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Use of the Workbook Method to estimate the prevalence of chronic hepatitis B infections in the European Union and European Economic Area, 2022
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Ana Paula Finatto Canabarro1,2
,
Erika Duffell1
,
Disa Hansson1
,
Sandra Dudareva3,4
,
Thomas Seyler5
,
Rene Niehus1
,
Ndeindo Ndeikoundam Ngangro1
,
Ziad El-Khatib6
,
Els Plettinckx7
,
Laure Mortgat7
,
Mariya Tyufekchieva8
,
Fani Theophanous9
,
Vratislav Němeček10
,
Marek Malý11
,
Maria Wessman12
,
Hanna Maria Aavik13
,
Cécile Brouard14
,
Ruth Zimmermann3
,
Dimitrios Paraskevis15
,
Georgia Nikolopoulou15
,
Zsuzsanna Molnár16
,
Emese Kozma16
,
Niamh Murphy17
,
Maria Elena Tosti18
,
Šarlote Konova19
,
Esther Walser-Domjan20
,
Judith Hübschen21
,
Carole Seguin-Devaux21
,
Tanya Melillo22
,
Eline Op de Coul23
,
Tom Woudenberg23
,
Robert Whittaker24
,
Małgorzata Stępień25
,
Magdalena Rosińska25
,
Vítor Cabral Veríssimo26
,
Rui Tato Marinho27,28,29
,
Victoria Hernando30
,
Asuncion Diaz30
,
Maria Axelsson31
,
Marie Nordahl31
,
Filippo Pericoli5
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View Affiliations Hide AffiliationsAffiliations: 1 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 2 Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden 3 Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany 4 Institute of Public Health, Riga Stradins University, Riga, Latvia 5 European Union Dugs Agency, Lisbon, Portugal 6 Institute for Surveillance & Infectious Disease Epidemiology - Austrian Agency for Health and Food Safety (AGES), Vienna, Austria 7 Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium 8 Ministry of Health, Bulgaria 9 Ministry of Health, Nicosia, Cyprus 10 National Reference Laboratory for Viral Hepatitis, National Institute of Public Health, Prague, Czech Republic 11 Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic 12 Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark 13 Health Board, Tallinn, Estonia 14 Santé Publique France, the National Public Health Agency, Saint-Maurice, France 15 National Public Health Organization, Marousi, Greece 16 National Center for Public Health and Pharmacy, Budapest, Hungary 17 HSE Health Protection Surveillance Centre, Dublin, Ireland 18 National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy 19 The Centre for Disease Prevention and Control, Riga, Latvia 20 Office of Public Health, Vaduz, Liechtenstein 21 Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg 22 Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Department of Health Regulation, Ministry for Health, Gwardamangia, Malta 23 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands 24 Section for Respiratory, Blood-borne and Sexually Transmitted Infections, Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway 25 Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health NIH – National Research Institute, Warsaw, Poland 26 Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal 27 Faculty of Medicine of the University of Lisbon, Lisbon, Portugal 28 Local Unit of Health Santa Maria, Medical School Lisbon, University of Lisbon, Portugal 29 National Programme for Viral Hepatitis, Directorate-General of Health, Lisbon, Portugal 30 National Centre of Epidemiology, Carlos III Health Institute, CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain 31 Public Health Agency of Sweden, Solna, SwedenCorrespondence:Erika DuffellErika.Duffell ecdc.europa.eu
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View Citation Hide Citation
Citation style for this article: Canabarro Ana Paula Finatto, Duffell Erika, Hansson Disa, Dudareva Sandra, Seyler Thomas, Niehus Rene, Ngangro Ndeindo Ndeikoundam, El-Khatib Ziad, Plettinckx Els, Mortgat Laure, Tyufekchieva Mariya, Theophanous Fani, Němeček Vratislav, Malý Marek, Wessman Maria, Aavik Hanna Maria, Brouard Cécile, Zimmermann Ruth, Paraskevis Dimitrios, Nikolopoulou Georgia, Molnár Zsuzsanna, Kozma Emese, Murphy Niamh, Tosti Maria Elena, Konova Šarlote, Walser-Domjan Esther, Hübschen Judith, Seguin-Devaux Carole, Melillo Tanya, de Coul Eline Op, Woudenberg Tom, Whittaker Robert, Stępień Małgorzata, Rosińska Magdalena, Veríssimo Vítor Cabral, Marinho Rui Tato, Hernando Victoria, Diaz Asuncion, Axelsson Maria, Nordahl Marie, Pericoli Filippo. Use of the Workbook Method to estimate the prevalence of chronic hepatitis B infections in the European Union and European Economic Area, 2022. Euro Surveill. 2026;31(14):pii=2500322. https://doi.org/10.2807/1560-7917.ES.2026.31.14.2500322 Received: 09 May 2025; Accepted: 04 Mar 2026
Abstract
Up-to-date estimates of chronic hepatitis B virus (HBV) prevalence in both general and key populations are challenging to obtain because of underdiagnosis, heterogeneous surveillance systems and underrepresentation of key populations.
