1. MDL UMC utrecht Health Strategy on HCV in The Netherlands van Hattum VHPB meeting May 2002

2. MDL UMC utrecht Health Strategy on HCV in The Netherlands epidemiology observations recommendations VHPB meeting May 2002

3. MDL UMC utrecht HCV in The Netherlands Epidemiology

4. MDL UMC 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 %

5. MDL UMC 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

6. MDL UMC 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

7. MDL UMC utrecht HCV in The Netherlands Epidemiology prevalence General population HCV observed in “random” population: 0.3-0.4 % Risk groups recipients of blood products0.1 % ivd users0.08 % allochtonous0.15 % risky behaviour <0.1 % + 0.4 % ~ 60 000 people, where are they ?

8. MDL UMC utrecht 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

9. MDL UMC utrecht 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

10. MDL UMC 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

11. MDL UMC 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 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

12. MDL UMC utrecht 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

13. 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

14. MDL UMC utrecht 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

15. MDL UMC utrecht 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

16. MDL UMC 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 measures providing information to clients / patients diagnosing new patients providing treatment current situation 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 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

17. MDL UMC 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 measures providing information to clients / patients diagnosing new patients providing treatment special treatment programs of risk groups 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 NLmost drug addicts are registered in programs everybody has a (mandatory) health insurance HC treatment (IFN+riba) is available and refundable 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 NLmost drug addicts are registered in programs everybody has a (mandatory) health insurance HC treatment (IFN+riba) is available and refundable

18. MDL UMC 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

19. MDL UMC utrecht Health Strategy on HCV in The Netherlands van Hattum end VHPB meeting May 2002