Health Strategy on HCV in The Netherlands

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Health Strategy on HCVin

The Netherlands

van Hattum

VHPB meeting May 2002

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The Netherlands

• epidemiology• observations• recommendations


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HCV in The Netherlands

Epidemiology

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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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Epidemiology

prevalence in recipients of blood products

• haemophiliacs (81 %) 1150• haemodialysis (2.7 %) 110• blood transfusions (est.) 13500

~ 0.1 % of general population

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Epidemiology

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

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Epidemiology

prevalence

General populationHCV observed in “random” population: 0.3-0.4 %

Risk groupsrecipients of blood products 0.1 %ivd users 0.08 %allochtonous 0.15 %risky behaviour <0.1 %

+ 0.4 %

~ 60 000 people, where are they ?

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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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Basic Facts

Minister of Health, Welfare and SportsHealth Council of the Netherlands

• overall prevalence is considered to be comparable toother countries in Northern Europe

• most prevalent risk groups:people who have used intravenous drugsrecipients of blood productsallochtonous descent

• general or focused screening programs to detectsporadic HC patients seem inefficient

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Basic Facts

Minister of Health, Welfare and Sports


• 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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Basic Facts

Minister of Health, Welfare and Sport


• it is the patients’ right that physicians provide themspontaneously with relevant information

• the general population lacks adequate knowledgeabout HCV, the transmission routes, the diseaseand possible treatment

• this prevents them from taking responsibility for theirown health

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Recommendations

Minister of Health, Welfare and SportHealth Council of the Netherlands

• a general look back, i.e. tracing and testing all peoplepossibly at risk in the past would be inefficient

• hospitals should keep precise records of the originand 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 allochtonous descent

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Recommendations



• tracing and treating patients with conditions that goalong 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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Recommendations

Minister of Health, Welfare and SportHealth Council of the Netherlands

• medical doctors of various disciplines must betrained 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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Recommendations



• 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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• 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 measuresproviding information to clients /

patientsdiagnosing new patientsproviding treatment

current situationHepatitis C Surveillance study1999/2000

mixed population, 1.5 million, 1.5 year

78 new hepatitis C patients diagnosed19 referred to internist / gastroenterologist 3 treated with IFN + ribavirin

Hepatitis C Surveillance study1999/2000

mixed population, 1.5 million, 1.5 year

78 new hepatitis C patients diagnosed19 referred to internist / gastroenterologist 3 treated with IFN + ribavirin

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• 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 measuresproviding information to clients /

patientsdiagnosing new patientsproviding treatment

• special treatment programs of risk groups

current situation

HC treatment of (ex) i.v. drug usersstarting up nation wide

pilot study: - feasibleif using infrastructure of drug user control programsif the present staff is trained

- good complianceIFN 6 months, 56 patients, 2 dropouts

In NL most drug addicts are registered in programseverybody has a (mandatory) health insuranceHC treatment (IFN+riba) is available and refundable

HC treatment of (ex) i.v. drug usersstarting up nation wide

pilot study: - feasibleif using infrastructure of drug user control programsif the present staff is trained

- good complianceIFN 6 months, 56 patients, 2 dropouts

In NL most drug addicts are registered in programseverybody has a (mandatory) health insuranceHC treatment (IFN+riba) is available and refundable

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Health Strategy on HCV in The Netherlands

• 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

summary

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The Netherlands

van Hattum end


Health Strategy on HCV in The Netherlands

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