Population-based prevalence and screening gaps of hepatitis C, B and D, Germany, 2020 to 2021

BACKGROUNDChronic hepatitis C (HCV) and hepatitis B (HBV) viruses remain major causes of liver-related morbidity and mortality. Despite a low prevalence in Germany, migration from higher-endemic regions and screening gaps may hinder progress towards World Health Organization (WHO) 2030 elimination targets. Population-based data are needed for surveillance, screening and elimination.AIMWe aimed to estimate prevalence of HCV, HBV and hepatitis D virus (HDV) in adults in Germany.METHODSWe retrospectively analysed 10,000 serum samples from the Multilocal and Serial Prevalence Study of Antibodies against SARS-CoV-2 in Germany (MuSPAD, 2020-2021), by age and gender distribution. Samples were pooled and tested for HCV and HBV by PCR, for HBV surface antigen (HBsAg) and for antibodies against HCV and HBV. Samples positive for HBsAg were analysed for HDV.RESULTSActive HCV infection (HCV RNA) was detected in four (0.04%; 95% CI: 0.02-0.1) persons. Seroprevalence for HCV was 0.17% (95% CI: 0.11-0.27), highest among 60-69-year-olds (0.53%). Active HBV infection (HBV DNA and/or HBsAg) was detected in 21 participants (0.21%; 95% confidence interval (CI): 0.14-0.32), peaking at 0.44% among 30-39-year-olds. No HDV infection was confirmed.CONCLUSIONRecognising that relevant high-risk groups may be underrepresented in our data, the overall HCV and HBV prevalence in Germany appears low but non-negligible. Adults under 35 years are not covered by the national health check programme for all adults aged ≥ 35 years, suggesting potential screening gaps. Systematic HDV testing among HBV-positive individuals and targeted testing strategies may support progress towards WHO elimination goals.