We aimed to test the Workbook Method to estimate chronic HBV prevalence in 2022 across the EU/EEA, by country and among men who have sex with men (MSM), people who inject drugs (PWID) and migrants.
We used the Robert Koch Institute’s version of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Workbook Method to generate HBV prevalence estimates for each EU/EEA country and for MSM, PWID and migrants within each country. We combined data on population size and HBV prevalence for each population group gathered from scientific sources and reviewed by the European Centre for Disease Prevention and Control’s hepatitis national contact points.
Overall, 0.7% (lower bound–upper bound: 0.5–0.9%) of the EU/EEA population (3,226,000 (2,397,000–4,149,000) individuals) were estimated to be living with HBV in 2022. National HBV prevalence ranged from 0.1% (0.1–1.0%) to 3.1% (2.8–3.3%). Prevalence estimates varied from 0.8% (0.5–1.0%) to 10.5% (9.3–11.9%) for migrants, < 0.1% to 8.7% (lower and upper bounds not available) for PWID and from < 0.1% (< 0.1– < 0.1%) to 10.5% (10.2–10.8%) for MSM.
Despite limitations, including the inability to address overlapping populations, these estimates confirm substantial chronic HBV prevalence in the EU/EEA, with considerable variation between countries and population groups. This relatively straightforward method offers an alternative means of generating HBV prevalence estimates.
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References
-
World Health Organization (WHO). Global hepatitis report 2024: Action for access in low- and middle-income countries. Geneva: WHO; 2024. Available from: https://www.who.int/publications/i/item/9789240091672
-
Bivegete S, McNaughton AL, Trickey A, Thornton Z, Scanlan B, Lim AG, et al. Estimates of hepatitis B virus prevalence among general population and key risk groups in EU/EEA/UK countries: a systematic review. Euro Surveill. 2023;28(30):2200738. https://doi.org/10.2807/1560-7917.ES.2023.28.30.2200738 PMID: 37498533
-
Razavi-Shearer D, Blach S, Gamkrelidze I, Estes C, Mooneyhan E, Razavi-Shearer K, et al. The disease burden of hepatitis B and hepatitis C from 2015 to 2030: the long and winding road. J Hepatol. 2022;77:S43. https://doi.org/10.1016/S0168-8278(22)00496-2
-
World Health Organization (WHO). Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Geneva: WHO; 2024. Available from: https://www.who.int/publications/i/item/9789240090903
-
Duffell EF, van de Laar MJ. Survey of surveillance systems and select prevention activities for hepatitis B and C, European Union/European Economic Area, 2009. Euro Surveill. 2015;20(13):17-24. https://doi.org/10.2807/1560-7917.ES2015.20.13.21080 PMID: 25860392
-
European Centre for Disease Prevention and Control (ECDC). Hepatitis B. - Annual epidemiological report 2023. Stockholm: ECDC; 2025. Available from: https://www.ecdc.europa.eu/en/publications-data/hepatitis-b-annual-epidemiological-report-2023
-
Sperle I, Steffen G, Leendertz SA, Sarma N, Beermann S, Thamm R, et al. Prevalence of Hepatitis B, C, and D in Germany: Results From a Scoping Review. Front public Heal. 2020;8:424.
