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Health Strategy on HCV in The Netherlands. V H PB meeting May 200 2. van Hattum. Health Strategy on HCV in The Netherlands. V H PB meeting May 200 2. epidemiology observations recommendations. HCV in The Netherlands Epidemiology. HCV in The Netherlands Epidemiology.

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Health strategy on hcv in the netherlands

Health Strategy on HCVinThe Netherlands

VHPB meetingMay 2002

van Hattum


Health strategy on hcv in the netherlands1

Health Strategy on HCVinThe Netherlands

VHPB meetingMay 2002

  • epidemiology

  • observations

  • recommendations



Hcv in the netherlands epidemiology1

HCV in The NetherlandsEpidemiology

  • 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 %


Hcv in the netherlands epidemiology2

HCV in The NetherlandsEpidemiology

  • prevalence in recipients of blood products

  • haemophiliacs (81 %) 1150

  • haemodialysis (2.7 %) 110

  • blood transfusions (est.) 13500

  • ~ 0.1 % of general population


Hcv in the netherlands epidemiology3

HCV in The NetherlandsEpidemiology

  • 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


Hcv in the netherlands epidemiology4

HCV in The NetherlandsEpidemiology

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 %

~ 60 000 people, where are they ?


Hcv in the netherlands basic facts

HCV in The NetherlandsBasic 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


Hcv in the netherlands basic facts1

HCV in The NetherlandsBasic 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


Hcv in the netherlands basic facts2

HCV in The NetherlandsBasic 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


Hcv in the netherlands basic facts3

HCV in The NetherlandsBasic 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


Hcv in the netherlands recommendations

HCV in The NetherlandsRecommendations

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 allochtonousdescent


Hcv in the netherlands recommendations1

HCV in The NetherlandsRecommendations

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


  • Hcv in the netherlands recommendations2

    HCV in The NetherlandsRecommendations

    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

      • hairdressers

      • chiropodists

      • acupuncturists

      • piercing / tattoo practitioners

      • ritual practitioners


    Hcv in the netherlands recommendations3

    HCV in The NetherlandsRecommendations

    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


  • Hcv in the netherlands

    HCV in The Netherlands

    Hepatitis C Surveillance study

    1999/2000

    mixed population, 1.5 million, 1.5 year

    78 new hepatitis C patients diagnosed

    19 referred to internist / gastroenterologist

    3 treated with IFN + ribavirin

    current situation

    • 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 measures

      • providing information to clients / patients

      • diagnosing new patients

      • providing treatment


    Hcv in the netherlands1

    HCV in The Netherlands

    current situation

    HC treatment of (ex) i.v. drug users

    starting up nation wide

    pilot study: - feasible

    if using infrastructure of drug user control programs

    if the present staff is trained

    - good compliance

    IFN 6 months, 56 patients, 2 dropouts

    In NL most drug addicts are registered in programs

    everybody has a (mandatory) health insurance

    HC treatment (IFN+riba) is available and refundable

    • 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 measures

      • providing information to clients / patients

      • diagnosing new patients

      • providing treatment

  • special treatment programs of risk groups


  • Health strategy on hcv in the netherlands2

    Health Strategy onHCV 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


  • Health strategy on hcv in the netherlands3

    Health Strategy on HCVinThe Netherlands

    VHPB meetingMay 2002

    van Hattum end