Experts caution against hidden hepatitis C spread

The Eurasian Harm Reduction Network (EHRN; formerly the Central and Eastern European Harm Reduction Network – CEEHRN) has warned of a hidden hepatitis C epidemic. Only between 10% and 40% of
European hepatitis C virus (HCV) carriers know about their infection, according to an EHRN report published on 1 October, World Hepatitis Awareness Day (WHAD).

The report summarises data from 17 European countries. Figures show that the level of knowledge about the infection, which may cause severe liver damage and ultimately be fatal, is low,
regardless of the country. This is partly due to lack of commitment to the issue at the national level, lack of awareness about HCV at the state and society level or lack of accessible testing,
adequate reporting and surveillance, says the EHRN. The network calls on policy-makers and health authorities to make a Europe-wide effort to ensure early diagnosis of HCV, as well as effective
measures to prevent infection and treatment for those infected.

According to Germany’s Robert Koch Institute for instance, there are nearly 50,000 reported cases of HCV in the country. Estimates, however, are 10 times higher, suggesting that up to 450,000
people might not be aware of their infection. Poland’s national health authorities know about 20,000 cases, while they believe that around 730,000 have not yet been diagnosed. In some regions
of Poland, HCV infection rates may be as high as 15%. In France, about 365,000 people may be infected, according to estimates. Some 56% of infections had been identified by 2005. The rest have
gone undiagnosed so far.

While it is true that 20% to 90% of new HCV cases are registered among past or current injecting drug users (IDUs), the general population is also affected. The prevalence of the virus varies
substantially, from 0.5% in northern Europe to 2% in Mediterranean countries. Sources of an infection with HCV include:

– tattoos or body piercings;
– sharing a toothbrush or a razor;
– blood transfusions before screening was introduced (in most countries before 1992);
– sharing equipment for injecting drugs or cocaine straws;
– medical or dental interventions in countries where equipment is not adequately sterilised;
– needle stick injuries (especially emergency services and healthcare workers).

Symptoms tend to be as non-specific as fatigue, loss of appetite, muscle and joint pains. People with chronic hepatitis C may not experience any symptoms at all. While there is no vaccine for
the C type of the infection, effective treatments are available and some people can even be cured of the disease.

HCV is around 10 times more infectious than the human immunodeficiency virus (HIV). Therefore, it requires less exposure to reach high prevalence. Worldwide, as many as 53,700 deaths annually
are directly attributable to hepatitis C, according to the World Health Organisation (WHO). But the present EHRN report suggests that – including deaths caused by liver cancer and cirrhosis
caused by HCV – hepatitis mortality may exceed 500,000 per year.

‘In the absence of sufficient awareness and testing in Europe, morbidity and mortality from HCV infections are rising and will continue to rise in the coming decades,’ said Jeffrey Lazarus of
the WHO.

EHRN estimates that ‘delays in preventing new HCV infections in the 15 western European countries of the EU alone will lead to an increase in treatment costs of an additional ?1.4 billion
annually’.

Greater commitment from policy-makers, healthcare officials and healthcare providers is needed to raise awareness of HCV and to facilitate and improve early diagnosis among the general
population, as well as among high risk groups such as injecting drug users (IDUs), says the EHRN. The organisation also calls for an improvement in diagnostic services. ‘Free-of-charge testing
is crucial to prevent further infections,’ the experts say.

In addition, different reporting systems and reporting practices in European countries make it difficult to compare data – if data is provided at all by national governments. For this reason,
the EHRN sees the need for a ‘hepatitis C case definition’ to be adopted at European level.

‘We are calling on the EU and national governments to urgently recognise hepatitis C as a major public health threat,’ said Nadine Piorkowsky, President of the European Liver Patient
Association (ELPA).

For further information, please visit:
http://www.ceehrn.org/hepatitis/

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