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Health Strategy on HCV in The Netherlands

Health Strategy on HCV in The Netherlands. V H PB meeting May 200 2. van Hattum. Health Strategy on HCV in The Netherlands. V H PB meeting May 200 2. epidemiology observations recommendations. HCV in The Netherlands Epidemiology. HCV in The Netherlands Epidemiology.

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Health Strategy on HCV in The Netherlands

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  1. Health Strategy on HCVinThe Netherlands VHPB meetingMay 2002 van Hattum

  2. Health Strategy on HCVinThe Netherlands VHPB meetingMay 2002 • epidemiology • observations • recommendations

  3. HCV in The NetherlandsEpidemiology

  4. HCV in The NetherlandsEpidemiology • 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 %

  5. HCV in The NetherlandsEpidemiology • prevalence in recipients of blood products • haemophiliacs (81 %) 1150 • haemodialysis (2.7 %) 110 • blood transfusions (est.) 13500 • ~ 0.1 % of general population

  6. HCV in The NetherlandsEpidemiology • prevalence, other groups • ivd users (75 %) 12000 • allochtonous (1 - 2.5 %) <25000 • ~ 0.2 % of general population • hospital infection, needle stick, transplantation, dentist • household, perinatal, sexual, tattoo/piercing

  7. HCV in The NetherlandsEpidemiology prevalence General population HCV observed in “random” population: 0.3-0.4 % Risk groups recipients of blood products 0.1 % ivd users 0.08 % allochtonous 0.15 % risky behaviour <0.1 % + 0.4 % ~ 60 000 people, where are they ?

  8. HCV in The NetherlandsBasic 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

  9. HCV in The NetherlandsBasic 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

  10. HCV in The NetherlandsBasic 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

  11. HCV in The NetherlandsBasic 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

  12. HCV in The NetherlandsRecommendations 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 • first generation of allochtonousdescent

  13. HCV in The NetherlandsRecommendations 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

  14. HCV in The NetherlandsRecommendations 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 • hairdressers • chiropodists • acupuncturists • piercing / tattoo practitioners • ritual practitioners

  15. HCV in The NetherlandsRecommendations 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

  16. HCV in The Netherlands Hepatitis C Surveillance study 1999/2000 mixed population, 1.5 million, 1.5 year 78 new hepatitis C patients diagnosed 19 referred to internist / gastroenterologist 3 treated with IFN + ribavirin current situation • active awareness programs in risk groups • training courses to professionals • in cooperation with the various professional societies • special aspects concerning each professional group • aiming at hygienic measures • providing information to clients / patients • diagnosing new patients • providing treatment

  17. HCV in The Netherlands current situation HC treatment of (ex) i.v. drug users starting up nation wide pilot study: - feasible if using infrastructure of drug user control programs if the present staff is trained - good compliance IFN 6 months, 56 patients, 2 dropouts In NL most drug addicts are registered in programs everybody has a (mandatory) health insurance HC treatment (IFN+riba) is available and refundable • active awareness programs in risk groups • training courses to professionals • in cooperation with the various professional societies • special aspects concerning each professional group • aiming at hygienic measures • providing information to clients / patients • diagnosing new patients • providing treatment • special treatment programs of risk groups

  18. Health Strategy onHCV 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

  19. Health Strategy on HCVinThe Netherlands VHPB meetingMay 2002 van Hattum end

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