Elsevier

Journal of Hepatology

Volume 48, Issue 1, January 2008, Pages 148-162
Journal of Hepatology

Review
The changing epidemiology of hepatitis C virus infection in Europe

https://doi.org/10.1016/j.jhep.2007.07.033Get rights and content

The epidemic of hepatitis C virus (HCV) infection in Europe is continuously evolving and epidemiological parameters (prevalence, incidence, disease transmission patterns and genotype distribution) have changed substantially during the last 15 years. Four main factors contribute to such changes: increased blood transfusion safety, improvement of healthcare conditions, continuous expansion of intravenous drug use and immigration to Europe from endemic areas. As a result, intravenous drug use has become the main risk factor for HCV transmission, prevalent infections have increased and genotype distribution has changed and diversified. Hence, prevalence data from studies conducted a decade ago may not be useful to estimate the current and future burden of HCV infection and additional epidemiological studies should be conducted, as well as new preventive strategies implemented to control the silent epidemic. This review summarizes recently published data on the epidemiology of HCV infection in Europe focusing on the factors currently shaping the epidemic.

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.

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