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Health Strategy on HCV in The Netherlands

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


                               ~ 0.1 % of general population


UMC utrecht                                               MDL
      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
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    0.1 %
      ivd users                       0.08 %
      allochtonous                    0.15 %
      risky behaviour                <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
                  • first generation of allochtonous descent   MDL
UMC utrecht
      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



                      Hepatitis C Surveillance study
      current situation
                          1999/2000

      • active awareness programs in risk groups 1.5 year
                     mixed population, 1.5 million,
      • training courses to professionals
                          78 with hepatitis C patients diagnosed
              • in cooperationnewthe various professional societies
              • special aspects concerning each professional group
                          19 referred to internist / gastroenterologist
                            3 treated with IFN + ribavirin
              aiming at        hygienic measures
                               providing information to clients / patients
                               diagnosing new patients
                               providing treatment



UMC utrecht                                                                  MDL
    HCV in The Netherlands




    current situation
    HC treatment of (ex) i.v. drug users
    • active awareness programs in risk groups
    starting up nation wide
    • training courses to professionals
    pilot 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 measures
                               hygienic
                               providing patients, to clients / patients
                     IFN 6 months, 56information 2 dropouts
                           diagnosing new patients
    In NL                  providing treatment
            most drug addicts are registered in programs
            everybody has a (mandatory) health insurance
     • special treatment(IFN+riba) is available and refundable
            HC treatment programs of risk groups
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                       end


UMC utrecht                                    MDL

				
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