ECDC publishes report examining responses to hepatitis B and C epidemics

On 15 June 2022, the European Centre for Disease Prevention and Control (ECDC) published a report, monitoring the progress of EU and EEA countries in 2020 towards meeting hepatitis elimination targets. 

In major findings from the report: 

• Nineteen EU and EEA countries have an action plan or strategy for viral hepatitis prevention and control, of which 11 countries reported national funding for implementation. 
• Twenty-two countries reported that there was testing guidance for hepatitis B or hepatitis C, however, many countries’ guidance did not include one or more of the key populations at risk for hepatitis infections. 
• Three countries reported that not all test costs were reimbursed, with nine countries reporting that testing was available in community-based drug service settings and 18 countries reported the existence of policies that require hepatitis tests be performed by healthcare workers, indicating another policy area that could be revised to allow for improved accessibility of testing. 
• Overall, 20 countries provided data for at least one of the four key stages of the hepatitis B continuum of care, while 23 countries provided data for at least one of the four key stages for the hepatitis C continuum of care. 
• The number of countries which were able to report data related to the continuum of care for both hepatitis B and C has fallen since 2018 and significant gaps in data completeness and robustness remain. Data was collected on WHO-defined indicators as well as newly proposed continuum of care indicators. 

The estimated number of people living with chronic hepatitis B virus infection by country varied from 183 to 3,312 per 100,000 population. However, these estimates were derived from a range of methods of varying quality and were often based on studies from before 2016. For hepatitis B, it was not possible to assess progress towards the 2020 WHO European Region action plan targets for most of the targets due to lack of data. For the 2020 diagnosis target, four of eight countries reporting relevant data had met the 50% target and in terms of viral suppression, two countries had met the target of 90% of those on treatment being virally suppressed. 

The estimated number of people living with current chronic hepatitis C virus infection by country ranged from 24 to 2,411 per 100,000 population. These estimates were also sourced from a range of methods and most estimates were from 2018 or earlier. For hepatitis C, data availability along the continuum of care was generally greater compared to hepatitis B, but it is still difficult to assess region-wide progress. Four of seven countries reporting relevant data achieved the 50% diagnosed target, with the best progress being seen in the HCV sustained virologic response target, with ten of the eleven countries reporting data exceeding the 90% target for those achieving SVR of those treated with antiviral medications. 

The COVID-19 pandemic had wide-reaching impacts on hepatitis services in the EU and EEA and has negatively impacted on some hepatitis B and C prevention and testing services. Most countries reported negative impacts of the pandemic on clinic visits for routine care, testing for hepatitis B virus and hepatitis C virus, or the provision of community-based services. Additionally, almost half of the countries reported that there was reduced laboratory capacity for hepatitis B and C testing, however, some routine hepatitis B prevention services, such as routine antenatal screening, were not largely affected by the pandemic. Six countries reported that routine infant and childhood hepatitis B vaccination was negatively affected. 

The COVID-19 pandemic did not appear to have a large impact on hepatitis B and C treatment and governmental funding for hepatitis programmes, though the pandemic did prompt some countries to implement newer strategies, such as virtual appointments and alternative modes of medication delivery. 

Source: ECDC, 15 June 2022