Health%20Strategy%20on%20HCV%20in%20The%20Netherlands

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Health Strategy on HCVinThe Netherlands
VHPB meeting May 2002
van Hattum
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Health Strategy on HCVinThe Netherlands
VHPB meeting May 2002

• epidemiology
• observations
• recommendations

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HCV in The NetherlandsEpidemiology
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HCV in The NetherlandsEpidemiology

• prevalence in the general population
• new blood donors 0.04
• estimated in general population 5-10x
• blood donors 1984-1990 lt0.2
• general population (low risk profile) 0.1
• general population (extrapolated) lt0.4

HCV observed in random population 0.3-0.4
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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

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HCV in The NetherlandsEpidemiology

• prevalence, other groups
• ivd users (75 ) 12000
• allochtonous (1 - 2.5 ) lt25000
• 0.2 of general population

• hospital infection, needle stick,
  transplantation, dentist
• household, perinatal, sexual, tattoo/piercing

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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 lt0.1 0.4

60 000 people, where are they ?
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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

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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

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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

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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

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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 allochtonous descent

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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

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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
• hair dressers
• chiropodists
• acupuncturists
• piercing / tattoo practitioners
• ritual practitioners

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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

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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

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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 (IFNriba) 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

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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

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Health Strategy on HCVinThe Netherlands
VHPB meeting May 2002
van Hattum end