Health Strategy on HCV in The Netherlands
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Transcript of Health Strategy on HCV in The Netherlands
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MDLUMC utrecht
Health Strategy on HCVin
The Netherlands
van Hattum
VHPB meeting May 2002
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MDLUMC utrecht
Health Strategy on HCVin
The Netherlands
• epidemiology• observations• recommendations
VHPB meeting May 2002
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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 (81 %) 1150• haemodialysis (2.7 %) 110• blood transfusions (est.) 13500
~ 0.1 % of general population
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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
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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
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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
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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 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
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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 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
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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
• 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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MDLUMC utrecht
Health Strategy on HCVin
The Netherlands
van Hattum end
VHPB meeting May 2002