SURVEILLANCE REPORT

Hepatitis B
Annual Epidemiological Report for 2020

Key facts
• For 2020, 29 EU/EEA Member States reported 14 428 cases of hepatitis B virus (HBV) infection.
Excluding the five countries that only reported acute cases, the number of cases (14 137) corresponds
to a crude rate of 4.2 cases per 100 000 population.
• Of all cases, 7% were reported as acute, 43% as chronic, 40% as ‘unknown’ and 11% could not be
classified.
• The highest rate of acute infections was observed among 35–44-year-olds, the highest rate of chronic
infections among 25–34-year-olds. The overall male-to-female ratio was 1.5:1.
• The rate of acute cases continued to decline over the last few years, which is in accordance with global
trends and most likely reflects the impact of national vaccination programmes.
• Among acute cases with complete information, heterosexual transmission was most commonly reported
(32%), followed by transmission among men who have sex with men (14%) and nosocomial
transmission (12%). Among chronic cases, mother-to-child transmission and nosocomial transmission
were the most common routes of transmission reported (52% and 12% respectively).
• Prevention and control programmes need further scaling up if European countries are to achieve the
goal of eliminating hepatitis B. Surveillance data are important in monitoring the epidemiological
situation, and there is a need to improve their quality.

Methods
This report is based on 2020 data retrieved from The European Surveillance System (TESSy) on 2 February 2022.
The European Surveillance System is a system for the collection, analysis and dissemination of data on
communicable diseases.
For a detailed description of methods used to produce this report, refer to the Methods chapter [1].
An overview of the national surveillance systems is available on the ECDC website [2].
A subset of the data used for this report is available through ECDC’s online Surveillance atlas of infectious
diseases [3].

Erratum: The figure 28% in the 'Age and sex' section on page 5 was corrected to 15% on December 19 2022.
Suggested citation: European Centre for Disease Prevention and Control. Hepatitis B. In: ECDC. Annual epidemiological report for
2020. Stockholm: ECDC; 2022.
Stockholm, July 2022
© European Centre for Disease Prevention and Control, 2022
Reproduction is authorised, provided the source is acknowledged.
Annual epidemiological report for 2020 SURVEILLANCE REPORT

This report includes data on newly diagnosed cases of hepatitis B reported to ECDC by EU/EEA countries. Countries
were requested to apply the EU 2018 case definition for reporting at the European level, but other case definitions
were also accepted [2].
Acute and chronic hepatitis B infections were differentiated by countries using defined criteria (Table 1).
Table 1. Criteria for differentiating acute and chronic hepatitis B
Stage Definition
Acute Detection of IgM core antigen-specific antibody (anti-HBc IgM)
or
Detection of hepatitis B surface antigen (HBsAg) and previous negative HBV markers less than six months ago
or
Detection of hepatitis B nucleic acid (HBV-DNA) and previous negative HBV markers less than six months ago

Any of the above with or without symptoms and signs (e.g. jaundice, elevated serum aminotransferase levels,
fatigue, abdominal pain, loss of appetite, intermittent nausea, vomiting, fever)
Chronic Detection of HBsAg or HBeAg or HBV-DNA
and
No detection of anti-HBc IgM (negative result)
or
Detection of HBsAg or HBeAg or HBV-DNA on two occasions that are six months apart*
Unknown Any newly diagnosed case which cannot be classified in accordance with the above definition of acute or chronic
infection

