MDLUMC utrecht

Health Strategy on HCVin

The Netherlands

van Hattum

VHPB meeting May 2002

MDLUMC utrecht

Health Strategy on HCVin

The Netherlands

• epidemiology• observations• recommendations

VHPB meeting May 2002

MDLUMC utrecht

HCV in The Netherlands

Epidemiology

MDLUMC utrecht

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 %

MDLUMC utrecht

HCV in The Netherlands

Epidemiology

prevalence in recipients of blood products

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

~ 0.1 % of general population

MDLUMC utrecht

HCV in The Netherlands

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

MDLUMC utrecht

HCV in The Netherlands

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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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

MDLUMC utrecht

HCV in The Netherlands

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

MDLUMC utrecht

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

MDLUMC utrecht

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 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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HCV in The Netherlands

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

MDLUMC utrecht

HCV in The Netherlands

Recommendations

Minister of Health, Welfare and Sport

Health Council of the Netherlands

• 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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HCV in The Netherlands

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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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

• 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

MDLUMC utrecht

HCV in The Netherlands

• 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

MDLUMC utrecht

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

MDLUMC utrecht

Health Strategy on HCVin

The Netherlands

van Hattum end

VHPB meeting May 2002