Emergency department screening reveals declining HCV viraemia but stable HBV prevalence in Western Europe: A sentinel surveillance opportunity.

BACKGROUND

The World Health Organization targets the elimination of viral hepatitis as a public health threat by 2030, requiring scalable strategies for hepatitis B (HBV) and C (HCV), especially in underserved populations. Emergency departments (EDs) offer a key setting for opt-out blood-borne virus screening, enabling early diagnosis and monitoring of elimination efforts.

METHODS

We reviewed Western European ED-based HCV and HBV screening studies (2005-2025), including HCV antibody (Ab) positivity with confirmatory HCV-RNA testing and/or HBV surface antigen (HBsAg) positivity. Temporal trends in HCV-RNA+/Ab+ and HBsAg prevalence were analyzed across countries.

RESULTS

Seventeen HCV studies from five countries (1500,659 individuals) identified 26,081 HCV Ab+ and 4347 HCV-RNA+ cases. Weighted viremic HCV prevalence declined from 56% in the pre-DAA era (2008-2015) to 10% in 2022-2024, consistently in Spain, England, and Ireland. Ten HBV studies (1425,954 individuals) showed stable HBsAg prevalence (0.70%).

CONCLUSION

ED-based screening reflects population-level changes in viral hepatitis. The decline in viremic HCV highlights the impact of DAA access, while stable HBV prevalence underscores unmet therapeutic needs. ED data could function as a low-cost sentinel surveillance system for hepatitis elimination in Europe.