*: in the event that the case was not notified the first time.
Surveillance systems across EU/EEA countries are heterogeneous [2]. Twenty-two countries submitted national
data for 2020 based on the 2012 or 2018 EU case definitions. The 2012 and 2018 case definitions are essentially
identical, except that the 2018 definition explicitly states that countries should differentiate between acute and
chronic cases according to ECDC requirements [4,5]. Four countries used the 2008 EU case definition and three
countries (Denmark, Germany and Italy) used national case definitions. The 2008 EU case definition only allows for
the reporting of acute hepatitis B cases, while the 2012 and 2018 case definitions include both acute and chronic
cases. All reported cases were included in the analysis regardless of the case definition used. Five countries
(France, Greece, Hungary, Lithuania and Spain) only submitted data on acute cases. Two countries (Belgium and
Bulgaria) submitted aggregate data only and did not differentiate stages of infection. No data for 2020 were
reported by the United Kingdom (UK) due to its withdrawal from the EU on 1 February 2020.
Annual notification rates were calculated per 100 000 population for countries with comprehensive surveillance
systems using Eurostat population data 1.
Hepatitis B data are presented by the ‘date of diagnosis’ or, if not available, by ‘date used for statistics’. When
comparing data using these two dates across the database, there were only minor differences between them in a
few countries.
Italy reported data using two data sources. One of these sources had national coverage but included only a limited
number of variables and did not identify cases as acute or chronic, which limited its inclusion in this report. The
other data source in Italy was a voluntary reporting system of acute cases covering 82.4% of the population in
2020. The sentinel population was considered representative of the wider population, so data were scaled up to
100%. This data source contains information on a range of variables and is used for certain epidemiological
analyses, including the route of transmission and importation status. The data source for Belgium was a sentinel
system with undetermined coverage. National rates were therefore not calculated for Belgium.

Epidemiology
Overall trends
For 2020, 29 EU/EEA Member States reported 14 428 cases of hepatitis B virus (HBV) infection. No data were
reported from Liechtenstein. Excluding the five countries that only reported acute cases, the number of cases (14
137) corresponds to a crude rate of 4.2 cases per 100 000 population. Of all cases, 979 (7%) were reported as
acute, 6 172 (43%) as chronic, 5 742 (40%) as ‘unknown’, and 1 535 cases (11%) could not be classified due to
an incompatible data format.

