Round table “Development of the Croatian National hepatitis strategy and Action plan” – ELPA – European Liver Patients Association

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2012-07-23 09:57

· The round table on hepatitis resulted in the formation of the work group for development of the Croatian National hepatitis strategy and Action plan, and in sending a circular letter to all Croatian GPs with recommendations for testing among their patients.
· This event was the launch of the World Hepatitis Day 2012 commemoration in Croatia 

Zagreb, Croatia, 6th July 2012. The high-level round table meeting entitled „Development of the Croatian National hepatitis strategy and Action plan“ was held in Novinarski dom in Zagreb. The gathering resulted in formation of the work group for elaboration of the Croatian National hepatitis strategy and Action plan. The organizers of the event were Croatian Association of Treated and Ill with Hepatitis „Hepatos“ and Croatian Alliance of Hepatitis Patients (SOH RH), under the auspices of the Ministry of Health of the Republic of Croatia and the WHO County office in Croatia. The participants of the round table were policy makers, health care experts, patients’ associations and international guests.

The President of CATIH Hepatos, SOH RH and the European Liver Patients’ Association (ELPA) gave the welcome speech on behalf of the organizers, followed by introductory words from prof. PhD Antoinette Kaic-Rak, head of the WHO Country office in Croatia and prof. PhD Rajko Ostojic, the Minister of Health of Croatia.In his speech, the Minister emphasized: “Hepatitis is a communicable infectious disease which will spread inexorably unless treated and prevented. All available analyses have shown that it is considerably more effective and cheaper to treat hepatitis in an early phase, than to treat infection sequelae such as cirrhosis, hepatocellurar carcinoma, liver failure and transplantation.”, warning that precisely because of these conditions we “urgently need an Action plan for fight against viral hepatitis, closely tracing the recommendations of the EU Parliament”.

The speakers were PhD. Bernard Kaic, head of the Vaccination service of the Croatian National Institute of Public Health, prof. PhD Adriana Vince, head of the Referral center for the diagnosis and treatment of viral hepatitis, PhD Irena Hrstic, head of the Internal medicine department at the General Hospital Pula and international guests – Achim Kautz, the Vice-president of ELPA and Charles Gore, the President of the World Hepatitis Alliance. The conclusions of the round table were summarized and presented by prof.PhD Nikola Bradaric, head of the Infectious diseases department at the Clinical Hospital Center Split.

Among other participants of the round table there were: representatives of the Croatian Institute for Health Insurance (HZZO), Croatian Institute of Transfusion Medicine, Croatian Government’s Office for Human Rights and Rights of the National Minorities, Croatian Prison Administration, health care experts – Key opinion leaders and the civil sector (SOH RH).

Referencing the National health care strategy which calls for a broad consensus of the profession, social partners and patients’ associations, MSc Tatjana Reic emphasized „…we would like to call for a wider collaboration between the health care sector and other areas of public action, having in mind particularly the civil sector. In addition, we consider it essential to initiate as many as possible independent discussions on health care provided to patients suffering from viral hepatitis“, concluding that “By all means, we always need more evidence and data, but when we have enough existing knowledge, it is our duty to act and take a lead.”

Chronic viral hepatitis is a worldwide public health problem and the leading cause of chronic liver diseases.  If left untreated, chronic viral hepatitis can lead to liver cirrhosis and primary liver cancer (HCC), one of several cancers with rising incidence. Perhaps one of the most important causes of this rising HCC incidence lies in the fact that 50-80 % of HCC cases are direct consequences of untreated viral hepatitis B and/or C. As much as 80 % of a total of 23 million infected Europeans do not know of their chronic infection with hepatitis and therefore do not have an opportunity to get treated, cured or keep their illness under control.

According to WHO estimates, around 2 billion people have been in contact with the hepatitis B virus, around 400 million people are chronic carriers of the hepatitis B virus and about a million people die from its consequences every year. Furthermore, around 150-170 million people have chronic hepatitis C, which is probably much less than the real number. It is eatimated that as much as 8 out o 10 carriers of the hepatitis C virus are unaware of their infection and therefore spread the virus uncontrollably and unconsciously. Precisely for this reason the number of new HCV infections climbs to 3 – 4 millions per year. It is estimated that 80-100 000 Croatian citizens are carriers of chronic viral hepatitis B or C. The cited epidemiological data confirm and prove that viral hepatitis is the key public health problem in Croatia, in Europe and in the world today. For this reason, the World Health Organization and the European Parliament strongly support development and implementation of national strategies for fight against viral hepatitis. This round table resulted in formation of the work group for development and elaboration of the Croatian National hepatitis strategy and Action plan.

