Researchers Identify Gaps in European Hepatitis Testing

Two recent surveys point to a wide variation in testing policies and practices for addressing hepatitis B and C infections in Europe as the viruses impose a “considerable burden of disease” on the continent.

The European Centre for Disease Prevention and Control, which seeks to strengthen the region’s defenses against infectious diseases, polled the 31 countries in the European Union and European Economic Area. The goal was to determine a starting point for unified action on viral hepatitis.

HBV and HCV affect an estimated 9 million to 10 million people in the EU and EEA. Many of them go undiagnosed, according to the survey findings released in May.

“The purpose of this work was to provide a baseline situation assessment to inform the guidance development process and to assess the availability and feasibility of collecting additional morbidity and mortality data,” the researchers wrote.

The ECDC also sought to compare information available to monitor Europe’s hepatitis B and C epidemics against the indicators the World Health Organization has determined are key to fighting viral hepatitis.

The first survey covered testing policy, practices, needs and priorities. The second looked at the availability of data on liver disease including hepatitis B and C. Of 31 member states, 21 responded to Survey 1 and 22 responded to Survey 2. The questions were distributed in March 2016.

Eleven countries, or 52% of those responding to the first survey, saw a need for European-level HBV/HCV testing guidance. The most commonly reported reason was that such direction would help countries develop a national policy, or to improve their existing program. Determining who should be tested, how to target those at risk, and how to monitor and evaluate screening initiatives were all deemed crucial to success.

The countries also were asked about risk groups. Thirteen reported having policies in place to cover injecting drug users, who are prime candidates for HCV infection. However other vulnerable groups including commercial sex workers, men who have sex with men, those practicing unsafe use of tattoos or piercings, and homeless individuals, were frequently omitted, the researchers found.

Eighteen countries reported implementing policies for testing pregnant women for HBV, which is often spread from an infected mother to her baby during birth. In comparison, six countries had policies for pregnant women involving HCV. Seventeen nations provided information on testing practices for HBV and HCV in prison settings, though the options varied.

In the second survey, data on liver cancer were the most frequently collected indicator. The survey found that a patient’s HBV or HCV status was recorded by only a small number of countries.

“Further work is likely to be required around HBV/HCV monitoring in order to meet the requirements of the WHO HBV/HCV core indicators,” the researchers noted.

The WHO stresses that information on hepatitis should be international, accessible and understandable; documented by data and analysis; and used by countries to monitor national programs. The indicators include disease prevalence, infrastructure for testing and treatment coverage.

“Given the burden of HBV/HCV infection, and in particular the burden of undiagnosed infection, the contribution of viral hepatitis to liver-related morbidity and mortality is likely to be considerable,” the researchers concluded.

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