---
title: "Epidemiology of Viral Hepatitis in Brazil: Comprehensive Scoping Review"
id: "plos-one-21-the-epidemiology-of-the-viral-hepatitis-in-brazil-a-scoping-review"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-21-the-epidemiology-of-the-viral-hepatitis-in-brazil-a-scoping-review"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353840"
published_at: "2026-07-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Epidemiology of Viral Hepatitis in Brazil: Comprehensive Scoping Review
## Provenance & Clinical Metadata
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- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0353840)
- **Published At:** 2026-07-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- **Viral hepatitis** poses a significant public health issue in Brazil, with substantial morbidity and mortality rates. - A **scoping review** analyzed 200 studies published between 2013 and 2024, encompassing over 14.5 million participants. - Hepatitis B was the most studied type, with **HBsAg** prevalence ranging from 0% to 7.5% across various populations, predominantly higher in endemic regions. - Hepatitis C showed seroprevalence ranging from 0.04% to 2.2%, notably higher among drug users at 36.9%. - The review highlights substantial **regional disparities** and indicates that **vulnerable populations**, such as incarcerated individuals, show drastically higher seroprevalence rates for hepatitis B and A. - The findings stress the need for improved epidemiological data, pointing out the predominance of cross-sectional studies without integration into broader social determinants of health, suggesting future research areas.
## Clinical Analysis & Structured Key Points
SKIP TO MAIN CONTENT Advertisement plos.org Create account Sign in About Browse Publish advanced search 0 Save 0 Citation 27 View 0 Share OPEN ACCESS PEER-REVIEWED RESEARCH ARTICLE The epidemiology of the viral hepatitis in Brazil: A scoping review Cesar Augusto Inoue , Thais Sena de Paula Domingues, Maria Cecilia Araripe Sucupira, Roberta Sitnik, Caroline Thomaz Panico, Denize Ornelas Pereira Salvador de Oliveira, Isis Aleixo Barone Esquiçati, Ketti Gleyzer de Oliveira, Nathalia Villa dos Santos, Peter James Robinson, Raquel Queiroz de Araujo, Roberta dos Santos Pereira, Sabrina David Pugliese, [ ... ], João Renato Rebello Pinho [ view all ] Published: July 17, 2026 https://doi.org/10.1371/journal.pone.0353840 Article Authors Metrics Comments Media Coverage Abstract Introduction Methodology Results Discussion Conclusion Supporting information References Reader Comments Figures Abstract Background Brazil has advanced toward eliminating viral hepatitis by 2030 through broad prevention, diagnosis, and treatment policies. Yet substantial gaps persist across the care continuum, especially in vulnerable populations and underserved regions. This scoping review synthesizes nationwide epidemiologic patterns and identifies knowledge gaps to inform policy. Methods We conducted a PRISMA‑guided scoping review on seven databases (2013–2024) for Portuguese/Spanish/English observational studies or systematic reviews with post‑2010 data, extracting epidemiological patterns by viral hepatitis type and population group. Results Across 200 included studies, the combined sample encompassed more than 14.5 million individuals. Hepatitis B was the most studied, followed by hepatitis C. Hepatitis A seroprevalence in general population ranged from 33.3–67.8%. In vulnerable populations, highest seroprevalence was among incarcerated populations (88.1%), followed by immigrants (87.4%) and transgender individuals (75.6%). Hepatitis B presented HBsAg prevalence ranging from 0–7.5% in the general population, with the highest rates in an endemic Amazon region. Hepatitis C seroprevalence varied from 0.04–2.2% in the general population, with higher rates among people who use drugs (36.9%). Hepatitis D was predominantly reported in the Amazon region, with prevalence ranging from 0–23.9%. For hepatitis E, prevalence in the general population ranged from 0.9–59.4%, with the highest value in the South region. Conclusions Viral hepatitis in Brazil shows heterogeneous epidemiologic patterns across regions and populations, alongside unequal research output. The predominance of small, cross‑sectional studies and their limited integration with social determinants of health highlight the need for future research employing methodologies that address the gaps identified in this review. The resulting evidence map can guide policies aligned with national elimination goals. Figures Citation: Inoue CA, Domingues TSdP, Sucupira MCA, Sitnik R, Panico CT, de Oliveira DOPS, et al. (2026) The epidemiology of the viral hepatitis in Brazil: A scoping review. PLoS One 21(7): e0353840. https://doi.org/10.1371/journal.pone.0353840 Editor: Vinícius Silva Belo, UFSJ: Universidade Federal de Sao Joao del-Rei, BRAZIL Received: August 18, 2025; Accepted: June 29, 2026; Published: July 17, 2026 Copyright: © 2026 Inoue et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting Information files. Funding: Initials of the authors who received each award: JRRP Grant numbers awarded to each author: NUP: 25000.171379/2023-67 The full name of each funder: Ministério da Saúde - Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS) URL of each funder website: https://www.gov.br/saude/pt-br/composicao/se/proadi-sus Did the sponsors or funders play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript? No. Competing interests: The authors have declared that no competing interests exist. Introduction Viral hepatitis represents a major public health issue, accounting for high rates of morbidity and mortality worldwide. It is estimated that these infections result in approximately 1.34 million deaths per year, with the majority attributed to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections [1,2]. Chronic forms of these infections are associated with severe clinical outcomes, such as liver cirrhosis and hepatocellular carcinoma, with HBV and HCV responsible for more than 50% of all liver cancer cases [1]. Brazil is estimated to be one of the countries with the highest viral hepatitis global burden, although national prevalence data remain limited [1,3]. Despite a decline in incidence and mortality rates over the years [4], largely due to the strengthening of public health policies such as the expansion of hepatitis B vaccination coverage and the incorporation of direct-acting antivirals for hepatitis C into the Brazilian Unified Health System (SUS), significant challenges remain in improving diagnostic coverage and access to treatment [3]. In addition, regional inequalities directly impact the country’s epidemiological landscape, underscoring the importance of health social determinants in shaping effective strategies for viral hepatitis prevention and control. These disparities are particularly relevant given Brazil’s continental dimensions and its strategic importance as the largest country in Latin America, both in population and territory. As such, the country plays a central role in achieving hepatitis elimination goals in the region. Its national efforts are aligned with the goals of the Sustainable Development Agenda and the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis [5,6]. Aligned with these commitments, the country has adopted measures to accelerate the elimination of viral hepatitis as a public health problem. Notable initiatives include the establishment of the Interministerial Committee for the Elimination of Tuberculosis and Other Socially Determined Diseases (Comitê Interministerial para a Eliminação da Tuberculose e de Outras Doenças Determinadas Socialmente – Cieds) [7] and the creation of the program “Brasil Saudável” [8], both aimed at promoting intersectoral actions to mitigate social vulnerabilities and reduce health inequities, particularly among historically neglected populations. Considering this context, this study proposes a scoping review of viral hepatitis A, B, C, D, and E epidemiology in Brazil over the last decade. The objective is to map epidemiological patterns, identify regional disparities and vulnerable populations, and uncover critical knowledge gaps. By consolidating and critically analyzing scientific literature, this review aims to support evidence-based public health policies and to highlight areas requiring further investment in research and epidemiological surveillance. Methodology Development of research questions using the “PCC Strategy” To conduct this scoping review, three guiding questions were formulated based on the central theme – “Epidemiology of viral hepatitis”: What evidence/information currently exists on the epidemiological profile and regional distribution of viral hepatitis cases in Brazil? What evidence/information currently exists on the global burden of viral hepatitis in Brazil? What evidence/information currently exists on the epidemiological profile and regional distribution of viral hepatitis cases in vulnerable populations in Brazil? These questions were structured following the PCC strategy (Population, Concept, and Context), as recommended by the Joanna Briggs Institute (JBI) for formulating scoping review questions [9]. Standardization and search strategy This scoping review was conducted according to JBI methodology [9,10] and reported following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines [11]. A protocol was developed for this scoping review, including the data extraction framework, prior to the conduct of the review. The protocol guided the study selection and data extraction processes. It was subsequently registered on the Open Science Framework platform (https://doi.org/10.17605/OSF.IO/NFUMV) during the review process and updated to reflect the final methodological approach. To ensure comprehensive search, Medical Subject Headings (MeSH), and text words were used, applied to titles, abstracts, and keywords (Table 1). The strategies were adapted according to each database structure (S1 Table). Download: PNG larger image TIFF original image Table 1. Descriptors and free terms used in the scoping review strategy. https://doi.org/10.1371/journal.pone.0353840.t001 The databases consulted were PubMed, Virtual Health Library (BVS), EMBASE, SciELO, Scopus, Web of Science, and CINAHL. The final search was conducted on 16th April 2024 and was restricted to references published between January 1, 2013, and March 15, 2024, containing data produced after January 1, 2010. Selection of articles and sources of