Estimating the scale of chronic hepatitis C virus infection in the EU/EEA: a focus on migrants from anti-HCV endemic countries

A M Falla,E Duffell,T Noori,I K Veldhuijzen,A A Ahmad

doi:10.1186/s12879-017-2908-5

Abstract

BackgroundIncreasing the proportion diagnosed with and on treatment for chronic hepatitis C (CHC) is key to the elimination of hepatitis C in Europe. This study contributes to secondary prevention planning in the European Union/European Economic Area (EU/EEA) by estimating the number of CHC (anti-HCV positive and viraemic) cases among migrants living in the EU/EEA and born in endemic countries, defining the most affected migrant populations, and assessing whether country of birth prevalence is a reliable proxy for migrant prevalence.MethodsMigrant country of birth and population size extracted from statistical databases and anti-HCV prevalence in countries of birth and in EU/EEA countries derived from a systematic literature search were used to estimate caseload among and most affected migrants. Reliability of country of birth prevalence as a proxy for migrant prevalence was assessed via a systematic literature search.ResultsApproximately 11% of the EU/EEA adult population is foreign-born, 79% of whom were born in endemic (anti-HCV prevalence ≥1%) countries. Anti-HCV/CHC prevalence in migrants from endemic countries residing in the EU/EEA is estimated at 2.3%/1.6%, corresponding to ~580,000 CHC infections or 14% of the CHC disease burden in the EU/EEA.The highest number of cases is found among migrants from Romania and Russia (50–60,000 cases each) and migrants from Italy, Morocco, Pakistan, Poland and Ukraine (25–35,000 cases each). Ten studies reporting prevalence in migrants in Europe were identified; in seven of these estimates, prevalence was comparable with the country of birth prevalence and in three estimates it was lower.DiscussionMigrants are disproportionately affected by CHC, account for a considerable number of CHC infections in EU/EEA countries, and are an important population for targeted case finding and treatment. Limited data suggest that country of birth prevalence can be used as a proxy for the prevalence in migrants.

Highlights

Increasing the proportion diagnosed with and on treatment for chronic hepatitis C (CHC) is key to the elimination of hepatitis C in Europe
Effective antiviral treatment can prevent the development of cirrhosis and hepatocellular carcinoma (HCC) and, with newer direct acting antivirals (DAAs) reporting cure rates in more than 90% of cases, [8] the elimination of hepatitis C virus (HCV) infection is possible in Europe [9]
Estimated CHC prevalence and number of infected cases in 31 European Economic Area (EU/EEA) countries (Table 1) The anti-HCV prevalence in the general population in the EU/EEA is estimated at 1.4%

Summary

Introduction

Increasing the proportion diagnosed with and on treatment for chronic hepatitis C (CHC) is key to the elimination of hepatitis C in Europe. Chronic HCV infection affects the liver and has a mostly asymptomatic onset, but can lead to cirrhosis and hepatocellular carcinoma (HCC) decades later [4]. Effective antiviral treatment can prevent the development of cirrhosis and HCC and, with newer direct acting antivirals (DAAs) reporting cure rates in more than 90% of cases, [8] the elimination of HCV infection is possible in Europe [9]. This will require continued primary prevention of new infections in parallel with expansion of secondary prevention through effective screening, linkage to care and treatment

Methods

Results

Discussion

Conclusion