Toward elimination of hepatitis A and B in Europe: vaccination successes, challenges, and opportunities

Hepatitis B and hepatitis A are vaccine-preventable infections of global concern. Hepatitis B virus (HBV) and hepatitis A virus (HAV) vaccines available in Europe are underutilized in some age groups. While most European countries implemented childhood HBV universal routine vaccination (URV), vaccination coverage among adults remains low. Low HAV vaccination coverage among high-risk populations due to variable national vaccination policies, low awareness of vaccination benefits, and other barriers, increases the risk for outbreaks. We discuss the awareness of hepatitis B and hepatitis A burden in different populations in Europe, vaccination recommendations, successes, challenges, and opportunities for their implementation. Awareness of at-risk populations and HBV/HAV vaccination recommendations should be raised among healthcare providers and the general population to increase access to vaccination. Increasing awareness that HBV vaccination contributes to reduction in the incidence of hepatocellular carcinoma can motivate adults to get vaccinated. Adult HBV URV may be considered in Europe, as in the United States, pending cost-effectiveness assessment at national levels. HAV vaccination recommendations should be updated and expanded to all at-risk persons. National HBV/HAV targets and vaccination strategies should be actively promoted to accelerate the elimination of viral hepatitis in Europe. Hepatitis B and hepatitis A virus (HBV and HAV) infections cause liver inflammation (hepatitis), with potentially severe disease requiring hospitalization. Chronic HBV infection may lead to liver damage and liver cancer. HAV infection can be life-threatening, particularly in older individuals or those with preexisting liver conditions. High HAV prevalence in certain countries increases infection risk for travelers and can trigger outbreaks. Unvaccinated persons, particularly those with risk exposures (e.g. travelers, men who have sex with men, or people who inject drugs), are at increased risk of infection with HBV or HAV. Vaccines against HBV and HAV with an acceptable safety profile and demonstrated effectiveness are available. However, people are often unaware of the risks of infection and the lifelong benefits of vaccination against HBV and HAV. Both patients and clinicians should be made aware of the severity of these infections, the risk of liver cancer from chronic hepatitis B, and how vaccines may help preventing threats to health from HAV and HBV infection. While most European countries have introduced universal childhood HBV vaccination, unvaccinated adults remain at risk for HBV infection later in life. Routine adult HBV vaccination could be considered in Europe, as in the United States, to better guarantee reaching risk populations and ensure protection before exposure to these infections. HAV vaccination recommendations differ across European countries. Overall, the policies and recommendations should be updated and harmonized across countries to ensure persons at risk are offered with a possibility to protect themselves with HBV and HAV vaccination.