Although the official epidemiological data from the Croatian National Institute of Public Health (HZJZ) mention a prevalence in Croatia of less than 0,5%, not all carriers have been detected. Certain groups of citizens are at increased risk of hepatitis B and C infection which makes prevalence in risk groups considerably higher than in the general population. Furthermore, the data from the HZJZ mention 150 – 200 new cases of HCC per year with an increasing tendency. It is therefore crucial that the surveillance of the risk groups be increased in order to detect and treat as many chronic patients as possible. This not only prevents the onset of untreated infection’s sequelae (such as HCC), but also prevents further spreading of the infection. Besides improved care for the health of the individuals, this initiative will bring considerable long-term savings to the Croatian health care system.

This kind of increased surveillance of viral hepatitis can best be implemented by inclusion of all general practitioners. As a result, the gathered professionals at the round table have sent the following reccommendation to Croatian general practitioners:

Unless already done, send to serological testing (viral hepatitis markers) all your patients from the risk groups including:

· Past and current illicit drug users, focusing primarily on intravenous users;· All people who had received blood transfusion or blood products prior to 1993;· People with risky sexual behaviour (promiscuous people regardless of their sexual orientation);· People who seek medical attention because of sexually transmitted diseases;· People whose partners are suffering from viral hepatitis;· People on hemodialysis;· HIV positive people;· Imprisoned people (current and past inmates),· Children whose parents have chronic viral hepatitis;· People who have undergone invasive cosmetic treatments (tattoo and piercing) in an uncontrolled environment;· People in need of imunosuppressive therapy, including chemotherapy, imunosuppression linked to organ transplantation and imunosuppressive therapy for rheumatic and gastroenterological diseases;· Veterans of the Croatian War for independence

· All people with clinical and/or laboratory signs of liver damage (especially a pathological ALT)

This round table is a continuation of the 2008 round table “Initiation of development of the Croatian National strategy for fight against viral hepatitis” which resulted in a consensus between the health care sector and the civil sector on need for elaboration and implementation of the National hepatitis strategy and the Resolution on fight against viral hepatitis which has been adopted by the Croatian Parliament in 2009.

This event has also officially launched this year’s World Hepatitis Day (WHD 2012) commemoration. The WHD is officially marked on 28th July every year and as many as 280 patient associations from 75 countries take part in it worldwide (under the umbrella of the World Hepatitis Alliance). Hepatos, as the leading association of the Croatian Alliance of Hepatitis Patients and the only Croatian member of ELPA, will mark WHD 2012 with a series of activities aimed at prevention of spreading of hepatitis B and C. The central action will take place on the beach Zrće on 28th July, with free and anonimous testing for hepatitis.

