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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9476-9493
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9476
Epidemiology of hepatitis C in Croatia in the European context
Tatjana Vilibic-Cavlek, Jasmina Kucinar, Bernard Kaic, Maja Vilibic, Nenad Pandak, Ljubo Barbic, Vladimir Stevanovic, Jasmina Vranes
Tatjana Vilibic-Cavlek, Department of Virology, Croatian National Institute of Public Health and School of Medicine University of Zagreb, Zagreb 10000, Croatia
Jasmina Kucinar, Department of Microbiology, Istria County Institute of Public Health, Pula 52100, Croatia
Bernard Kaic, Department of Epidemiology, Croatian National Institute of Public Health, Zagreb 10000, Croatia
Maja Vilibic, Vrapce University Psychiatric Hospital, Zagreb 10000, Croatia
Nenad Pandak, Department of Infectious Diseases, General Hospital “Dr Josip Bencevic”, Slavonski Brod 35000, Croatia and School of Medicine University of Osijek, Osijek 31000, Croatia
Ljubo Barbic, Vladimir Stevanovic, Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb 10000, Croatia
Jasmina Vranes, Department of Microbiology, Public Health Institute “Dr Andrija Stampar” and School of Medicine University of Zagreb, Zagreb 10000, Croatia
Author contributions: Vilibic-Cavlek T made contributions to conception and design of the study, acquisition of the data, involved in drafting the manuscript; Kaic B and Vranes J made contributions to design, involved in drafting and revising the manuscript critically; Kucinar J, Vilibic M, Barbic L, Pandak N and Stevanovic V made contributions in acquisition of the data, involved in drafting the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: Authors reported no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tatjana Vilibic-Cavlek, MD, PhD, Department of Virology, Croatian National Institute of Public Health and School of Medicine University of Zagreb, Rockefellerova 12, Zagreb 10000, Croatia. tatjana.vilibic-cavlek@hzjz.hr
Telephone: +385-1-4863238
Received: April 21, 2015
Peer-review started: April 23, 2015
First decision: May 18, 2015
Revised: June 3, 2015
Accepted: July 18, 2015
Article in press: July 18, 2015
Published online: August 28, 2015
Abstract

We analyzed prevalence, risk factors and hepatitis C virus (HCV) genotype distribution in different population groups in Croatia in the context of HCV epidemiology in Europe, with the aim to gather all existing information on HCV infection in Croatia which will be used to advise upon preventive measures. It is estimated that 35000-45000 of the Croatian population is chronically infected with HCV. Like in other European countries, there have been changes in the HCV epidemiology in Croatia over the past few decades. In some risk groups (polytransfused and hemodialysis patients), a significant decrease in the HCV prevalence was observed after the introduction of routine HCV screening of blood/blood products in 1992. Injecting drug users (IDUs) still represent a group with the highest risk for HCV infection with prevalence ranging from 29% to 65%. Compared to the prevalence in the Croatian general population (0.9%), higher prevalence rates were found in prison populations (8.3%-44%), human immunodeficiency virus-infected patients (15%), persons with high-risk sexual behavior (4.6%) and alcohol abusers (2.4%). Low/very low prevalence was reported in children and adolescents (0.3%) as well as in blood donors (0%-0.009%). In addition, distribution of HCV genotypes has changed due to different routes of transmission. In the general population, genotypes 1 and 3 are most widely distributed (60.4%-79.8% and 12.9%-47.9%, respectively). The similar genotype distribution is found in groups with high-risk sexual behavior. Genotype 3 is predominant in Croatian IDUs (60.5%-83.9%) while in the prison population genotypes 3 and 1 are equally distributed (52.4% and 47.6%). Data on HCV prevalence and risk factors for transmission are useful for implementation of preventive measures and HCV screening.

Keywords: Hepatitis C, Seroprevalence, Genotypes, Croatia, Europe

Core tip: As in other European countries, epidemiology of hepatitis C has changed in Croatia in last few decades. In addition, changes in the hepatitis C virus (HCV) genotype distribution were observed due to changes in prevailing routes of transmission. Although a decline in HCV prevalence was observed in some risk groups (polytransfused and hemodialysis patients), HCV prevalence is still high in injecting drug users (IDUs) (29%-65%), reaching 100% in older injectors and those reporting sharing injection equipment. In addition, a high HCV prevalence (8.3%-44%) was found in Croatian prisoners reflecting high proportion of IDUs within this population group. Since IDUs represent a group with the highest risk for HCV, strategies to reduce risk among IDUs should be considered.