evidence The inclusion and exclusion criteria are described in Table 2. Download: PNG larger image TIFF original image Table 2. Inclusion and exclusion criteria. https://doi.org/10.1371/journal.pone.0353840.t002 Selection of texts included in the scoping review Article selection followed a structured three-step process. Initially, references were organized in EndNote v.20 software [12], with duplicate removal. Then, two independent reviewers screened titles and abstracts in the Rayyan platform [13], excluding studies irrelevant to the research questions. Finally, selected texts underwent full-text reading to confirm eligibility. In cases of disagreement, a third reviewer was consulted to resolve conflicts [10]. Data extraction from selected texts Data extraction followed JBI guidelines, using a standardized form in the REDCap platform [14,15]. The form included variables such as publication type, study characteristics (author, year, location, methodological design), target population characterization (age group, sex at birth, race/ethnicity, and education level), sample size, epidemiological data (prevalence, incidence, mortality, vaccination coverage). Populations included in this scoping review were categorized based on official documents from the Brazilian Ministry of Health [16] and grouped by similarity, considering epidemiological characteristics and associated vulnerabilities. The classification was structured into six categories with operational definitions as follows. (1) General population and proxy groups were defined as samples intended to approximate the broader community distribution or routinely screened groups used as proxies for population-level estimates (for example, blood donors and pregnant women). (2) Age groups were defined as samples explicitly restricted to a specific age range (for example, children or older adults). (3) Clinical populations were defined as groups characterized by clinical conditions or healthcare-related exposures that may modify viral hepatitis risk, testing pathways, or disease susceptibility; this category included individuals with chronic diseases, or liver diseases, those on hemodialysis, transplant recipients, people with a history of blood transfusion, people living with HIV/aids (PLWHA), and individuals with alcohol abuse. (4) Occupational risk groups were defined as workers whose professional activities entail potential exposure to blood or body fluids, sharp injuries, or contaminated materials, this category included healthcare workers, urban sanitation/waste collection workers, beauty sector workers, and public safety personnel. (5) Remote area populations were defined as communities living in geographically remote settings or with limited access to health services and surveillance, including rural, riverside, quilombola, and Indigenous communities. (6) Socially and structurally vulnerable populations were defined as groups experiencing social exclusion, marginalization, or structural barriers to prevention, diagnosis, and care, which may increase exposure or reduce access to timely services, this category included gay and men who have sex with men (MSM), transgender individuals, immigrants and refugees, incarcerated individuals, homeless people, people who use drugs (PWUD), and sex workers. Additionally, in line with national surveillance reports and clinical guidelines, we defined a seventh analytic stratum called Amazonian populations. This stratum covers the Legal Amazon region and includes urban, rural, riverine, and Indigenous communities which are prioritized for viral hepatitis prevention and screening [16–19]. Epidemiological data were collected and extracted following the established standardization. Discrepancies between reviewers were resolved through the same process as described for study selection. In cases of overlap between population groups, where the study did not present specific values for each population, prevalence was assigned to multiple groups, ensuring the representativeness of the different contexts analyzed. Data analysis Extracted data were analyzed descriptively and categorized according to the variables defined in the extraction form. The primary analytical approach incorporated key variables including publication characteristics, study design methodology, geographic coverage of data collection (whether national or regional in scope), the hepatitis virus type being examined, and the target population under investigation. Each study was classified based on the population groups previously established by the reviewers. In cases of overlap, such as studies involving multiple groups simultaneously (e.g., transgender incarcerated individuals, sex workers residing in the Amazon region, gay men and MSM living with HIV/aids), all relevant categories were assigned, allowing for a more comprehensive analysis. Data extraction was followed by an analysis plan development aggregating information on all viral hepatitis types and subsequently stratifying them by specific hepatitis type. Results were presented according to the number of references addressing each variable in the extraction form. Since a single study could report multiple variables, the total records per category did not necessarily correspond to the total number of studies included in the review. Epidemiological data, such as prevalence, incidence, and mortality, were extracted from the articles based on findings consistent with viral hepatitis infection, confirmed by serological testing or medical records. The epidemiological data were systematized according to the specific serological markers for each type of viral hepatitis, with these values being used for analysis within each population group defined in the scoping review design. To optimize result presentation, a graph was developed for each hepatitis type containing study identification, publication year, and sample size. As a scoping review, this study mapped descriptive epidemiological data and did not pursue meta-analyses, risk factor hierarchies, or causal inference, which fall under analytical epidemiology, although the extracted data included information on prevalence. Described results prioritized the most relevant prevalence data; therefore, not all studies in this review were presented in the text. Results PRISMA flowchart description The search in the PubMed, LILACS, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL databases, and gray literature resulted in the identification of 7,649 references. After removing 5,999 records (5,120 duplicates, 790 data collection outside time frame, 88 without abstracts, and 1 in an unsupported language), 1,650 references were selected for title and abstract screening (Fig 1 and S1 Table). Download: PNG larger image TIFF original image Fig 1. Flowchart of the study selection. https://doi.org/10.1371/journal.pone.0353840.g001 At this stage, 1,116 articles were excluded according to the pre-established eligibility criteria. The remaining 534 articles underwent full-text reading, leading to the exclusion of 335 studies. Among the exclusion reasons, 12 articles were considered duplicates at this stage, mainly gray literature and conference abstracts whose full texts were identified in the final selection. One study was excluded for being in a language incompatible with the scope criteria. Four articles did not present data on viral hepatitis epidemiology in Brazil, while 16 studies did not address viral hepatitis. Thirty-six articles lacked relevant epidemiological information. Another 37 studies were discarded for not presenting pertinent data to the analysis, and 18 were excluded due to poor methodological quality or scientific rigor. Additionally, 14 texts were unavailable in full, 113 studies were excluded for having a data collection period outside the inclusion criteria, and 84 articles were not original publications or presented study design incompatible with the criteria of this review. In the end, 200 studies were included, one of which was identified through manual search (Fig 1). General information Among the 200 articles, the period between 2017 and 2020 (n = 92) had the highest number of included texts. Regarding publication type, 173 references were peer-reviewed original articles, followed by short communications (n = 15), conference abstracts (n = 9), and dissertations and theses (n = 3). Almost all included articles (n = 181) were cross-sectional studies, 6 were cohort studies, 4 were ecological studies, 3 employed mixed methodology (cross-sectional study combined with a cohort study), and 3 were based on secondary data/surveillance data. Few studies had national coverage (n = 13), while most had regional reach, distributed in descending order across the following regions: Southeast, Central-West, North, Northeast, and South (Fig 2). Download: PNG larger image TIFF original image Fig 2. Brazil’s geopolitical map: macro-regions and states A, B. (A) Map authored by the authors in R from IBGE vector boundary data. No basemap or satellite imagery was used. Data source: Brazilian Institute of Geography and Statistics (IBGE) (accessed on 19 Jan 2026): https://www.ibge.gov.br/en/geosciences/downloads-geosciences.html?lang=en-GB. (B) State abbreviations by Brazilian macro-region: North: AC – Acre; AM – Amazonas; AP – Amapá; PA – Pará; RO – Rondônia; RR – Roraima; TO – Tocantins. Northeast: AL – Alagoas; BA – Bahia; CE – Ceará; MA – Maranhão; PB – Paraíba; PE – Pernambuco; PI – Piauí; RN – Rio Grande do Norte; SE – Sergipe. Central-West: DF – Federal District; GO – Goiás; MS – Mato Grosso do Sul; MT – Mato Grosso. Southeast: ES – Espírito Santo; MG – Minas Gerais; RJ – Rio de Janeiro; SP – São Paulo. South: PR – Paraná; RS – Rio Grande do Sul; SC – Santa Catarina. https://doi.org/10.1371/journal.pone.0353840.g002 Collectively, the evidence base comprises more than 14.5 million participants. Sample sizes varied widely overall (minimum 38; maximum 11,397,607; median 464). Hepatitis A showed the broadest range (51–11,397,607; median 523; 25 studies), while hepatitis B contributed to the largest evidence base (115 studies; 56–1,991,120; median 435). Hepatitis C had the highest median sample size (median 600; 81–1,991,120; 91 studies). In contrast, hepatitis D study sizes were consistently low, with no dataset exceeding 4,000 participants (38–3,983; median 560.5; 16 studies). Hepatitis E study sizes were also limited, all below 3,000 participants (150–3,000; median 434; 30 studies). Most studies were conducted exclusively wit
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