Transcript hepatitis C, overzicht GR advies

VHPB meeting
May 2002
Health Strategy on HCV
in
The Netherlands
van Hattum
UMC utrecht
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VHPB meeting
May 2002
Health Strategy on HCV
in
The Netherlands
• epidemiology
• observations
• recommendations
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HCV in The Netherlands
Epidemiology
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HCV in The Netherlands
Epidemiology
prevalence in the general population
• new blood donors:
0.04 %
estimated in general population: 5-10x
• blood donors 1984-1990:
<0.2 %
• general population (low risk profile):
0.1 %
• general population (extrapolated):
<0.4 %
HCV observed in “random” population: 0.3-0.4 %
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HCV in The Netherlands
Epidemiology
prevalence in recipients of blood products
• haemophiliacs
• haemodialysis
• blood transfusions
(81 %)
(2.7 %)
(est.)
1150
110
13500
~ 0.1 % of general population
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HCV in The Netherlands
Epidemiology
prevalence, other groups
• ivd users
• allochtonous
(75 %)
(1 - 2.5 %)
12000
<25000
~ 0.2 % of general population
• hospital infection, needle stick, transplantation, dentist
• household, perinatal, sexual, tattoo/piercing
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HCV in The Netherlands
Epidemiology
prevalence
General population
HCV observed in “random” population: 0.3-0.4 %
Risk groups
recipients of blood products
ivd users
allochtonous
risky behaviour
0.1 %
0.08 %
0.15 %
<0.1 %
+ 0.4 %
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~ 60 000 people, where are they ?
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HCV in The Netherlands
Basic Facts
Minister of Health, Welfare and Sports
Health Council of the Netherlands
• chronic hepatitis C is a serious disease
• hepatitis C virus can be detected with great accuracy
• hep C is aggravated by hep A, hep B, HIV or alcohol
• treatment is available and may result in elimination of
the HCV and cure
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HCV in The Netherlands
Basic Facts
Minister of Health, Welfare and Sports
Health Council of the Netherlands
• overall prevalence is considered to be comparable to
other countries in Northern Europe
• most prevalent risk groups:
people who have used intravenous drugs
recipients of blood products
allochtonous descent
• general or focused screening programs to detect
sporadic HC patients seem inefficient
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HCV in The Netherlands
Basic Facts
Minister of Health, Welfare and Sports
Health Council of the Netherlands
• HCV is transmitted mainly via blood or blood products
• hygienic measures among non-regular practitioners
(tattoo, piercing, acupuncture, ritual) are unclear
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HCV in The Netherlands
Basic Facts
Minister of Health, Welfare and Sport
Health Council of the Netherlands
• it is the patients’ right that physicians provide them
spontaneously with relevant information
• the general population lacks adequate knowledge
about HCV, the transmission routes, the disease
and possible treatment
• this prevents them from taking responsibility for their
own health
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HCV in The Netherlands
Recommendations
Minister of Health, Welfare and Sport
Health Council of the Netherlands
• a general look back, i.e. tracing and testing all people
possibly at risk in the past would be inefficient
• hospitals should keep precise records of the origin
and use of blood products
• epidemiological research is required as to the
prevalence of HCV infection in the various
population groups
• children of HCV positive mothers
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• first generation of allochtonous descent
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HCV in The Netherlands
Recommendations
Minister of Health, Welfare and Sport
Health Council of the Netherlands
• tracing and treating patients with conditions that go
along with increased likelihood of HCV infection
• haemophiliacs
• haemodialysis patients
• polytransfusees
• patients with organ transplants
• patients with puncture wounds
• patients with hep C must be advised to stop alcohol
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HCV in The Netherlands
Recommendations
Minister of Health, Welfare and Sport
Health Council of the Netherlands
• medical doctors of various disciplines must be
trained on diagnostics and advising patients
• professionals involved in increased risk of HCV
transmission must be informed on hygiene
• hair dressers
• chiropodists
• acupuncturists
• piercing / tattoo practitioners
• ritual practitioners
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HCV in The Netherlands
Recommendations
Minister of Health, Welfare and Sport
Health Council of the Netherlands
• information to the general population
• the disease
• the transmission
• the possibility to treat
• goal-oriented information to people in risk groups
• seek medical care
• if necessary, receive treatment
• Immigrants should be informed through their own channels
• intermediaries should be trained for that purpose
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HCV in The Netherlands
current situationHepatitis C Surveillance study
1999/2000
• active awareness
programs
in risk
mixed
population,
1.5groups
million, 1.5 year
• training courses to professionals
78 new
hepatitis
C patients
diagnosed
• in cooperation
with the
various professional
societies
• special aspects
concerning
professional
group
19 referred
toeach
internist
/ gastroenterologist
3 treated with IFN + ribavirin
aiming at
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hygienic measures
providing information to clients / patients
diagnosing new patients
providing treatment
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HCV in The Netherlands
current situation
HC treatment of (ex) i.v. drug users
•starting
activeupawareness
nation wide programs in risk groups
•pilot
training
courses to professionals
study: - feasible
• in cooperation with the various professional societies
if using infrastructure of drug user control programs
• special aspects concerning each professional group
if the present staff is trained
- good
aiming
at compliance
hygienic measures
IFN 6 months,
56information
patients, 2todropouts
providing
clients / patients
In NL
diagnosing new patients
providing
treatmentin programs
most drug addicts
are registered
everybody has a (mandatory) health insurance
• special
programs
of risk groups
HCtreatment
treatment (IFN+riba)
is available
and refundable
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Health Strategy on HCV in The Netherlands
summary
• collect data on epidemiology and support research
• improve the awareness of the disease and hygiene
• general population
• risk groups
• improve recognition of the disease and hygiene
• by non-medical practitioners
• by medical professionals
• improve treatment of the disease
• stimulate referral: non-medical, general practitioner, specialist
• stimulate adequate treatment by the specialists
• support treatment programmes for risk groups
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VHPB meeting
May 2002
Health Strategy on HCV
in
The Netherlands
van Hattum
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end
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