Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Christos Thomadakis¹, Ilias Gountas¹, Erika Duffell², Konstantinos Gountas¹, Benjamin Bluemel², Thomas Seyler³, Filippo Maria Pericoli³, Irene Kászoni-Rückerl⁴, Ziad El-Khatib⁵, Martin Busch⁶, Irene Schmutterer⁶, Thomas Vanwolleghem^{7

8}, Sofieke Klamer⁹, Els Plettinckx⁹, Laure Mortgat⁹, Dominique Van Beckhoven⁹, Tonka Varleva¹⁰, Mirjana Lana Kosanovic Licina¹¹, Tatjana Nemeth Blazic¹², Diana Nonković^{13

14}, Fanitsa Theophanous¹⁵, Vratislav Nemecek¹⁶, Marek Maly¹⁷, Peer Brehm Christensen^{18

19}, Susan Cowan²⁰, Kristi Rüütel²¹, Henrikki Brummer-Korvenkontio²², Cécile Brouard²³, Gyde Steffen²⁴, Amrei Krings²⁴, Sandra Dudareva²⁴, Ruth Zimmermann²⁴, Georgia Nikolopoulou²⁵, Zsuzsanna Molnár²⁶, Emese Kozma²⁶, Magnús Gottfredsson^{27

28}, Niamh Murphy²⁹, Loreta A Kondili^{30

31}, Maria Elena Tosti³⁰, Anna Rita Ciccaglione³², Barbara Suligoi³³, Raina Nikiforova³⁴, Renate Putnina³⁴, Ligita Jancoriene³⁵, Carole Seguin-Devaux³⁶, Tanya Melillo³⁷, Anders Boyd^{38

39

40}, Marc van der Valk^{39

40}, Eline Op de Coul⁴¹, Robert Whittaker⁴², Hilde Kløvstad⁴², Małgorzata Stępień⁴³, Magdalena Rosińska⁴³, Cristina Valente⁴⁴, Rui Tato Marinho⁴⁵, Odette Popovici⁴⁶, Mária Avdičová⁴⁷, Jana Kerlik⁴⁷, Irena Klavs⁴⁸, Mojca Maticic⁴⁹, Asuncion Diaz⁵⁰, Julia Del Amo⁵¹, Josefine Lundberg Ederth⁵², Maria Axelsson⁵², Georgios Nikolopoulos¹

