Viral Hepatitis in Croatia

Objective: The aim of this study was to review the epidemiology of hepatitis a virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) infections in Croatia with emphasis on the influence on the national health and health care system. Materials and Methods: We conducted a literature search of data on the epidemiology of viral hepatitis in Croatia with a review of national data from our reference centers. Results: Since the year 2000, the incidence of hepatitis A in Croatia has shown a continuous and stable decline with only four cases recorded in 2012. Concerning chronic HBV infection, Croatia is classified among the countries with a low prevalence, only <2%. The prevalence of HCV infection ranges between 0.035 and 1.6%. HDV infection is uncommon and the majority of infected persons are intravenous drug addicts. Vaccination against HAV has not been included in the regular vaccination calendar; only persons, who are suffering from chronic liver diseases or those traveling to highly endemic regions, are vaccinated against it. Immunization against hepatitis B was introduced in 1992 and for years was mandatory for persons at increased risk. The vaccination of adolescents was introduced in 1999, while universal mandatory vaccination of newborns was finally introduced in 2007. Like all measures for preventing and treating communicable diseases in Croatia, vaccination against hepatitis is free of charge and fully covered by health insurance for every inhabitant who is required to be vaccinated. There are serious problems concerning the treatment of hepatitis in Croatia which has been in an economic crisis for several years. The treatment of acute hepatitis is symptomatic, except in cases of hepatitis B in immunocompromised persons, acute hepatitis C in persons who have positive HCV RNA three months prior to the start of therapy and healthcare workers from the onset of the disease. As of this year, the protease inhibitors have been registered in Croatia. So far, approximately 30 patients have been included in triple therapy, mainly with donated medicine for treatment-naive patients with genotype 1 and relapsers following prior dual therapy with genotype 1. Conclusion: Enhanced understanding of viral, host, and environmental factors that influence disease progression, as well as prevention as a cornerstone, may ultimately improve the burden of viral hepatitis in Croatia.