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Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses that cause acute and/or chronic infection, referred to as types A, B, C, D and E. People who are infected can experience mild illness or serious and permanent liver damage.

Viral hepatitis is a largely neglected epidemic in the WHO European Region. An estimated 14 million people live with chronic hepatitis B, and an estimated 9 million people are infected with hepatitis C, but most are unaware that they are infected. Because it is often left untreated, chronic hepatitis is a major cause of liver cirrhosis and primary liver cancer. Hepatitis B is responsible for about 36 000 deaths per year in the Region, with hepatitis C responsible for around 86 000 deaths annually.

People who inject drugs are particularly vulnerable to hepatitis and, in some settings, almost all are infected with hepatitis C. As they are also more vulnerable to HIV infection, co-infection with both HIV and hepatitis is particularly common among those who inject drugs in the Region. Between 70-90% of injecting drug users living with HIV also have hepatitis C infection. With increasing availability of effective treatment for HIV, chronic, untreated viral hepatitis is increasingly a major cause of death among people living with HIV in the Region.

As a person with hepatitis may have no symptoms for a long time, the epidemic is largely hidden and was until recently not fully recognized as a public health problem in the Region. As a result:

• hepatitis surveillance is weak – the number of persons living with different forms of chronic hepatitis are not known accurately;
• the cost of diagnosis and treatment of hepatitis remains very high; and
• access to prevention and treatment services is limited in many countries of the Region, particularly in eastern European and central Asian countries.