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, contributing substantially to liver-related morbidity and mortality. Many infected individuals remain undiagnosed, limiting access to treatment and hindering progress toward the elimination targets proposed by the World Health Organization for 2030. Emergency Departments (ED) represent a strategic setting for opportunistic screening because they frequently attend individuals who may have limited contact with primary care services, including vulnerable and migrant populations. This study aimed to evaluate the implementation of opportunistic screening for HBV and HCV in ED within the Girona Health Region in Spain, and to estimate infection prevalence, characterize epidemiological risk profiles, and assess linkage to specialist care. Methods A prospective observational study was conducted in the ED of two public hospitals between October 2023 and January 2024. Adults older than 18 years who required blood testing for clinical reasons were offered screening for hepatitis B surface antigen and antibodies to HCV. Confirmation of active hepatitis C infection was performed using HCV RNA testing. Demographic, epidemiological, and clinical variables were collected. Positive results were communicated to the clinical team and referral pathways to specialist care were activated. Associations between infection status and patient characteristics were evaluated using univariate regression analysis. Results A total of 1,998 patients with valid screening results were included. Antibodies to HCV were detected in 39 individuals (1.95%), and 10 patients (0.50%) had confirmed active infection; 50% of these cases were previously undiagnosed. Seven patients were successfully linked to specialist care and five initiated treatment. Active infection was more frequent among individuals with a history of heroin (18.75%). Hepatitis B surface antigen was detected in 15 patients (0.75%), of whom 60% had no prior diagnosis. Hepatitis B infection was significantly more common among individuals born outside Spain, particularly those from South-Saharan Africa (11.11%), North Africa (2.22%), and Eastern Europe (2.04%). Conclusions Opportunistic screening for hepatitis B and hepatitis C in ED is feasible and effective for identifying undiagnosed infections and facilitating linkage to care. ED–based screening may represent an important complementary strategy for viral hepatitis elimination, particularly in regions with diverse populations and migrant communities.