Chronic hepatitis B is substantially prevalent across Europe, affecting an estimated 0.7 per cent of the population in the region in 2022, according to a new study published in Eurosurveillance. While this overall burden represents a decrease from the 2005 to 2015 estimate of 1 per cent, infection rates vary significantly across countries, with the highest estimates found in countries in southern and eastern Europe, and the lowest in northern and western countries. This also has implications for Australia, as people born overseas represent the majority of individuals with hepatitis B in Australia, many of them from Europe.
Certain key populations—such as migrants from countries with a higher HBV endemicity and lower vaccination coverage than the destination country, men who have sex with men (MSM), and people who inject drugs (PWID)—are disproportionately affected by chronic HBV infection, with higher prevalence rates than the general population. Interestingly, though, people who did not belong to any key population comprised about two thirds of all HBV cases.
The study found that between 2.4 and 4.1 million people were living with chronic hepatitis B in 2022, with national prevalence ranging from 0.1 per cent to 3.1 per cent
“The analysis confirms that the overall burden of chronic HBV infection remains considerable in the EU/EEA, with major differences between countries and key populations,” said epidemiologist Ana Paula Finatto Canabarro, lead researcher on the study. “The findings further underscore the complexity of the HBV situation in EU/EEA countries and the need for tailored, population-specific interventions.”
The Diagnosis Challenge
Estimates suggest that only 15.7 per cent of people with chronic hepatitis B in the World Health Organization (WHO) European Region have been diagnosed. Accurate and up-to-date prevalence data for chronic hepatitis B are critical to informing efforts to scale up diagnosis, but obtaining them remains a challenge.
The infection is mostly asymptomatic, and testing practices can vary wildly from country to country, and even in regions within countries, so surveillance data do not provide robust enough information for estimating prevalence. In addition, key populations disproportionately affected by the infection are under-represented in prevalence surveys, and sometimes actively excluded—look at the treatment of LGBTQIA+ and immigrant people in Hungary under Viktor Orbán, who just lost power after 16 years, for example.
…key populations disproportionately affected by the infection are under-represented in prevalence surveys, and sometimes actively excluded
Given these limitations, researchers used the United Nations’ Workbook Method to estimate prevalence by country and among men who have sex with men (MSM), people who inject drugs (PWID) and migrants. Prevalence was calculated by combining data on population size and hepatitis B prevalence for key populations. These data were gathered from scientific sources and reviewed by the European Centre for Disease Prevention and Control’s hepatitis national contact points.
The study found that between 2.4 and 4.1 million people were living with chronic hepatitis B in 2022, with national prevalence ranging from 0.1 per cent to 3.1 per cent.
Among migrants, prevalence varied from as little as 0.8 per cent to over 10 per cent in some countries. All of the countries where migrants comprised over three quarters of cases were located in north-western Europe, apart from Cyprus. The burden across countries ranged between under 0.1 per cent to 8.7 per cent among people who inject drugs, and under 0.1 per cent to 10.5 per cent for men who have sex with men, with no clear geographical pattern.
Cases among people who inject drugs and men who have sex with men accounted for fewer cases at the national level compared to migrants and people outside of these populations, but prevalence was still higher.
These estimates confirm substantial chronic hepatitis B prevalence in the EU/EEA. Still, the methodology has several limitations, as it depends heavily on data quality and does not account for overlapping populations.
Improving Estimates
The marked differences between countries and population groups in the prevalence of infection show just why public health interventions specifically tailored to particular population groups are so vital. But while these results align with previous research and provide reasonable estimates, they are still only estimates. There is still a need for better empirical data and further research to address the limitations of this study, as accurate and current estimates are crucial to support and monitor prevention and control policies.
To eliminate viral hepatitis by 2030, policy makers and healthcare providers need to know who are living with viral hepatitis in order to develop strategies to help those people access treatment.
Last updated 17 April 2026
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