-
Walker N, Stover J, Stanecki K, Zaniewski AE, Grassly NC, Garcia-Calleja JM, et al. The workbook approach to making estimates and projecting future scenarios of HIV/AIDS in countries with low level and concentrated epidemics. Sex Transm Infect. 2004;80(Suppl 1) Suppl 1;i10-3. PMID: 15249693
-
Koopsen J, van Steenbergen JE, Richardus JH, Prins M, Op de Coul ELM, Croes EA, et al. Chronic hepatitis B and C infections in the Netherlands: estimated prevalence in risk groups and the general population. Epidemiol Infect. 2019;147:e147. https://doi.org/10.1017/S0950268819000359 PMID: 30869044
-
Kremer-Flach K, Zimmermann R, An der Heiden M, Dudareva S.Estimated number of people infected with hepatitis B and C virus in Germany in 2013: a baseline prevalence estimate using the workbook method. Front Public Health. 2025;13:1471256. https://doi.org/10.1017/S0950268819000359 PMID: 30869044
-
Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, et al. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023;8(10):879-907. https://doi.org/10.1016/S2468-1253(23)00197-8 PMID: 37517414
-
Eurostat. Population on 1 January by age group, sex and country of birth (migr_pop3ctb). Luxembourg: Eurostat; 2024. Available from: https://ec.europa.eu/eurostat/databrowser/view/migr_pop3ctb/default/table?lang=en
-
Thomadakis C, Gountas I, Duffell E, Gountas K, Bluemel B, Seyler T, et al. Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis. Lancet Reg Health Eur. 2023;36:100792. https://doi.org/10.1016/j.lanepe.2023.100792 PMID: 38188273
-
European Union Drugs Agency (EUDA). Viral hepatitis elimination barometer among people who inject drugs in Europe. Lisbon: EUDA. [Accessed: 14 Apr 2024]. Available from: https://www.euda.europa.eu/publications/data-factsheet/viral-hepatitis-elimination-barometer-among-people-who-inject-drugs-in-europe_en
-
Marcus U, Hickson F, Weatherburn P, Schmidt AJ, EMIS Network. Estimating the size of the MSM populations for 38 European countries by calculating the survey-surveillance discrepancies (SSD) between self-reported new HIV diagnoses from the European MSM internet survey (EMIS) and surveillance-reported HIV diagnoses among MSM in 2009. BMC Public Health. 2013;13(1):919. https://doi.org/10.1186/1471-2458-13-919 PMID: 24088198
-
Trickey A, Bivegete S, Duffell E, McNaughton AL, Nerlander L, Walker JG, et al. Estimating hepatitis B virus prevalence among key population groups for European Union and European Economic Area countries and the United Kingdom: a modelling study. BMC Infect Dis. 2023;23(1):457. https://doi.org/10.1186/s12879-023-08433-3 PMID: 37430220
-
Council of the European Union. Refugees from Ukraine in the EU. Brussels: Council of the European Union. [Accessed: 2 Dec 2023]. Available from: https://www.consilium.europa.eu/en/infographics/ukraine-refugees-eu/
-
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55. https://doi.org/10.1016/S0140-6736(15)61412-X PMID: 26231459
-
WHO Publication. Hepatitis B vaccines: WHO position paper--recommendations. Vaccine. 2010;28(3):589-90. https://doi.org/10.1016/j.vaccine.2009.10.110 PMID: 19896455
-
Galimska J. The expanded programme on immunization calendar in Poland. Vaccine. 2000;18(Suppl 1):S41-3. https://doi.org/10.1016/S0264-410X(99)00461-2 PMID: 10683544
-
Statistics Denmark. Population Statistics (FOLK1C). Copenhagen, Denmark: Statistics Denmark. [Accessed: 6 Feb 2024]. Available from: https://statbank.dk/statbank5a/SelectVarVal/Define.asp?MainTable=FOLK1C&PLanguage=1&PXSId=0&wsid=cfsearch
