Hepatitis B/C in the countries of the EU/EEA: a systematic review of the prevalence among at-risk groups

Abstract

BackgroundIn 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030. Robust epidemiological information underpins all efforts to achieve elimination and this systematic review provides estimates of HBsAg and anti-HCV prevalence in the European Union/European Economic Area (EU/EEA) among three at-risk populations: people in prison, men who have sex with men (MSM), and people who inject drugs (PWID).MethodsEstimates of the prevalence among the three risk groups included in our study were derived from multiple sources. A systematic search of literature published during 2005–2015 was conducted without linguistic restrictions to identify studies among people in prison and HIV negative/HIV sero-status unknown MSM. National surveillance focal points were contacted to validate the search results. Studies were assessed for risk of bias and high quality estimates were pooled at country level. PWID data were extracted from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) repository.ResultsDespite gaps, we report 68 single study/pooled HBsAg/anti-HCV prevalence estimates covering 23/31 EU/EEA countries, 42 of which were of intermediate/high prevalence using the WHO endemicity threshold (of ≥2%). This includes 20 of the 23 estimates among PWID, 20 of the 28 high quality estimates among people in prison, and four of the 17 estimates among MSM. In general terms, the highest HBsAg prevalence was found among people in prison (range of 0.3% - 25.2%) followed by PWID (0.5% - 6.1%) and MSM (0.0% - 1.4%). The highest prevalence of anti-HCV was also found among people in prison (4.3% - 86.3%) and PWID (13.8% - 84.3%) followed by MSM (0.0% - 4.7%).ConclusionsOur results suggest prioritisation of PWID and the prison population as the key populations for HBV/HCV screening and treatment given their dynamic interaction and high prevalence. The findings of this study do not seem to strongly support the continued classification of MSM as a high risk group for chronic hepatitis B infection. However, we still consider MSM a key population for targeted action given the emerging evidence of viral hepatitis transmission within this risk group together with the complex interaction of HBV/HCV and HIV.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-2988-x) contains supplementary material, which is available to authorized users.

Prevalence of Hepatitis C Virus and Associated Risk Factors among Inmates at New Bell Prison, Douala, Cameroon

“…These findings are similar to those reported by Adoga [19]. In the prison milieu, overcrowding and precarious conditions with increased promiscuity favours this practice which is well known as risk factor of HCV infection.…”

Prevalence and risk factors for HBV and HCV among incarcerated people who inject drugs in Iran: a cross sectional study

“…Furthermore, prisoners are prone to hide their real injection status. However, the ndings of a study by Falla et al in Europe showed that the prevalence of HBV and HCV in prisoners is higher than that among injecting drug users (3). It highlights the fact that imprisonment results in the gathering of a large group of patients and provides a chance to implement health-related interventions, including diagnosis, treatment, and prevention programs.…”

“…Studies have shown that a large proportion of cases with HBV and HCV are exclusively observed in speci c groups such as prisoners and people who inject drugs (PWID) (3), that might be attributed to different reasons. First, a signi cant percentage of prisoners are incarcerated due to drug-related crimes (4), therefore, there is a high population of PWID in prisons.…”

Trends in hepatitis C virus seroprevalence and associated risk factors among men who have sex with men in Montréal: results from three cross-sectional studies (2005, 2009, 2018)

“…Global HCV seroprevalence among MSM living with HIV was estimated at 6.4% from 2002-2015 [11]. Comparatively, the burden of HCV has remained stable among HIV-negative MSM, with estimates of HCV seroprevalence ranging from 0.0-3.4% [12][13][14][15][16], and a global incidence of 0.4/1,000 person-years [17]. Nevertheless, recent cases of acute HCV infection have been reported among HIV-negative MSM without a history of injection drug use (IDU) in Europe [18], the United States [19], and Vancouver, British Columbia (Canada) [20].…”