1
Eurostat database: http://epp.eurostat.ec.europa.eu

2
SURVEILLANCE REPORT Annual epidemiological report for 2020

Twenty-five countries were able to provide data on acute cases (Table 2). The overall rate of acute cases was 0.3
per 100 000 population, ranging from no cases in Croatia, Cyprus and Malta to 0.8 cases per 100 000 population in
Latvia (Figure 1). When restricting the analysis to the 20 countries that reported consistently from 2011–2020, the
rate for acute cases showed a steady decline from 0.8 cases per 100 000 population in 2011 to 0.4 in 2019, with a
drop to 0.2 in 2020 (Figure 2).
Twenty-one countries submitted data on chronic infections. The overall notification rate was 2.6 cases per 100 000
population, ranging from zero in in Luxembourg, Malta and Romania to 8.8 in Iceland (Table 2). Among the 16
countries that reported consistently between 2011 and 2020, there has been a variable rate of reported chronic
cases with a high of 6.6 in 2015 and a low of 2.8 in 2020 (Figure 2).
Table 2. Number and rate per 100 000 population of reported hepatitis B cases in the EU/EEA by
country and year, 2016–2020
2016 2017 2018 2019 2020
Country All All All All All AcuteI ChronicI UnknownI
Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate
Austria 1 533 17.6 1 418 16.2 1 288 14.6 1 191 13.4 937 10.5 36 0.4 329 3.7 572 6.4
BelgiumII 1 722 - 1 634 - 1 982 - 2 021 - 1 423 - . - . - . -
Bulgaria 219 3.1 249 3.5 215 3.0 198 2.8 112 1.6 . - . - . -
Croatia 117 2.8 97 2.3 98 2.4 93 2.3 22 0.5 0 0.0 7 0.2 15 0.4
Cyprus 3 0.4 35 4.1 83 9.6 108 12.3 29 3.3 0 0.0 29 3.3 . -
Czechia 270 2.6 303 2.9 323 3.0 317 3.0 169 1.6 27 0.3 142 1.3 . -
Denmark 275 4.8 262 4.6 164 2.8 170 2.9 152 2.6 15 0.3 136 2.3 1 0.0
Estonia 23 1.7 14 1.1 19 1.4 18 1.4 23 1.7 2 0.2 21 1.6 . -
Finland 348 6.3 266 4.8 239 4.3 238 4.3 166 3.0 4 0.1 162 2.9 . -
FranceIII, IV . - . - . - . - . - 51 0.1 . - . -
Germany 3 461 4.2 3 594 4.4 4 521 5.5 8 937 10.8 6 712 8.1 371 0.4 3 034 3.6 3 307 4.0
GreeceIII . - . - . - . - . - 14 0.1 . - . -
HungaryIII . - . - . - . - . - 14 0.1 . - . -
Iceland 59 17.7 68 20.1 44 12.6 49 13.7 33 9.1 1 0.3 32 8.8 0 0.0
Ireland 484 10.2 527 11.0 498 10.3 513 10.5 333 6.7 10 0.2 252 5.1 71 1.4
Italy 308 0.5 437 0.7 379 0.6 341 0.6 172 0.3 - - . - 172 0.3
Latvia 450 22.9 348 17.8 326 16.9 294 15.3 162 8.5 15 0.8 147 7.7 . -
LithuaniaIII . - . - . - . - . - 10 0.4 . - . -
Luxembourg 66 11.5 60 10.2 47 7.8 52 8.5 518 82.7 - - 0 0.0 518 82.7
Malta 33 7.3 25 5.4 25 5.3 23 4.7 39 7.6 0 0.0 0 0.0 39 7.6
Netherlands 1 128 6.6 1 224 7.2 1 141 6.6 1 169 6.8 799 4.6 92 0.5 695 4.0 12 0.1
Norway 763 14.6 478 9.1 365 6.9 393 7.4 225 4.2 4 0.1 221 4.1 . -
Poland 3 806 10.0 3 363 8.9 3 196 8.4 2 854 7.5 993 2.6 14 0.0 156 0.4 823 2.2
Portugal 168 1.6 181 1.8 189 1.8 201 2.0 112 1.1 29 0.3 35 0.3 48 0.5
Romania 196 1.0 133 0.7 119 0.6 103 0.5 21 0.1 21 0.1 0 0.0 . -
Slovakia 165 3.0 141 2.6 131 2.4 140 2.6 87 1.6 18 0.3 69 1.3 . -
Slovenia 40 1.9 77 3.7 78 3.8 60 2.9 94 4.5 2 0.1 26 1.2 66 3.1
SpainIII . - . - . - . - . - 202 0.4 . - . -
Sweden 2 039 20.7 1 239 12.4 1 130 11.2 1 098 10.7 804 7.8 27 0.3 679 6.6 98 0.9
United Kingdom 12 572 19.2 10 390 15.8 7 778 11.7 9 254 13.9 . - . - . - . -
Total EU/EEA 30 248 7.8 26 563 6.8 24 378 6.1 29 835 7.5 14 137 4.2 979 0.3 6 172 2.6 5 742 2.3

Data presented by date of diagnosis.

.: data not reported
-: rates not calculated
i: Includes cases reported by countries as acute, chronic or unknown using the differentiation criteria.
ii: Data from Belgium came from a sentinel system with undefined coverage, therefore population rates cannot be calculated.
iii: ’All cases’ not displayed for countries that only reported acute cases.
iv: Underreporting of acute hepatitis B in France estimated at 73% in 2016.

3
Annual epidemiological report for 2020 SURVEILLANCE REPORT

Figure 1. Notification rate of acute hepatitis B cases* per 100 000 population by country, EU/EEA,
2020

*: Countries included if able to present data by disease status, used case definition that includes only acute cases (e.g. EU 2008)
or known to only report acute cases and had national coverage.
**: Underreporting of acute hepatitis B in France estimated at 73% in 2016.
Source: Country reports from Austria, Croatia, Cyprus, the Czechia, Denmark, Estonia, Finland, France**, Germany, Greece,
Hungary, Iceland, Ireland, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia,
Spain, and Sweden.

4
SURVEILLANCE REPORT Annual epidemiological report for 2020

Figure 2. Notification rates of acute and chronic hepatitis B per 100 000 population by year in
EU/EEA countries reporting consistently, 2011–2020

Logarithmic scale
10
Rate per 100 000 population

1
Chronic
Acute

0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Year

Source: Country reports.