-
European Centre for Disease Prevention and Control (ECDC). Systematic review on hepatitis B and C prevalence in the EU/EEA. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/systematic-review-hepatitis-b-and-c-prevalence-eueea
-
Hofstraat SHI, Falla AM, Duffell EF, Hahné SJM, Amato-Gauci AJ, Veldhuijzen IK, et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;145(14):2873-85. https://doi.org/10.1017/S0950268817001947 PMID: 28891457
-
European Centre for Disease Prevention and Control (ECDC). Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/epidemiological-assessment-hepatitis-b-and-c-among-migrants-eueea
-
Laisaar KT, Avi R, DeHovitz J, Uusküla A. Estonia at the threshold of the fourth decade of the AIDS era in Europe. AIDS Res Hum Retroviruses. 2011;27(8):841-51. https://doi.org/10.1089/aid.2010.0223 PMID: 21142588
-
Marty L, Lemsalu L, Costagliola D, Vals K, Kaupe R, Linina I. The HIV Epidemic in Two Baltic States: A Tale of Two Stories? Presented at HepHIV 2019 Conference. Bucharest, Romania; 2019. Poster PS1/02. Available from: https://eurotest.org/media/ngeel30o/ps1_02.pdf
-
European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2023–2022 data. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/hivaids-surveillance-europe-2023-2022-data
-
United Nations. Global Compact for Safe, Orderly and Regular Migration. Resolution A/RES/73/195. New York: United Nations; 2019. Available from: https://digitallibrary.un.org/record/1660537?v=pdf
-
European Centre for Disease Prevention and Control (ECDC). Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/public-health-guidance-screening-and-vaccination-infectious-diseases-newly
-
Razavi-Shearer DM, Kondili LA, Hall S, Buti M, Gamkrelidze I, Naveira MCM, et al. Estimating the impact of displacement from Ukraine on HBV and HCV prevalence among migrants in the European Union, 2024: a modeling study. Lancet Reg Health Eur. 2025;58:101452. https://doi.org/10.1016/j.lanepe.2025.101452 PMID: 40980817
-
European Centre for Disease Prevention and Control (ECDC). Prevention of hepatitis B and C in the EU/EEA. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/prevention-hepatitis-b-and-c-eueea-2024
-
European Centre for Disease Prevention and Control (ECDC). Monitoring of the responses to the hepatitis B and C epidemics in EU/EEA countries, 2023. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/en/publications-data/monitoring-responses-hepatitis-b-and-c-epidemics-eueea-countries-2023
-
European Centre for Disease Prevention and Control (ECDC). Testing of HIV, hepatitis B and hepatitis C in the European Union/European Economic Area (EU/EEA). Stockholm: ECDC; 2025. Available from: https://www.ecdc.europa.eu/en/publications-data/testing-hiv-hepatitis-b-and-hepatitis-c-european-union-european-economic-area
-
Sheena BS, Hiebert L, Han H, Ippolito H, Abbasi-Kangevari M, Abbasi-Kangevari Z, et al. Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol. 2022;7(9):796-829. https://doi.org/10.1016/S2468-1253(22)00124-8 PMID: 35738290
-
Vriend HJ, Van Veen MG, Prins M, Urbanus AT, Boot HJ, Op De Coul ELM. Hepatitis C virus prevalence in The Netherlands: migrants account for most infections. Epidemiol Infect. 2013;141(6):1310-7. https://doi.org/10.1017/S0950268812001884 PMID: 22963908
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