMed

Marshall A.D., Cunningham E.B., Nielsen S., et al. Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe. Lancet Gastroenterol Hepatol. 2018;3:125–133. PubMed

Maticic M., Zorman J.V., Gregorcic S., Schatz E., Lazarus J.V. Changes to the national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs between 2013 and 2016: a cross-sectional survey of 34 European countries. Harm Reduct J. 2019;16:32. PubMed PMC

Tan S., Makela S., Heller D., et al. A Bayesian evidence synthesis approach to estimate disease prevalence in hard-to-reach populations: hepatitis C in New York City. Epidemics. 2018;23:96–109. PubMed

Prevost T.C., Presanis A.M., Taylor A., Goldberg D.J., Hutchinson S.J., De Angelis D. Estimating the number of people with hepatitis C virus who have ever injected drugs and have yet to be diagnosed: an evidence synthesis approach for Scotland. Addiction. 2015;110:1287–1300. PubMed PMC

Johannesson J.M., Fridriksdottir R.H., Love T.J., et al. High rate of hepatitis C virus reinfection among recently injecting drug users: results from the TraP hep C program-A prospective nationwide, population-based study. Clin Infect Dis. 2022;75:1732–1739. PubMed PMC

Christensen P.B., Debrabant B., Cowan S., Debrabant K., Ovrehus A., Duberg A.S. Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020. Euro Surveill. 2022;27 PubMed PMC

European Centre for Disease Prevention and Control (ECDC) ECDC; Stockholm: 2023. 7th meeting of the hepatitis B and C network: meeting report.

Karlsen T.H., Sheron N., Zelber-Sagi S., et al. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet. 2022;399:61–116. PubMed