Acute cases: Country reports from Austria, the Czechia, Denmark, Estonia, Finland, France*, Germany, Greece, Hungary, Iceland,
Ireland, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden.
Chronic cases: Country reports from Austria, Cyprus, Denmark, Estonia, Finland, Ireland, Latvia, Malta, the Netherlands, Norway,
Portugal, Romania, Slovakia, Slovenia and Sweden.
*: Underreporting of acute hepatitis B in France estimated at 73% in 2016.

Age and sex

In 2020, 8 127 cases of hepatitis B were reported in males (5.0 cases per 100 000 population) and 5 911 cases
were reported in females (3.4 cases per 100 000 population), excluding countries that only reported acute cases.
This represents a male-to-female ratio of 1.5:1. The male-to-female ratio was higher among acute cases (2.1:1)
than chronic cases (1.3:1). Half of all cases were among 25–44-year-olds. The age distributions among reported
cases of acute and chronic infections were similar (Figure 3), with 10% of acute and 7% of chronic cases in people
under 25 years of age. Among countries reporting consistently every year since 2011, the proportion of acute
cases below 25 years of age declined from 15% in 2011 to 10% in 2020. The proportion of chronic cases under 25
declined from 20% in 2011 to 8% in 2020.

5
Annual epidemiological report for 2020 SURVEILLANCE REPORT

Figure 3. Notification rates of acute and chronic hepatitis B per 100 000 population by age group and
disease status, EU/EEA, 2020

4
Rate per 100 000 population

3
Acute
Chronic

0
<5 5–14 15–19 20–24 25–34 35–44 45–54 55–64 ≥65
Age group (years)

Source: Country reports.

Acute cases – Austria, Croatia, Cyprus, the Czechia, Denmark, Estonia, Finland, France*, Germany, Greece, Hungary, Iceland,
Ireland, Latvia, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden.
Chronic cases – Austria, Croatia, Cyprus, the Czechia, Denmark, Estonia, Finland, Germany, Iceland, Ireland, Latvia, Luxembourg,
Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia and Sweden.
*: Underreporting of acute hepatitis B in France estimated at 73% in 2016.

6
SURVEILLANCE REPORT Annual epidemiological report for 2020

The age distribution among male and female acute cases was similar, although female cases tended to be
younger. Rates were higher among females in the younger age groups, but in age groups 20 and older, the rates
were higher among males (Figure 4).
Figure 4. Rate of reported acute hepatitis B cases per 100 000 population by age group and sex,
EU/EEA, 2020

1.0
Rate per 100 000 population

0.5
Male
Female

0.0
<5 5–14 15–19 20–24 25–34 35–44 45–54 55–64 ≥65
Age group (years)

Source: Country reports.

Austria, Croatia, Cyprus, the Czechia, Denmark, Estonia, Finland, France*, Germany, Greece, Hungary, Iceland, Ireland, Latvia,
Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden.
*: Underreporting of acute hepatitis B in France estimated at 73% in 2016.

Route of transmission
Data on transmission were complete for 29% of the acute and 18% of the chronic hepatitis B cases reported in
2020. For the 287 acute cases with complete information, heterosexual transmission was most commonly reported
(32%), followed by transmission among men who have sex with men (14%) and nosocomial transmission (12%;
Figure 5). Italy and Poland accounted for 77% of the acute cases attributed to nosocomial transmission. For the 1
095 chronic cases with complete information, mother-to-child transmission and nosocomial transmission were the
most common routes of transmission reported (52% and 12% respectively). Poland reported 79% of chronic cases
attributed to nosocomial transmission. Among chronic cases attributed to mother-to-child transmission, 61% were
reported by the Netherlands, 17% by Denmark and 13% by Sweden. Of the chronic cases attributed to mother-to-
child transmission, 77% were classified as being imported. Due to incompleteness and variation of reporting over
time, trends are difficult to interpret and not reported.

