Overview of epidemiology and disease burden of hepatitis B in the European region.

The European Regional Office of the World Health Organization (WHO) carried out a survey to collect the available surveillance data on hepatitis B and to determine the preventive strategies and policies in 50 countries in the European region. A questionnaire was sent to every country to obtain data on acute hepatitis B incidence over the past five years as well as estimates of the prevalence of hepatitis B carriage and infection in the general population. Although the surveillance systems vary in their methods and completeness, the pattern of disease is clear. In western Europe, rates vary from north to south. Southern countries have incidence rates of about 6 per 100,000 per year whereas northern countries such as Scandinavia, Ireland and the UK have much lower rates of about 1 per 100,000. Central Europe has markedly higher rates of about 20 per 100,000 per year. The highest rates are found in the Central Asian Republics, where the rates are close to 100 per 100,000 per year. Mortality data on cancer liver diseases are also available. These, together with data on the prevalence of hepatitis B in the general population of each country, provide estimates of the number of deaths attributable to hepatitis B for each country. These estimates, in comparison with other preventable causes of death, illustrate the importance of hepatitis B in Europe. Most countries have some form of selective vaccination policy, although the risk groups targeted vary markedly from country to country. Only Albania, Bulgaria, France, Israel, Italy, Portugal and Spain have implemented national universal hepatitis B vaccination programmes.