Affiliations

¹ Medical School, University of Cyprus, Nicosia, Cyprus.
² European Centre for Disease Prevention and Control, Stockholm, Sweden.
³ European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
⁴ VII/A/11 Communicable Diseases and Disease Control, Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria.
⁵ Institute for Surveillance & Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria.
⁶ Addiction Competence Center, Austrian National Public Health Institute, Vienna, Austria.
⁷ Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
⁸ Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
⁹ Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
¹⁰ Scientific Research Institute, Medical University, Pleven, Bulgaria.
¹¹ Communicable Disease Epidemiology Department, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia.
¹² 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.
¹³ Teaching Institute of Public Health Split and Dalmatia County, Split, Croatia.
¹⁴ Department of Health Studies, University of Split, Split, Croatia.
¹⁵ Ministry of Health, Nicosia, Cyprus.
¹⁶ National Reference Laboratory for Viral Hepatitis, National Institute of Public Health, Prague, Czech Republic.
¹⁷ Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic.
¹⁸ Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
¹⁹ Clinical Institute, University of Southern Denmark, Odense, Denmark.
²⁰ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
²¹ National Institute of Health Development, Tallinn, Estonia.
²² Finnish Institute for Health and Welfare, Helsinki, Finland.
²³ Santé Publique France, The National Public Health Agency, Saint-Maurice, France.
²⁴ Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
²⁵ National Public Health Organization, Marousi, Greece.
²⁶ National Center for Public Health and Pharmacy, Budapest, Hungary.
²⁷ Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
²⁸ Landspitali University Hospital, Reykjavík, Iceland.
²⁹ HSE Health Protection Surveillance Centre, Dublin, Ireland.
³⁰ National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
³¹ UniCamillus-Saint Camillus International University of Health and Medical Sciences, Rome, Italy.
³² Viral Hepatitis, Oncovirus and Retrovirus Disease Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
³³ National AIDS Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
³⁴ The Centre for Disease Prevention and Control, Riga, Latvia.
³⁵ Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania.
³⁶ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
³⁷ Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Department of Health Regulation, Ministry for Health, Gwardamangia, Malta.
³⁸ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
³⁹ stichting hiv monitoring, Amsterdam, the Netherlands.
⁴⁰ Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
⁴¹ Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
⁴² Section for Respiratory, Blood-borne and Sexually Transmitted Infections, Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
⁴³ Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland.
⁴⁴ Department of Infectious Diseases, Hospitais da Universidade de Coimbra, Directorate General of Health, Coimbra, Portugal.
⁴⁵ Centro Hospitalar Universitário Lisboa Norte, Medical School of Lisbon, Directorate General of Health, Ministry of Health, Lisbon, Portugal.
⁴⁶ National Centre for Surveillance and Control of Communicable Diseases, National Institute of Public Health Romania, Bucharest, Romania.
⁴⁷ Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia.
⁴⁸ National Institute of Public Health, Ljubljana, Slovenia.
⁴⁹ Clinic for Infectious Diseases, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁵⁰ National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain.
⁵¹ Division for HIV, STI, Viral Hepatitis and Tuberculosis Control, Ministry of Health, Madrid, Spain.
⁵² Public Health Agency of Sweden, Solna, Sweden.

PMID: 38188273
PMCID: PMC10769889
DOI: 10.1016/j.lanepe.2023.100792

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Christos Thomadakis et al. Lancet Reg Health Eur. 2023.

. 2023 Dec 13:36:100792.

doi: 10.1016/j.lanepe.2023.100792. eCollection 2024 Jan.

Authors

Affiliations

¹ Medical School, University of Cyprus, Nicosia, Cyprus.
² European Centre for Disease Prevention and Control, Stockholm, Sweden.
³ European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
⁴ VII/A/11 Communicable Diseases and Disease Control, Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria.
⁵ Institute for Surveillance & Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria.
⁶ Addiction Competence Center, Austrian National Public Health Institute, Vienna, Austria.
⁷ Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
⁸ Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
⁹ Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
¹⁰ Scientific Research Institute, Medical University, Pleven, Bulgaria.
¹¹ Communicable Disease Epidemiology Department, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia.
¹² 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.
¹³ Teaching Institute of Public Health Split and Dalmatia County, Split, Croatia.
¹⁴ Department of Health Studies, University of Split, Split, Croatia.
¹⁵ Ministry of Health, Nicosia, Cyprus.
¹⁶ National Reference Laboratory for Viral Hepatitis, National Institute of Public Health, Prague, Czech Republic.
¹⁷ Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic.
¹⁸ Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
¹⁹ Clinical Institute, University of Southern Denmark, Odense, Denmark.
²⁰ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.
²¹ National Institute of Health Development, Tallinn, Estonia.
²² Finnish Institute for Health and Welfare, Helsinki, Finland.
²³ Santé Publique France, The National Public Health Agency, Saint-Maurice, France.
²⁴ Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
²⁵ National Public Health Organization, Marousi, Greece.
²⁶ National Center for Public Health and Pharmacy, Budapest, Hungary.
²⁷ Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland.
²⁸ Landspitali University Hospital, Reykjavík, Iceland.
²⁹ HSE Health Protection Surveillance Centre, Dublin, Ireland.
³⁰ National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
³¹ UniCamillus-Saint Camillus International University of Health and Medical Sciences, Rome, Italy.
³² Viral Hepatitis, Oncovirus and Retrovirus Disease Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
³³ National AIDS Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
³⁴ The Centre for Disease Prevention and Control, Riga, Latvia.
³⁵ Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania.
³⁶ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
³⁷ Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Department of Health Regulation, Ministry for Health, Gwardamangia, Malta.
³⁸ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
³⁹ stichting hiv monitoring, Amsterdam, the Netherlands.
⁴⁰ Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
⁴¹ Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
⁴² Section for Respiratory, Blood-borne and Sexually Transmitted Infections, Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
⁴³ Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland.
⁴⁴ Department of Infectious Diseases, Hospitais da Universidade de Coimbra, Directorate General of Health, Coimbra, Portugal.
⁴⁵ Centro Hospitalar Universitário Lisboa Norte, Medical School of Lisbon, Directorate General of Health, Ministry of Health, Lisbon, Portugal.
⁴⁶ National Centre for Surveillance and Control of Communicable Diseases, National Institute of Public Health Romania, Bucharest, Romania.
⁴⁷ Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia.
⁴⁸ National Institute of Public Health, Ljubljana, Slovenia.
⁴⁹ Clinic for Infectious Diseases, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁵⁰ National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain.
⁵¹ Division for HIV, STI, Viral Hepatitis and Tuberculosis Control, Ministry of Health, Madrid, Spain.
⁵² Public Health Agency of Sweden, Solna, Sweden.