·    The round table on hepatitis resulted in formation of the work group for developmet of the Croatian National hepatitis strategy and Action plan and in sending a circular letter to all Croatian GPs with recommendations for testing among their patients.·    This event was the launch of the World Hepatitis Day 2012 commemoration in Croatia  Zagreb, 6th July 2012 – The high-level round table meeting entitled „Development of the Croatian National hepatitis strategy and Action plan“ was held in Novinarski dom in Zagreb. The gathering resulted in formation of the work group for elaboration of the Croatian National hepatitis strategy and Action plan. The organizers of the event were Croatian Association of Treated and Ill with Hepatitis „Hepatos“ and Croatian Alliance of Hepatitis Patients (SOH RH), under the auspices of the Ministry of Health of the Republic of Croatia and the WHO County office in Croatia. The participants of the round table were policy makers, health care experts, patients’ associations and international guests. The President of CATIH Hepatos, SOH RH and the European Liver Patients’ Association (ELPA) gave the welcome speech on behalf of the organizers, followed by introductory words from prof. PhD Antoinette Kaic-Rak, head of the WHO Country office in Croatia and prof. PhD Rajko Ostojic, the Minister of Health of Croatia.In his speech, the Minister emphasized: “Hepatitis is a communicable infectious disease which will spread inexorably unless treated and prevented. All available analyses have shown that it is considerably more effective and cheaper to treat hepatitis in an early phase, than to treat infection sequelae such as cirrhosis, hepatocellurar carcinoma, liver failure and transplantation.”, warning that precisely because of these conditions we “urgently need an Action plan for fight against viral hepatitis, closely tracing the recommendations of the EU Parliament”. The speakers were PhD. Bernard Kaic, head of the Vaccination service of the Croatian National Institute of Public Health, prof. PhD Adriana Vince, head of the Referral center for the diagnosis and treatment of viral hepatitis, PhD Irena Hrstic, head of the Internal medicine department at the General Hospital Pula and international guests- Achim Kautz, the Vice-president of ELPA and Charles Gore, the President of the World Hepatitis Alliance. The conclusions of the round table were summarized and presented by prof.PhD Nikola Bradaric, head of the Infectious diseases department at the Clinical Hospital Center Split.Among other participants of the round table there were: representatives of the Croatian Institute for Health Insurance (HZZO), Croatian Institute of Transfusion Medicine, Croatian Government’s Office for Human Rights and Rights of the National Minorities, Croatian Prison Administration, health care experts – Key opinion leaders and the civil sector (SOH RH).Referencing the National health care strategy which calls for a broad consensus of the profession, social partners and patients’ associations, MSc Tatjana Reic emphasized „…we would like to call for a wider collaboration between the health care sector and other areas of public action, having in mind particularly the civil sector. In addition, we consider it essential to initiate as many as possible independent discussions on health care provided to patients suffering from viral hepatitis“, concluding that “By all means, we always need more evidence and data, but when we have enough existing knowledge, it is our duty to act and take a lead.”Chronic viral hepatitis is a worldwide public health problem and the leading cause of chronic liver diseases.  If left untreated, chronic viral hepatitis can lead to liver cirrhosis and primary liver cancer (HCC), one of several cancers with rising incidence. Perhaps one of the most important causes of this rising HCC incidence lies in the fact that 50-80 % of HCC cases are direct consequences of untreated viral hepatitis B and/or C. As much as 80% of a total of 23 million infected Europeans do not know of their chronic infection with hepatitis and therefore do not have an opportunity to get treated, cured or keep their illness under control.According to WHO estimates, around 2 billion people have been in contact with the hepatitis B virus, around 400 million people are chronic carriers of the hepatitis B virus and about a million people die from its consequences every year. Furthermore, around 150-170 million people have chronic hepatitis C, which is probably much less than the real number. It is eatimated that as much as 8 out o 10 carriers of the hepatitis C virus are unaware of their infection and therefore spread the virus uncontrollably and unconsciously. Precisely for this reason the number of new HCV infections climbs to 3 – 4 millions per year. It is estimated that 80-100 000 Croatian citizens are carriers of chronic viral hepatitis B or C. The cited epidemiological data confirm and prove that viral hepatitis is the key public health problem in Croatia, in Europe and in the world today. For this reason, the World Health Organization and the European Parliament strongly support development and implementation of national strategies for fight against viral hepatitis. This round table resulted in formation of the work group for development and elaboration of the Croatian National hepatitis strategy and Action plan.Although the official epidemiological data from the Croatian National Institute of Public Health (HZJZ) mention a prevalence in Croatia of less than 0,5%, not all carriers have been detected. Certain groups of citizens are at increased risk of hepatitis B and C infection which makes prevalence in risk groups considerably higher than in the general population. Furthermore, the data from the HZJZ mention 150 – 200 new cases of HCC per year with an increasing tendency. It is therefore crucial that the surveillance of the risk groups be increased in order to detect and treat as many chronic patients as possible. This not only prevents the onset of untreated infection’s sequelae (such as HCC), but also prevents further spreading of the infection. Besides improved care for the health of the individuals, this initiative will bring considerable long-term savings to the Croatian health care system.This kind of increased surveillance of viral hepatitis can best be implemented by inclusion of all general practitioners. As a result, the gathered professionals at the round table have sent the following reccommendation to Croatian general practitioners:Unless already done, send to serological testing (viral hepatitis markers) all your patients from the risk groups including:·         Past and current illicit drug users, focusing primarily on intravenous users;·         All people who had received blood transfusion or blood products prior to 1993;·         People with risky sexual behaviour (promiscuous people regardless of their sexual orientation);·         People who seek medical attention because of sexually transmitted diseases;·         People whose partners are suffering from viral hepatitis;·         People on hemodialysis;·         HIV positive people;·         Imprisoned people (current and past inmates),·         Children whose parents have chronic viral hepatitis;·         People who have undergone invasive cosmetic treatments ( tattoo and piercing) in an uncontrolled environment;·         Poeople in need of imunosuppressive therapy, including chemotherapy, imunosuppression linked to organ transplantation and imunosuppressive therapy for rheumatic and gastroenterological diseases;·         Veterans of the Croatian War for independence ·         All people with clinical and/or laboratory signs of liver damage (especially a pathological ALT) This round table is a continuation of the 2008 round table “Initiation of development of the Croatian National strategy for fight against viral hepatitis” which resulted in a consensus between the health care sector and the civil sector on need for elaboration and implementation of the National hepatitis strategy and the Resolution on fight against viral hepatitis which has been adopted by the Croatian Parliament in 2009. This event has also officially launched this year’s World Hepatitis Day (WHD 2012) commemoration. The WHD is officially marked on 28th July every year and as many as 280 patient associations from 75 countries take part in it worldwide (under the umbrella of the World Hepatitis Alliance). Hepatos, as the leading association of the Croatian Alliance of Hepatitis Patients and the only Croatian member of ELPA, will mark WHD 2012 with a series of activities aimed at prevention of spreading of hepatitis B and C. The central action will take place on the beach Zrće on 28th July, with free and anonimous testing for hepatitis.