Kremer-Flach Katrin, Zimmermann Ruth, An der Heiden Matthias, Dudareva Sandra
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
Front Public Health. 2025 Apr 7;13:1471256. doi: 10.3389/fpubh.2025.1471256. eCollection 2025.
Hepatitis B (HBV) and hepatitis C (HCV) viral infections are uncommon in Germany, though these infections have a higher prevalence among certain subpopulations, such as some first-generation migrant groups, people who inject drugs (PWID), and HIV-positive men who have sex with men (HIV+MSM). Repeated estimates of the number of people infected with HBV and HCV are essential to facilitate the monitoring and elimination efforts by 2030. We estimated the total number of people infected with HBV and HCV in Germany, and the number in each specific subpopulation. We based our calculations on data from 2013, a year that we strategically chose to coincide with the availability of data from serological surveys, the advent of highly effective antiviral therapy for HCV, and significant migrant flows in the following years.
We used the workbook method, a technique that combines subpopulation size and prevalence data. We included different population groups (general population excluding vulnerable groups, migrants stratified by nationality, people who inject opioids (PWIO) and HIV+MSM). We estimated the number of people infected with HBV and the number of people infected with HCV. Estimates of the number of people infected with HBV and HCV are reported with the lower and upper confidence limits.
We estimated 228,000 (179,000-291,000) HBV-infected adults (≥ 18 years of age) in Germany in 2013, of whom 41% ( = 93,000 [52,000-169,000]) were in the general population excluding vulnerable groups. Another 58% (132,000; 126,000-137,000) were migrants, 1.0% (2,400; 900-6,200) PWIO and 0.4% (1,000; 800-1,400) were HIV+MSM. We estimated 214,000 (135,000-340,000) HCV-infected adults in Germany in 2013, of whom 47% (100,000; 38,000-267,000) were in the general population excluding vulnerable groups, 26.0% (56,000; 47,000-66,000) were migrants, 26% (56,000; 50,000-62,000) were PWIO, and 1.0% (2,500; 2,200-2,800) were HIV+MSM, respectively.
Our results indicate that more than half of HBV-infected individuals were migrants, and more than half of HCV-infected individuals were PWIO or migrants. This highlights the importance of including relevant subpopulations in national estimates, surveillance, prevention, and therapy. Our estimates serve as a baseline reference for subsequent updates and ongoing monitoring of HBV and HCV epidemiology in Germany.
乙型肝炎（HBV）和丙型肝炎（HCV）病毒感染在德国并不常见，尽管这些感染在某些亚人群中患病率较高，例如一些第一代移民群体、注射吸毒者（PWID）以及与男性发生性行为的艾滋病毒阳性男性（HIV+MSM）。重复估计HBV和HCV感染者的人数对于推动到2030年的监测和消除工作至关重要。我们估计了德国HBV和HCV感染者的总数，以及每个特定亚人群中的感染人数。我们的计算基于2013年的数据，我们战略性地选择这一年，是因为这一年有血清学调查数据、HCV高效抗病毒疗法问世，以及随后几年有大量移民流动。
我们使用了工作簿方法，这是一种结合亚人群规模和患病率数据的技术。我们纳入了不同的人群组（不包括弱势群体的普通人群、按国籍分层的移民、注射阿片类药物者（PWIO）和HIV+MSM）。我们估计了HBV感染者人数和HCV感染者人数。报告了HBV和HCV感染者人数的估计值以及置信区间下限和上限。
我们估计2013年德国有22.8万（17.9万 - 29.1万）名HBV感染的成年人（≥18岁），其中41%（=9.3万[5.2万 - 16.9万]）在不包括弱势群体的普通人群中。另外58%（13.2万；12.6万 - 13.7万）是移民，1.0%（2400；900 - 6200）是PWIO，0.4%（1000；800 - 1400）是HIV+MSM。我们估计2013年德国有21.4万（13.5万 - 34万）名HCV感染的成年人，其中47%（10万；3.8万 - 26.7万）在不包括弱势群体的普通人群中，26.0%（5.6万；4.7万 - 6.6万）是移民，26%（5.6万；5万 - 6.2万）是PWIO，1.0%（2500；2200 - 2800）是HIV+MSM。
我们的结果表明，超过一半的HBV感染者是移民，超过一半的HCV感染者是PWIO或移民。这突出了在国家估计、监测、预防和治疗中纳入相关亚人群的重要性。我们的估计值为德国后续更新和持续监测HBV和HCV流行病学提供了基线参考。