PMID: 38188273
PMCID: PMC10769889
DOI: 10.1016/j.lanepe.2023.100792

Abstract

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 = π_recρ_rec + π_exρ_ex + π_nonρ_non; π_rec, π_ex, and π_non represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρ_rec, ρ_ex, and ρ_non 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.

Keywords: Chronic hepatitis; Elimination; Europe; HCV; Hepatitis C; Prevalence.

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Conflict of interest statement

IG: He is currently an employee of MSD Greece. He joined MSD after his post-doctoral work at the University of Cyprus. TV: He has received grants from Gilead Sciences and Bristol Myers Squibb; he has served as a consultant for Janssen Pharmaceuticals, Gilead Sciences, AbbVie, Bristol Myers Squibb; and he has served as a sponsored lecturer for Gilead Sciences and Abbvie. PBC: He has received unrestricted research grants for other studies from Abbvie, Gilead, and MSD. MG: He has received consultancy and speaker’s fees from Gilead Sciences. LAK: She has received personal lecturer fee from Abbvie and Gilead Sciences and an institutional grant from Gilead Italy Fellowship 2022. LJ: She has received honorarium for lectures from AbbVie and MSD; offered consultancy to AbbVie, MSD, Tamro; and received conference attending fee from AbbVie, MSD, Pfizer, Swixx Biopharma. CSD: She has received educational and research grants for other studies from Abbvie and Gilead Sciences. MV: He participated in advisory boards (ViiV, Gilead, and MSD–fees paid to his institution); he has received independent research grants from ViiV and Gilead (paid to his institution). CV: She has received honorarium for lectures and consultancy from AbbVie, Gilead, MSD, and ViiV Healthcare. AD: She has received a grant for another study and speaker fee at a conference about HIV from Gilead Sciences. AB: He has received speaker's fees from Gilead Sciences. GN: He has received an ASKLEPIOS grant (HIV-related competitive grant) from Gilead Sciences (Greece). All other authors declare no conflict of interest.

Figures

**Fig. 1**
Prevalence (%) of chronic hepatitis C virus (HCV) infection (cHCV) in European Union—European Economic Area (EU/EEA) countries. Notes: HCV-RNA prevalence is used as a proxy for cHCV; Population: 15–79 years old.

**Fig. 2**
Least proportion (%) of prevalence of chronic hepatitis C virus (HCV) infection (cHCV) that is attributed to injection drug use in the European Union—European Economic Area (EU/EEA). Notes: HCV-RNA prevalence is used as a proxy for cHCV; Population: 15–79 years old.

See this image and copyright information in PMC

References

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1. 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. - PMC - PubMed
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Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Affiliations

Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous