'A major challenge to public health', warns EU drugs agency

Hepatitis C — the 'hidden epidemic'

‘A hidden epidemic’ and ‘a major challenge to public health’ – this is how the EU drugs agency, the Lisbon-based EMCDDA, describes hepatitis C in the latest edition of its Drugs in focus series, out today.

The agency says that over the past few years hepatitis C has emerged as a major threat to public health worldwide. Within the EU the total number of infected people is unknown but ‘probably over one million and possibly up to several millions’.

Agency chief Georges Estievenart says it’s a threat European policy-makers can’t afford to ignore. ‘The implications of inaction for EU public health budgets are likely to be considerable. It is better to provide screening, prevention education and treatment now than to let the disease spread and to wait until sufferers become chronically ill. In this field the principle of precaution is a “must”.’

Entitled Hepatitis C: A hidden epidemic. A major challenge to public health, today’s document aims to focus the attention of EU policy-makers on the key issues surrounding this challenging area of European public health.

On a positive note, the agency records that, since the introduction of screening of blood and blood products for hepatitis C, transmission of the virus has been ‘dramatically reduced’. Injecting drug users are now the group at greatest risk of infection, accounting for up to 60-90% of new infections.

It declares: ‘Health-promotion activities are needed to discourage people from injecting drugs or to change their behaviour to reduce the risk of contracting the virus if they are unable to stop. Hepatitis C is a highly infectious and potentially fatal disease that attacks the liver. Yet people who have contracted the virus often remain symptom-free for many years and most cases are undiagnosed. Public and professional awareness of the disease needs to be raised to encourage people at risk to come forward for testing and referral for treatment where it is appropriate.’

In a reference to the drugs challenge posed by imminent EU enlargement, the agency states: ‘Young and new injectors are at high risk of contracting hepatitis C shortly after they begin injecting. Wherever injecting drug use is likely to increase, such as some of the new EU Member States, new epidemics of hepatitis C are likely to emerge.’

The key issues

So, what are the key issues for EU policy-makers to focus on in attempting to tackle this major public health threat?

Marcel Reimen, Chairman of the EMCDDA Management Board, stated: ‘The key to effective prevention is to reduce the number of people who start to inject drugs and to influence the behaviour of young and new injectors. To achieve this we need to raise awareness of hepatitis C amongst professionals, drug users and the wider public.’

More formally, the briefing document lists the policy priorities thus:

  1. It is important that policy-makers acknowledge the future impact of hepatitis C infection and place prevention and treatment of the disease high on the policy agenda.

  2. All EU States face escalating costs due to the hidden HCV epidemic. Each year of delay in preventing new HCV infections in the EU may lead to an increase in treatment costs of an additional 1.4 billion euros.

  3. The risk of transmission of HCV can be reduced through measures to alter high-risk behaviour such as sharing needles and other injecting equipment, as well as through action to reduce injecting drug use.

  4. There is a short window of opportunity for prevention with young and new injectors. It is vital that interventions are targeted at this group, and at new populations where drug injecting may be spreading, including in the new member states.

  5. Improved screening and monitoring systems for hepatitis C infection would help ensure that people needing treatment for HCV are identified early. They would also enable both trends in HCV infection and the effectiveness of preventative strategies to be monitored.

  6. There is a need to review treatment guidelines for hepatitis C and to develop strategies for interdisciplinary cooperation between hepatologists and addiction specialists to include drug users in treatment.

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