7
Annual epidemiological report for 2020 SURVEILLANCE REPORT

Figure 5. Transmission category of hepatitis B cases by acute and chronic disease status, EU/EEA,
2020a

Heterosexual transmission

Sex between men

Nosocomial*

Non-occupational injuries**
Transmission category

Household

Other

Sexual transmission (not specified)

Acute
Injecting drug use
Chronic
Needle-stick and other occupational exposure***

Mother-to-child transmission

Blood and blood products

Organ and tissues

Haemodialysis

0 20 40 60
Proportion of cases (%)

a
Cases with known transmission status.
*: Nosocomial transmission includes hospitals, nursing homes, psychiatric institutions and dental services. This category refers
mainly to patients exposed through healthcare settings, distinct from ’needle-stick and other occupational exposure’, which refers
to staff.
**: ‘Non-occupational injuries’ include needle sticks that occur outside a health care setting, bites, tattoos, piercings.
***: ’Needle-stick and other occupational exposure’ refers to occupational injuries
Source: Acute reports from Austria, the Czechia, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Italy, Latvia, the
Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Spain and Sweden.
Chronic reports from Austria, Croatia, Denmark, Estonia, Finland, Germany, Ireland, Latvia, the Netherlands, Norway, Poland,
Portugal, Slovakia and Sweden.
i: Underreporting of acute hepatitis B in France estimated at 73% in 2016.

Importation status
Of 5 241 cases (36% of all reported cases) with information on importation status from 15 countries, 2 322 (44%)
were reported as imported. The majority of these imported cases (86%) were chronic infections, and among those,
86% were reported by four countries (Germany, the Netherlands, Norway and Sweden). The proportion of chronic
cases (64%) reported as imported was higher than the proportion of acute cases (15%), indicating that migrant
populations are disproportionally affected, mainly because migrants are already infected with hepatitis B prior to
arrival. Data completeness on importation status among chronic cases varied across countries, but among those
with complete data (>75%), the proportion of cases classified as imported ranged from <10% (the Czechia,
Estonia, Poland, Slovakia) to over 90% (Iceland, Ireland, the Netherlands, Norway and Sweden).

8
SURVEILLANCE REPORT Annual epidemiological report for 2020

Discussion
The number of newly diagnosed hepatitis B infections reported from countries across Europe remains high, with
the majority of these infections classified as chronic. A marked variation between countries in the distribution of
acute and chronic cases was observed. This geographical variation most likely reflects differences in local testing
and reporting practices as well as underlying epidemiological differences. For acute hepatitis B cases, no important
geographical trends were observed, even though the underlying prevalence of chronic hepatitis B infection is
known to be highest in eastern Europe [6]. For newly diagnosed cases of chronic hepatitis B reported to ECDC, the
geographical trends are unclear as data for many countries are missing. However, some of the highest rates were
reported from northern and western European countries, such as Iceland, Ireland, and Sweden which is contrary
to what may be expected based on seroprevalence surveys that indicate these countries to be of low endemicity
(<1.0%) [6]. The discrepancy between reported notifications and prevalence estimates highlights the difficulty in
interpreting routine surveillance data for chronic infections which are mostly asymptomatic until the late stages of
the disease. The chronic hepatitis B data reported appear to reflect the intensity of local testing and screening
policies, with the highest rates reported from countries that are known to have comprehensive testing programmes
[8,9]. Prevalence surveys using rigorous sampling methods give a better indication of disease burden. However,
prevalence surveys from northern European countries with high levels of immigration may underestimate the true
prevalence of hepatitis B, as their studies might not include the migrant populations from intermediate and high
(>1.0%) endemicity countries [7]. The high number of cases of chronic hepatitis B reported from northern Europe
also has a strong influence on trends.
The overall trend for acute cases in the EU/EEA has shown a steady decline from 2011–2020. The decrease is most
likely related to national hepatitis B vaccination programmes [10]. For both acute and chronic cases, a steeper
decline in rates of new diagnoses was seen in 2020 compared to the trajectory in earlier years. This may be the
result of a combination of changes in healthcare seeking behaviours and testing practices during the COVID-19
pandemic. For acute cases, changes in behaviours and reduced sexual contact patterns may also have resulted in a
reduction of new infections.
A survey of wide range of actors involved in the provision of testing services found that the majority reported
service disruptions and declines in testing volumes during the COVID-19 pandemic, in particular, in the early part of
2020 [11]. A study in the Netherlands found a 40% reduction in the number of diagnosed chronic cases in 2020
compared to 2019 and found that the weekly relative reduction in new chronic HBV and HCV diagnoses mirrored
the weekly number of COVID-19 admissions [12]. An earlier study did not find a reduction in the number of acute
cases, likely because acute hepatitis B infection is often symptomatic and diagnoses rates are less likely to be
impacted by changes in testing efforts or healthcare seeking behaviours [13]. It will be important to monitor trends
in 2021 and 2022 to gain a more complete picture.
Data completeness for several variables is poor but has improved recently. The number of countries reporting data
has remained stable over the last few years.
Data on importation status of cases remain incomplete, but the impact of migration on reported cases of
hepatitis B in Europe is striking for some countries, especially among chronic infections. In recent decades,
migrants to many countries in Europe have come from countries with high prevalence of hepatitis B and prevalence
among some of these migrant groups is high [7,14]. A recent study on the epidemiological burden of hepatitis
among migrant populations estimated the burden of infection among migrants in relation to the overall number of
chronically infected hepatitis B cases in Europe to be around 25% [14]. The study concluded that migrant
populations are often disproportionately affected by hepatitis B and are a key risk group for chronic hepatitis B in
certain EU/EEA countries. The influence of migration on hepatitis B highlights the need for countries to develop
evidence-based screening interventions that target the most affected migrant communities. It also highlights the
importance of monitoring routine surveillance indicators of migration, such as importation status.
Transmission data are key to understanding the epidemiology of hepatitis B. While transmission data completeness
is better for acute cases than chronic cases, the overall incompleteness impairs the interpretation of differences
between countries and data are unlikely to be fully representative. The most common routes of transmission
reported among acute cases include heterosexual contact, sex between men and nosocomial transmission.
Although nosocomial transmission is uncommon for acute cases in most European countries, it remains a key route
of transmission in some, highlighting the importance of maintaining robust infection prevention and control
practices across healthcare settings. Mother-to-child transmission was the most common route of transmission
among reported chronic cases but is dominated by the large number of cases reported by three western European
countries (Denmark, the Netherlands and Sweden), with most of these cases classified as imported. The validity of
the reported route of transmission among imported cases is not known and could form a subject for future study.
Changes over time in the completeness of transmission data reporting impede any comparisons of the data over
the period.

9
Annual epidemiological report for 2020 SURVEILLANCE REPORT

Public health implications

Robust epidemiological information is essential to inform effective prevention and control priorities, assess the
impact of implemented strategies and monitor progress towards achieving the global elimination targets. The
interpretation of hepatitis B data collected through routine notification-based surveillance is challenging because of
the asymptomatic nature of chronic infections, differences in testing programmes, continued differences in
surveillance practices between countries and data quality issues. Despite such challenges, the relatively high
number of reported cases (especially of chronically infected persons) and diversity in reported transmission routes
across Europe suggest that countries need to maintain and strengthen local prevention and control programmes,
including comprehensive vaccination programmes. Robust evidence of ongoing transmission and the continued
importation of cases to many European countries demonstrate a clear need to improve the quality of surveillance
data, especially regarding data on transmission routes, country of birth and whether cases are considered
imported. Further work is also needed to assist countries in adopting the current EU case definition to standardise
surveillance across countries. ECDC will continue to support Member States in this area and develop alternative
epidemiological methods to complement routine surveillance, such as seroprevalence surveys and sentinel
surveillance which will help provide a more complete understanding of the epidemiology.
In May 2017, the World Health Assembly adopted the first global health sector strategy on viral hepatitis that aims
at elimination by 2030 [15]. The concept of elimination for these infections is based on reducing the incidence of
chronic infections by 90% and associated mortality by 65% by 2030 compared to 2015 levels. Achieving these
targets will require significant scaling up of key interventions, including comprehensive hepatitis B childhood
vaccination, birth dose vaccination or other means to prevent mother-to-child transmission, improved systems to
assure safe blood transfusions/blood products, injection safety, interventions aimed at prevention of transmission
among people who inject drugs and increased testing with linkage to care and treatment. To support the
implementation of this strategy, it is important that countries maintain a strong surveillance system to monitor the
impact of the interventions. This also highlights the need for continued efforts to improve the quality of the
collected and reported data.

