Emergency Department Screening Reveals Declining HCV Viraemia but Stable HBV Prevalence in Western Europe: A Sentinel Surveillance Opportunity

Background: The World Health Organization targets the elimination of viral hepatitis as a public health threat by 2030, requiring scalable strategies for hepatitis B (HBV) and C (HCV), especially in underserved populations.Emergency departments (EDs) offer a key setting for opt-out blood-borne virus screening, enabling early diagnosis and monitoring of elimination efforts.Methods: We reviewed Western European ED-based HCV and HBV screening studies (2005-2025), including HCV antibody positivity with confirmatory HCV-RNA testing and/or HBsAg positivity.Temporal trends in HCV-RNA+/Ab+ and HBsAg prevalence were analyzed across countries.Results: Seventeen HCV studies from five countries (1,500,659 individuals) identified 26,081 HCV Ab+ and 4,347 HCV-RNA+ cases.Weighted viraemic HCV prevalence declined from 56% in the pre-DAA era (2008-2015) to 10% in 2022-2024, consistently in Spain, England, and Ireland.Ten HBV studies (1,425,954 individuals) showed stable HBsAg prevalence (0.70%).Conclusions: ED-based screening reflects population-level changes in viral hepatitis.The decline in viraemic HCV highlights the impact of DAA access, while stable HBV prevalence underscores unmet therapeutic needs.ED data could function as a low-cost sentinel surveillance system for hepatitis elimination in Europe.