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VHPB meeting May 2002 Health Strategy on HCV in The Netherlands van Hattum UMC utrecht MDL VHPB meeting May 2002 Health Strategy on HCV in The Netherlands • epidemiology • observations • recommendations UMC utrecht MDL HCV in The Netherlands Epidemiology UMC utrecht MDL 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 % UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 % UMC utrecht ~ 60 000 people, where are they ? MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht • first generation of allochtonous descent MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht MDL 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 UMC utrecht hygienic measures providing information to clients / patients diagnosing new patients providing treatment MDL 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 UMC utrecht MDL 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 UMC utrecht MDL VHPB meeting May 2002 Health Strategy on HCV in The Netherlands van Hattum UMC utrecht end MDL