Between 2.4 and 4.1 million people across Europe are estimated to be living with chronic hepatitis B infection, according to a new study published in the journal Eurosurveillance by the European Centre for Disease Prevention and Control (ECDC). That works out to around 0.7% of the population of the EU and European Economic Area — and a large proportion of those affected are unaware they carry the virus.
The overall infection rate has fallen since a previous estimate put it at 1% between 2005 and 2015, which is encouraging. But the burden is far from evenly spread. Countries in southern and eastern Europe show the highest rates of infection, while those in the north and west have significantly lower levels. At the country level, national prevalence ranges from as low as 0.1% to as high as 3.1%, a striking difference that points to the need for country-specific responses rather than a one-size-fits-all approach.
“The analysis confirms that the overall burden of chronic HBV infection remains considerable in the EU/EEA, with major differences between countries and key populations,” said the researchers. “The findings further underscore the complexity of the HBV situation in EU/EEA countries and the need for tailored, population-specific interventions.”
Certain groups carry a disproportionately high burden of infection. The study looked specifically at migrants, people who inject drugs, and men who have sex with men, all groups known to be at higher risk.
Among migrants, prevalence varied widely, from 0.8% to 10.5% depending on the country. In northwestern Europe in particular, migrants accounted for more than three quarters of cases in several countries. For people who inject drugs and men who have sex with men, prevalence figures also varied considerably between countries, with no clear geographical pattern.
That said, it is important not to lose sight of the bigger picture: roughly two thirds of all cases were found among people who did not belong to any of these specific groups. This means that while targeted interventions for high-risk populations are essential, broad public health strategies aimed at the general population remain just as important.
One of the biggest obstacles in tackling hepatitis B is that the infection is mostly asymptomatic, and most people who have it feel perfectly well and have no idea they are infected. Estimates suggest that only 16% of people with chronic hepatitis B in the wider WHO European Region have actually been diagnosed. That leaves the vast majority undetected and, in many cases, untreated.
This makes accurate data on how widespread the infection is incredibly difficult to obtain. Testing practices vary from country to country, and the groups most affected are often underrepresented in health surveys. To work around these limitations, the researchers used a modelling approach developed by the United Nations, combining data from multiple scientific sources and reviewed by national hepatitis experts across Europe.
Understanding how many people are living with hepatitis B is not just an academic exercise. It directly shapes decisions about where to invest in testing programmes, how to target healthcare outreach, and how to monitor whether prevention and treatment policies are actually working.
The researchers are clear that more and better data are still needed. The current methodology, while the best available, has limitations: it depends heavily on the quality of the underlying data and cannot fully account for overlapping populations. Further research is needed to fill these gaps.
What the study does make clear is that hepatitis B remains a significant public health challenge across Europe, one that demands both targeted action for the most vulnerable groups and broader strategies to reach the many people living with the infection who simply do not know it yet.
Canabarro Ana Paula Finatto, Duffell Erika, Hansson Disa, Dudareva Sandra, Seyler Thomas,et al. Use of the Workbook Method to estimate the prevalence of chronic hepatitis B infections in the European Union and European Economic Area, 2022. Euro Surveill. 2026;31(14):pii=2500322.https://doi.org/10.2807/1560-7917.ES.2026.31.14.2500322