Use of the Workbook Method to estimate the prevalence of chronic hepatitis B infections in the European Union and European Economic Area, 2022

Background: Up-to-date estimates of chronic hepatitis B virus (HBV) prevalence in both general and key populations are challenging to obtain because of under-diagnosis, heterogeneous surveillance systems and underrepresentation of key populations. 

Aim: 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. 

Methods: 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. 

Results: 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. 

Conclusion: 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.