Epidemiology of hepatitis B in Europe and worldwide

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Introduction

Hepatitis B virus (HBV) infection is a major public health problem and cause of infectious disease mortality worldwide. Approximately 2 billion people – one third of the world's population – have serologic evidence of past or present HBV infection, and 350 million people are chronically infected. Each year over 1 million people die from HBV-related chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC) [1]. HCC is one of the most common cancers worldwide, and HBV is responsible for at least 75% of these cancers [2].

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Geographic patterns of transmission

The endemicity of HBV infection varies greatly worldwide [3], [4] and is influenced primarily by the predominant age at which infection occurs (Table 1). Endemicity of infection is considered high in those parts of the world where at least 8% of the population is hepatitis B surface antigen (HBsAg)-positive. In these areas, 70–90% of the population generally have serological evidence of previous HBV infection. Almost all infections occur during either the perinatal period or early in childhood

Modes of transmission

The incubation period of hepatitis B is long, ranging from 45 to 160 days (average 120). HBV is transmitted by percutaneous and mucous membrane exposures to infectious blood and body fluids that contain blood. Although HBsAg has been detected in a wide variety of body fluids, only serum, semen, and saliva have been demonstrated to be infectious [5], [6]. The presence of hepatitis B e antigen (HBeAg) in serum correlates with higher titers of HBV (up to 109 particles/ml) and greater infectivity

Current epidemiology

In most developed countries, including those in northern and western Europe, the highest incidence of acute hepatitis B is among young adults, and high-risk sexual activity and injecting drug use account for most cases of newly acquired hepatitis B [36], [37], [38], [39]. However, even in these low HBV endemic countries, a substantial number of children become infected with HBV, many of whom belong to families that have immigrated from high HBV endemic countries [3], [40], [41]. Since over 90%

Prevention

The primary goal of hepatitis B prevention programs is reduction of HBV-related chronic liver disease and chronic HBV infection. A secondary goal is the prevention of acute hepatitis B. HBV infection can be prevented by screening blood, plasma, organ, tissue, and semen donors, virus inactivation of plasma-derived products, risk-reduction counseling and services, and implementation and maintenance of infection control practices. Although such activities can reduce or eliminate the potential risk

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