A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel Markus Cornberg 1 , Homie A. Razavi 2 , Alfredo Alberti 3 , Enos Bernasconi 4 , Maria Buti 5,6 , Curtis Cooper 7 , Olav Dalgard 8 , John F. Dillion 9 , Robert Flisiak 10 , Xavier Forns 11 , Sona Frankova 12 , Adrian Goldis 13 , Ioannis Goulis 14 , Waldemar Halota 15 , Bela Hunyady 16,17 , Martin Lagging 18 , Angela Largen 2 , Michael Makara 19 , Spilios Manolakopoulos 20 , Patrick Marcellin 21 , Rui T. Marinho 22 , Stanislas Pol 23 , Thierry Poynard 24 , Massimo Puoti 25 , Olga Sagalova 26 , Scott Sibbel 2 , Krzysztof Simon 27 , Carolyn Wallace 2 , Kendra Young 2 , Cihan Yurdaydin 28 , Eli Zuckerman 29 , Francesco Negro 30 and Stefan Zeuzem 31 1 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany 2 Center for Disease Analysis, Kromite, Louisville, CO, USA 3 Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Padova, Italy 4 Department of Internal Medicine, Regional Hospital, Lugano, Switzerland 5 Hospital General Universitari Vall d’Hebron, Barcelona, Spain 6 Centro de Investigaci ´ on Biom ´ edica en Red de Enfermedades Hep ´ aticas y Digestivas (CIBERehd), Barcelona, Spain 7 Department of Medicine, Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada 8 Medical Department, Oslo University Hospital, Rikshospitalet, Oslo, Norway 9 Biomedical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK 10 Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland 11 Liver Unit, Hospital Cl´ ınic, Institut d’Investigacions Biome ` diques August Pi i Sunyer (IDIBAPS) and Centro de Investigaci ´ on Biom ´ edica en Red de Enfermedades Hep ´ aticas y Digestivas (CIBERehd), Barcelona, Spain 12 Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic 13 Clinic of Gastroenterology, University of Medicine ‘Victor Babes’, Timisoara, Romania 14 4th Department of Medicine, Medical School, Aristotelian University of Thessaloniki, Thessaloniki, Greece 15 Department of Infectious Diseases and Hepatology, Nicolaus Copernicus University in Torun (Poland), L. Rydygier Medical University, Bydgoszcz, Poland 16 Department of Medicine, Kaposi M ´ or Teaching Hospital, Kaposv´ ar, Hungary 17 First Department of Medicine, University of P ´ ecs, P ´ ecs, Hungary 18 Department of Infectious Diseases/Virology, University of Gothenburg, Sweden 19 Central Outpatient Clinic, Saint Laszlo Hospital, Budapest, Hungary 20 2nd Academic Department, Hippokration General Hospital, Athens, Greece 21 Viral Hepatitis Research Unit, Ho ˆ pital Beaujon, University of Paris VII, Clichy, France 22 Department of Gastroenterology and Hepatology, Hospital Santa Maria, Lisbon, Portugal 23 Inserm U-1016 et Unit ´ e d’H ´ epatologie, Universit ´ e Paris Descartes, Assistance Publique Ho ˆ pitaux de Paris, Paris, France 24 Department of Hepatology, Universit ´ e Pierre et Marie Curie Liver Center, Paris, France 25 Department of Infectious Diseases, AO Ospedale Niguarda Ca Granda, Milano, Italy 26 Department of Infectious Diseases, Clinic of the Chelyabinsk State Medical Academy, Chelyabinsk, Russia 27 Department and Clinic of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Medical University Wroclaw, Wroclaw, Poland 28 Department of Gastroenterology, School of Medicine, Ankara University, TipFakultesi Hastanesi, Ankara, Turkey 29 Liver Unit, Carmel Medical Center, Haifa, Israel 30 Services de Gastroenterologie et d’Hepatologie et de Pathologie Clinique, Hopitaux Universitaires, Gene ` ve, Switzerland 31 Klinikum der Johann Wolfgang Goethe-Universit ¨ at, Medizinische Klinik 1, Theodor-Stern-Kai 7, Frankfurt am Main, Germany Abstract Background and Aim: Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. Methodology: Data references were identified through indexed journals and non-indexed sources. In this work, 13 000 articles were reviewed and 860 were selected based on their relevance. Results: Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence ( 0.5%) estimates were from northern European countries and the highest ( Z3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with well- established HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and Keywords diagnosis – epidemiology – HCV – hepatitis C – incidence – mortality – prevalence Abbreviations CHC, chronic hepatitis C; CHS, Clalit Health Services; ECDC, European Center for Disease Prevention and Control; EEG, electroencephalogram; EHSSS, The Enhanced Hepatitis Strain Surveillance System of Canada; EMCDDA, European Monitoring Centre for Drugs and Drug Addiction; EU, European Union; FOPH, Swiss Federal Office of Public Health; HCV, hepatitis C virus; HPA, Liver International ISSN 1478-3223 Liver International (2011) 30 c  2011 John Wiley & Sons A/S