Viral hepatitis detection through emergency hospital departments in a Spanish region with high immigration: implications for elimination strategies

Background Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) remains a major global public health problem, as many infected individuals remain undiagnosed. Emergency departments (ED) represent a strategic setting for opportunistic screening. This study aimed to evaluate implementation strategies of opportunistic screening in ED within the Girona Health Region in Spain. Methods A prospective observational study was conducted in the ED of the Hospital Universitari de Girona Dr. Josep Trueta (HUGJT) and the Hospital Santa Caterina (HSC) between October 2023 and January 2024. Adults older than 18 years who required blood testing for clinical reasons were screened. In HUGJT screening was automated within the electronic system (opt-out strategy), while in HSC it was performed following a specific request from the attending physician. Comparisons of screening outcomes between hospitals and patient characteristics were evaluated using non-parametric tests. Results A total of 1695 patients from HUGJT (54.3% coverage) and 303 patients from HSC (6.9% coverage) with valid screening results were included. In HUGJT, antibodies to HCV were detected in 37 individuals (2.2%); while active infection was confirmed in 9 patients (0.5%) (50.0% were previously undiagnosed), being more frequent among individuals with a history of heroin (20.0%). Hepatitis B surface antigen was detected in 11 patients (0.6%) (60.0% had no prior diagnosis), being more common among individuals born outside Spain, particularly those from South-Saharan Africa (7.1%), North Africa (3.2%), and Eastern Europe (2.2%). Conclusions Opt-out opportunistic screening in ED is effective for identifying undiagnosed infections and facilitating linkage to care.