John C Martin Foundation.

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Background and Aim: Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. Methodology: Data references were identified through indexed journals and non-indexed sources. In this work, 13 000 articles were reviewed and 860 were selected based on their relevance. Results: Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence ( 0.5%) estimates were from northern European countries and the highest (Z3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with wellestablished HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and Keywords diagnosis -epidemiology -HCV -hepatitis C -incidence -mortality -prevalence Conclusion: Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in the region.Chronic hepatitis C (CHC) is a major health burden in Europe. Recent data suggest that patients with CHC have a higher overall morbidity and mortality (1, 2). A significant portion of liver transplantation in Europe is attributable to cirrhosis and hepatocellular carcinoma because of CHC (3). The socioeconomic impact of hepatitis C virus (HCV) infection is tremendous. The incidence of complications of CHC will not decline over the next 10 years despite improved efficacy of antiviral therapy because most patients with CHC remain undiagnosed (4). Prevention of new infections, HCV screening and early treatment have the potential to reduce the overall morbidity and mortality. However, the cost-effectiveness of HCV screening may depend on the HCV prevalence (5). Decisions on public health issues such as HCV screening and prevention measures are dependent on reliable epidemiological data regarding HCV prevalence and transmission routes. The epidemiological status in Europe is continuously evolving and may vary significantly among the different regions throughout Europe (6). Thus, different countries may need different strategies to reduce the overall burden of HCV infection.Because epidemiological data are the basis for the development of preventive measures, we aimed to systematically identify, review and characterize HCV epidemiology throughout Europe. We included Canada and Israel in our analysis because their healthcare systems and the epidemiological situation are similar to many European countries. MethodsA comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed...

SUMMARY. Chronic infection with hepatitis C virus (HCV) is a leading indicator for liver disease. New treatment options are becoming available, and there is a need to characterize the epidemiology and disease burden of HCV. Data for prevalence, viremia, genotype, diagnosis and treatment were obtained through literature searches and expert consensus for 16 countries. For some countries, data from centralized registries were used to estimate diagnosis and treatment rates. Data for the number of liver transplants and the proportion attributable to HCV were obtained from centralized databases. Viremic prevalence estimates varied widely between countries, ranging from 0.3% in Austria, England and Germany to 8.5% in Egypt. The largest viremic populations were in Egypt, with 6 358 000 cases in 2008 and Brazil with 2 106 000 cases in 2007. The age distribution of cases differed between countries. In most countries, prevalence rates were higher among males, reflecting higher rates of injection drug use. Diagnosis, treatment and transplant levels also differed considerably between countries. Reliable estimates characterizing HCV-infected populations are critical for addressing HCV-related morbidity and mortality. There is a need to quantify the burden of chronic HCV infection at the national level.

Summary The number of hepatitis C virus (HCV) infections is projected to decline while those with advanced liver disease will increase. A modeling approach was used to forecast two treatment scenarios: (i) the impact of increased treatment efficacy while keeping the number of treated patients constant and (ii) increasing efficacy and treatment rate. This analysis suggests that successful diagnosis and treatment of a small proportion of patients can contribute significantly to the reduction of disease burden in the countries studied. The largest reduction in HCV‐related morbidity and mortality occurs when increased treatment is combined with higher efficacy therapies, generally in combination with increased diagnosis. With a treatment rate of approximately 10%, this analysis suggests it is possible to achieve elimination of HCV (defined as a >90% decline in total infections by 2030). However, for most countries presented, this will require a 3–5 fold increase in diagnosis and/or treatment. Thus, building the public health and clinical provider capacity for improved diagnosis and treatment will be critical.

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