10
SURVEILLANCE REPORT Annual epidemiological report for 2020

References
1. European Centre for Disease Prevention and Control. Introduction to the Annual Epidemiological Report. In: ECDC.
Annual epidemiological report for 2017 [Internet]. Stockholm: ECDC; 2017 [cited 10 December 2018]. Available from:
http://ecdc.europa.eu/annual-epidemiological-reports/methods
2. European Centre for Disease Prevention and Control. Surveillance systems overview [Internet]. Stockholm: ECDC; 2017
[cited 10 December 2018]. Available from: http://ecdc.europa.eu/publications-data/surveillance-systems-overview-2017
3. European Centre for Disease Prevention and Control. Surveillance atlas of infectious diseases [Internet]. Stockholm:
ECDC; 2017 [cited 30 May 2017]. Available from:
http://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=26
4. European Commission. Commission implementing decision of 8 August 2012 amending Decision 2002/253/EC laying
down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of
the European Parliament and of the Council (2012/506/EU) (notified under document C(2012) 5538) (Text with EEA
relevance) (2012/506/EU) – Annex 2.17 Hepatitis B (Hepatitis B virus). Brussels: European Commission; 2012. Available
from: http://eur-lex.europa.eu/legal-
content/EN/TXT/PDF/?uri=CELEX:32012D0506&qid=1428573336660&from=EN#page=15
5. European Commission. Commission implementing decision (EU) 2018/945 of 22 June 2018 on the communicable diseases
and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. ) –
Annex 3.17 Hepatitis B (Hepatitis B virus). Brussels: European Commission; 2012. Available from: https://eur-
lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945
6. European Centre for Disease Prevention and Control. Systematic review on hepatitis B and C prevalence in the EU/EEA.
Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/publications-data/systematic-review-hepatitis-b-and-c-
prevalence-eueea
7. Sharma S, Carballo M, Feld JJ, Janssen HL. Immigration and viral hepatitis. J Hepatol. 2015 Aug;63(2):515-522.
8. Duffell EF, van de Laar MJ. Survey of surveillance systems and select prevention activities for hepatitis B and C, European
Union/European Economic Area, 2009. Euro Surveill. 2015 Apr 2;20(13):17-24. Available from:
http://www.eurosurveillance.org/content/10.2807/1560-7917.ES2015.20.13.21080
9. European Centre for Disease Prevention and Control. Surveillance and prevention of hepatitis B and C in Europe.
Stockholm: ECDC; 2010. Available from: http://ecdc.europa.eu/publications-data/surveillance-and-prevention-hepatitis-b-
and-c-europe
10. Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: New estimates of age-
specific HBsAg seroprevalence and endemicity. Vaccine. 2012 Mar 9;(30) 2212-2219.
11. Simões D, Stengaard AR, Combs L, Raben D. Impact of the COVID-19 pandemic on testing services for HIV, viral
hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020. Eurosurveillance. 2020
Nov 26;25(47):2001943.
12. Sonneveld MJ, Veldhuijzen IK, van de Laar TJ, de Coul EL, van der Meer AJ. Decrease in viral hepatitis diagnoses during
the COVID-19 pandemic in the Netherlands. Journal of Hepatology. 2021 Apr 19.
13. Middeldorp M, van Lier A, van der Maas N, Veldhuijzen I, Freudenburg W, van Sorge NM, Sanders EA, Knol MJ, de Melker
HE. Short term impact of the COVID-19 pandemic on incidence of vaccine preventable diseases and participation in
routine infant vaccinations in the Netherlands in the period March-September 2020. Vaccine. 2021 Feb 12;39(7):1039-43.
14. European Centre for Disease Prevention and Control. Epidemiological assessment of hepatitis B and C among migrants in
the EU/EEA. Stockholm: ECDC; 2016. Available from: http://ecdc.europa.eu/publications-data/epidemiological-
assessment-hepatitis-b-and-c-among-migrants-eueea
15. World Health Organization. Global health sector strategy on viral hepatitis 2017–2021. Geneva: WHO; 2017. Available
from: http://www.who.int/hepatitis/strategy2016-2021/ghss-hep

11