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Review
. 2023 Jan 13;13(1):224.
doi: 10.3390/life13010224.

Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia

Tatjana Vilibic-Cavlek  1   2 , Snjezana Zidovec-Lepej  3 , Thomas Ferenc  4 , Vladimir Savic  5 , Tatjana Nemeth-Blazic  6 , Mateja Vujica Ferenc  7 , Maja Bogdanic  1 , Maja Vilibic  8   9 , Bojana Simunov  10 , Natasa Janev-Holcer  11   12 , Pavle Jelicic  11 , Dominik Ljubas  13 , Tian Kosar  1 , Maja Ilic  6 , Jasmina Kucinar  14 , Ljubo Barbic  15 , Vladimir Stevanovic  15 , Anna Mrzljak  2   16
Affiliations
Review

Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia

Tatjana Vilibic-Cavlek et al. Life (Basel). .

Abstract

Viral hepatitis is a significant cause of morbidity and mortality worldwide. In Croatia, hepatitis B virus (HBV) and hepatitis C virus (HCV) are widely distributed, especially in some high-risk groups such as people who inject drugs (PWID), prisoners, and highly promiscuous groups. The seroprevalence of HBV ranges from 7.0% in the general population to 38.8% in PWID, depending on the region. The seroprevalence of HCV is highest among PWID (29-75.5%) as compared to 0.9% in the general population. Analyzing the distribution of HCV genotypes, no substantial changes in the molecular epidemiology of the two most frequent HCV genotypes (1 and 3) in the past 20 years were observed. However, the predominance of subtype 1b compared to subtype 1a as detected in 1996-2005 was not confirmed in 2008-2015. Hepatitis A virus (HAV) incidence was high in the past with a decreasing trend since the 2000s, except for an outbreak in 2017-2018 as part of the large European outbreak, which was mainly among men who have sex with men. Hepatitis E virus (HEV) is an emerging virus detected for the first time in Croatia in 2012. The seroprevalence of HEV is high among hemodialysis patients (27.9%) and liver transplant recipients (19.3-24.4%). In addition, higher seroprevalence rates were observed in animal-related professions (e.g., veterinarians, 15.2%; hunters, 14.9%). All detected HEV strains belonged to genotype 3.

Keywords: Croatia; Hepatotropic viruses (A–E); molecular epidemiology; seroprevalence.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; in the decision to publish the results.

Figures

Figure 1
Figure 1
Hepatitis A in Croatia—historical data (1954–2020): number of reported cases (A) and deaths (B) in the National Notifiable Diseases Surveillance System.
Figure 2
Figure 2
Phylogenetic tree of selected human hepatitis C virus (HCV) isolates from Croatia and genotype 1–8 representative strains as well as subtype 1a-1o representative strains (in bold). Designations include GenBank accession numbers (in parentheses) and detection years for Croatian strains. A maximum likelihood phylogenetic analysis was conducted, and an evolutionary analysis was performed by using MEGA11 [32].
Figure 3
Figure 3
Phylogenetic tree of HEV human isolates from Croatia and genotype 3 subtype reference strains (in bold) according to Smith et al. [35]. Designations include GenBank accession numbers (in parentheses) and detection years for Croatian strains. A maximum likelihood phylogenetic analysis was conducted, and an evolutionary analysis was performed by using MEGA11 [32].
Figure 4
Figure 4
Prevalence of viral hepatitis markers in PWID in Croatia.
Figure 5
Figure 5
Prevalence of HBsAg in Croatian maternity hospitals (1997–2021).
Figure 6
Figure 6
Prevalence of HBV (line) and HCV (dashes) infection in voluntary blood donors (1998–2021): number of positive samples (A), prevalence/105 donors (B); serology results, serology + NAAT *, NAAT †.
See this image and copyright information in PMC

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