Hepatitis B and C in injecting drug users in Europe - Teodora Groshkova, Dagmar Hedrich, Luigi Nisini, Alessandra Bo & Lucas Wiessing, EMCDDA ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Hepatitis B and C in injecting drug users in Europe Teodora Groshkova, Dagmar Hedrich, Luigi Nisini, Alessandra Bo & Lucas Wiessing, EMCDDA INHSU, 2nd International Symposium on Hepatitis Care in Substance Users, 16 September 2011
• The authors of this presentation declare no interests with potential for conflict.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) • Decentralised EU agency, 27 EU countries + 3 non-EU • Mission: “To provide factual, objective, reliable and comparable information concerning drugs and drug addiction and their consequences” • Network of national focal points and expert groups, annual reporting by EU Member States to EMCDDA • One key area is the monitoring of viral hepatitis infections and their control in injecting drug users • EMCDDA Annual Report and Statistical Bulletin: http://emcdda.europa.eu/
Main messages • Injecting drug users (IDUs) constitute a large (>40%) proportion of the notified cases of hepatitis C (and B) where risk factor information is available • Prevalence of serological markers is very high in this group, across Europe • Coverage of harm reduction interventions has substantially increased, but remains variable between countries • Prison is a high priority setting for responses development
% IDUs among HCV and HBV notifications with
% IDUs among HCV and HBV notifications with known risk
known risk factorfactor
information, EU 2004-09
information, EU 2004-2009
100%
80%
60% 62.7
40% 37.6
25.9
20%
%
HCV Acute & HCV Acute HBV Acute
Chronic
Average (larger bar) and median are shown, data from 19 countries (HCV), 16 countries (HBV)Hepatitis notifications: strengths and limitations
• Hepatitis B/C notifications data are unreliable (70-80% of acute
cases are asymptomatic; under-reporting can be 50-98%) (Hagan
et al., 2002; Hansen et al., 2008)
• Absolute numbers and rates are considerable underestimates
and should not be used to compare prevalence
• Proportion of IDUs among cases with known risk may be a more
reliable indicator
• Caution as can still depend on differential screening practices,
although in acute cases perhaps less soHepatitis C virus antibodies prevalence among injecting drug users in
Europe, 2008-2009 or most recent data available
0 < 40%
40 < 60%
≥ 60%
unknown
Source: EMCDDA and Reitox National Focal Points (EU); IHRA, EHRN and WHO/Europe (other countries)
Colour indicates midpoint of national data, or if not available, of local data.HCV antibody prevalence among injecting drug users –
studies with national and subnational coverage 2008-2009
100%
National Subnational
75%
50%
25%
%
Malta
Slovakia
Italy
Hungary
Norway
Slovenia
Austria
Greece
UK
Cyprus
Denmark
Netherlands
Croatia
Bulgaria
Portugal
Sweden
Romania
Czech R.
BelgiumHCV prevalence in samples of young injecting drug users
(under age 25), national & subnational studies 2008-09
100%
National Subnational
75%
50%
25%
%
Hungary
Czech R.
Slovenia
Belgium
Cyprus
Poland
Sweden
Slovakia
Bulgaria
Portugal
Malta
Austria
UK
GreeceHCV prevalence in samples of new injecting drug users (
HBV antibody (aHBc) prevalence among IDUs – studies
with national and subnational coverage 2008-2009
100%
National Subnational
75%
50%
25%
%
Netherlands
Norway
Slovenia
Belgium
Poland
Slovakia
Malta
Austria
UK
Croatia
Italy
GreeceHBV infection (HBsAg) prevalence among IDUs – studies
with national and subnational coverage 2008-2009
20%
National Subnational
15%
10%
5%
%
Hungary
Netherlands
Norway
Belgium
Cyprus
Romania
Poland
Bulgaria
Portugal
Croatia
GreecePrevalence data: strengths and limitations • Denominator is IDU population, not the general population, different interpretation • Diagnostic testing data may underestimate prevalence (but indicator of incidence/trends) • Prevalence among young and new injectors relatively robust indicator of incidence among IDUs
Prevention and care
• Hepatitis C more infectious than HIV. Need higher coverage /
intensity of: oral substitution treatment (OST), needle & syringe
provision, information, voluntary counselling & testing etc.
