ReviewThe changing epidemiology of hepatitis C virus infection in Europe☆
Section snippets
Search methods
The information in this report is based on peer-reviewed medical articles published up to March 2007. A PubMed search was made using the terms “hepatitis C” or “HCV” in combination with the roots “epidemiol*, “inciden*, “prevalen*, geno*”, Europe and each of the European country names. Updates and reviews on HCV epidemiology were also included and bibliographies of the articles retrieved were used to find other references. Several databases (WHO, UN, Eurostat, EMCCDDA, Eurosurveillance and
Background
Despite significant geographic and temporal differences in the epidemiology of HCV infection in Europe, it has been suggested that the initial spread of the virus started during the last century through the use of unsafe parenteral injections, invasive medical and surgical procedures and transfusion of blood products. An epidemic explosion of intravenous drug use (IDU) shortly followed the iatrogenic spread. The timing and the extent to which health-care-related transmission or IDU fuelled the
Blood transfusion safety
Blood transfusions were a leading cause of the spread of HCV in most European countries since World War II. In the late 1980s, 2% to 10% of blood units in developed countries transmitted HCV [12], [19], [56], [57]. Consequently, most chronic transfusion recipients and patients receiving clotting factor concentrates were infected [58], [59], [60], [61]. However, implementation of an all-volunteer blood donor system (1980), effective virus-inactivation procedures for blood derivatives (1987), and
Improvement in safety of health-care-related procedures
Use of disposable injection items, improvement of disinfection techniques for non-disposable equipment, and adherence to standard infection control measures [87], [88], [89], [90] have likely lowered iatrogenic HCV infection. However, health-care-related infections continue to occur even in countries with high sanitary standards. Such infections are mostly patient-to-patient transmissions (either sporadic or as small outbreaks), and are more common in areas and settings with higher HCV
Injection drug use as the core of the HCV epidemic
In certain European countries (UK, Sweden, Norway), illegal injection drug use (IDU) has been the dominant mode of HCV transmission during the past 35 years, accounting for 60% to 90% of prevalent infections [42], [118], [119], [120], [121]. As already stated, IDU has become the main transmission mechanism of HCV in Western Europe [3] and, along with the explosive increase of IDU in Eastern Europe, has placed drug users (IDUs) at the core of the HCV epidemic [122].
The European Monitoring Centre
Immigration as part of the epidemiological change
Several European countries have sustained high net migration rates for decades, but uncontrolled migratory flows from developing countries are more recent and a substantial proportion of the estimated 20 million immigrants living in the EU have arrived during the last 15 years. As shown in Table 2, in some countries up to 12% of the population is composed of immigrants. Immigration is a new phenomenon in some EU members like Spain, which, after centuries of net emigration, has become host to
Facing the consequences of the changing epidemiology of HCV in Europe
Epidemiological changes of HCV infection in Europe have long been identified, but the consequences have yet to be adequately addressed. Fig. 5 summarizes the recommended strategies to face current challenges of the new epidemiological situation. New large-scale epidemiological studies, including accurate molecular methods to identify subtypes and recombinants, are required to estimate the current and future burden of the infection. Such studies, however, should not delay the immediate measures (
Acknowledgments
This work has been supported in part by the Spanish Ministry of Science and Education grant SAF 2006-03681; the Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, grant PI061244, Fundació Marató TV3 052310 and FIPSE 36623/06.
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The authors declare that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.