Hepatitis B and C among healthcare workers and patient groups at increased risk of iatrogenic transmission in the EU/EEA: a systematic review.

In the EU/EEA approximately 9 million people are chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), and many are undiagnosed. Targeted active case finding initiatives are needed. Iatrogenic transmission of HBV/HCV is relevant in Europe but people at risk of infection are often overlooked. We aimed to identify groups at increased risk of HBV/HCV infection due to iatrogenic transmission, including health care workers, and to estimate incidence and prevalence. We systematically searched PubMed and Embase in February 2017 using strings combining terms for HBV/HCV, occurrence and population subgroups. We screened all retrieved publications and quality assessed included articles. A pre-defined set of variables were extracted, detailed summary tables developed per population group of interest, virus and outcome. 38 articles were included, two reported on HBV, 22 on HCV and 16 on both, contributing 70 estimates of prevalence or incidence among: haemodialysis recipients, diabetes patients, recipients of substances of human origin, recipients of medical/dental procedures and healthcare workers. Estimates varied widely from 0.4% to 11.7% for HBV and from 0.7% to over 90% for HCV with most being higher than in the general population. Despite the limited number of studies retrieved, mostly old and focussed on populations with multiple risk factors, our findings highlight the importance of considering population groups at higher risk for HBV/HCV iatrogenic transmission as target groups for active case finding in the EU/EEA. Test offer should be guided by individual risk assessment alongside local epidemiological data and local context