Imagine you are severely ill and you do not even know it. Imagine that when you finally realise you are sick, the damage might be irreversible. Due to the long-term infection which went unnoticed you now cannot be cured and you might even have developed cancer.
Unknown and often untreated, viral hepatitis affects mil- lions of people across Europe. But as many infections with a hepatitis virus do not show any symptoms, the so-called 'silent disease' is often not diagnosed. Although the vast majority of those with acute infection fully recover after a few weeks, a large proportion of infected persons eventually develop chronic infections. Left untreated, chronic infection with hepatitis B and C may progress to liver cirrhosis or cancer. Between 2006 and 2012, more than 110,000 cases of hepatitis B and over 206,000 hepatitis C infections were reported in Europe - and this is known to be an underestimate of the true situation.
There are five known hepatitis viruses, referred to as types A, B, C, D and E. They can cause acute, and in the case of hepatitis B and C also chronic, liver disease. While infection with the hepatitis A virus is typically caused by consumption of contaminated food or water and causes an acute infection, hepatitis B and C usually occur as a result of contact with infected blood or body fluids and can develop into a life- threatening chronic infection.
The European centre for disease prevention and control (ECDC) coordinates the enhanced surveillance for hepatitis A, B and C to help countries to assess the hepatitis disease burden, evaluate existing prevention and control strategies, and to define epidemiological trends or trans- mission patterns across Europe, to help stop the 'silent disease'.
Looking at the bare numbers, the impact of hepatitis on public health in Europe is quite diverse. Between 2007 and 2012, ECDC and EFSA, our sister agency working on food safety in Europe, reported and assessed 14 outbreaks with strong evidence of hepatitis A as the cause. These outbreaks indicate that hepatitis A is a re- emerging food-borne health threat in Europe. In 2012 alone, almost 48,000 hepatitis B and C cases were diagnosed across Europe (17,329 cases of hepatitis B and 30,607 cases of hepatitis C). While the number of acute cases of hepatitis B has been continuously declining since 2006 - most likely thanks to vaccination programmes in many European countries - the rates of reported chronic cases have doubled. As for hepatitis C, which often leads to chronic infection, the number of reported cases remains at a high level since 2006. This shows us that we need to strengthen existing prevention and control programmes to change these trends.
Hepatitis is a disease with many faces, and world hepatitis day on 28 July gives us a good opportunity to increase aware- ness and understanding of it - and to stress that viral hepatitis is preventable.
For hepatitis A and B, vaccination is the most effective individual prevention measure and the available vaccines provide a high level of protection. Immunisation against hepatitis B is part of most national vaccination schedules in Europe, whereas hepatitis A vaccination is usually only recommended to travellers. Vaccination policy is in the mandate of the member states, and the recent food-borne outbreaks of hepatitis A in the EU raise the question whether they should not consider options for broader vaccination recommendations against hepatitis A. Currently, there is no vaccine for hepatitis C available but research is ongoing. Prevention thus depends on actively reducing the risk of exposure to the hepatitis C virus. Particularly through harm reduction programmes among people who inject drugs, the most affected population across Europe. There is still a lot we can do to help stop the 'silent disease'.