• Interventions using multiple combined approaches and
strategies are likely more effective than individual approaches
(Pollack and Heimer, EMCDDA 2004; Hagan, Pouget, and Des Jarlais, 2011)
• Evaluate antiviral treatment as a prevention tool (e.g.
modelling and ecological studies for HIV)
• Targeted vaccination for HBV in IDUs, and in general population
• Review drug policies where they conflict with public health, e.g.
cooperation between low-threshold services and police
• Educate medical staff on how to work with drug users, combine
services and expertise (OST and viral treatment)Essential elements for reaching high coverage at national level
Introduction of OST and NSPs in the 27 EU Member States
25
no. countries providing
20
15
10
5
0
1965 1970 1975 1980 1985 1990 1995 2000 2005
Methadone Needle/syringe programmes, publicly fundedScaling up OST between 1993 and 2009 in EU-27
800000
700000
Clients in substitution treatment
600000
500000
EU 12
400000
EU 15
300000
200000
100000
0
1993 1995 1997/1998 2001/2002 2003 2005 2007 2008 2009Opioid maintenance treatment clients (%)
0
10
20
30
40
50
60
70
80
90
Sl
ov
ak
ia
Po
la
2009*
nd
Li
th
ua
ni
a
G
re
ec
e
*or most recent year available
C
yp
ru
s
H
un
ga
r y
C
ze
ch
R
ep
Th .
e
N
et
he
rl a
nd
s
Fi
nl
an
d
Ita
ly
Ire
la
nd
Au
st
ria
G
er
m
an
y
N
or
w
ay
Lu
xe
m
bo
ur
g
M
al
ta
OST coverage among estimated opioid users, EUOST availability in prisons in the EU* (expert
rating)
Substitution/maintenance is not
available in prisons
Exists in just a few prisons
LU SE FI
NO
EE
Exists in more than a few prisons but
LV not in a majority of them
DK* LT
UK Exists in a majority of prisons (but not
IE NL PL
in nearly all of them)
BE DE
CZ
SK Exists in nearly all prisons
FR AT HU
RO
SI HR*
IT
BG
PT ES
EL TR
CY
MT
*EU, plus Croatia, Turkey and Norway% of prison population in OST, EU* 2008 *EU, plus Croatia, Turkey and Norway
Syringes distributed through specialised programmes in
the EU*, per estimated IDU per year (2004-2009)
400
350
300
Number of syringes
250
200
150
100
50
0
ta
ay
ia
a
e
n
s
y
l
ia
lic
g
ia
ga
ar
ru
ec
ki
e
ur
tv
al
at
n
w
ub
ed
a
yp
g
tu
to
La
M
bo
re
ro
or
ov
un
ep
r
Es
Sw
C
G
Po
C
N
m
Sl
H
R
xe
ch
Lu
ze
C
*EU, plus Croatia and NorwayChanges in the availability of different NSP types in the 27 Member States 2006 to 2009
EU 27 availability of NSPs at NUTS (Nomenclature of territorial units for statistics) 2 level
EU 27 geographical availability of NSPs at NUTS 3 level
Conclusions • IDUs form a large proportion of the notified hepatitis B and C cases in Europe where risk factors are known • Prevalence data show high HCV-ab (>50%) and aHBc levels (>25%) in IDUs • Prevalence data suggest high incidence in young and new IDUs • Coverage of interventions has increased, but remains variable • Better data are needed on coverage of testing and antiviral therapy
Thank you. Acknowledgements EMCDDA / Reitox national focal points and EU DRID experts
You can also read
