“In 2021 without a pandemic involved, we would have achieved the objectives.” This was confirmed by the coordinator of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE) and head of the Hepatology Section of the HU La Paz in Madrid, Javier García-Samaniego. This expert does not doubt that Spain “is one step away from achieving historic health success and relegating hepatitis C to the category of a rare disease due to its low prevalence.”
García-Samaniego has made these statements on the occasion of World Day against Viral Hepatitis and assures that Spain is, at this time, “the country in the world with the most reasons to celebrate, especially in relation to hepatitis C”. In fact, with the projection of data from 2020, prior to the outbreak of the pandemic, the Polaris Observatory (which includes experts from all over the world, including Spaniards) already considered Spain as the only country in the world that was going to meet all the objectives Elimination by 2021: 90% reduction in new infections; 65% reduction in deaths from cirrhosis and liver cancer; a diagnosis greater than 90% of cases; and the treatment of at least 80% of the people with the requirements for it.
The reasons for this optimism come, on the one hand, from the learning achieved by the diagnostic management of Covid-19 and, on the other, from the learning achieved in the #HepCityFree program, through which the commitment of local Spanish corporations to the elimination of hepatitis C, especially in the vulnerable population. Regarding the first, the AEHVE coordinator refers to the experience that is being developed in Galicia, which is being a pioneer worldwide in the diagnostic analysis of the hepatitis C virus (HCV) by pooling samples (PCR), also known as pooling, with excellent health results and considerable financial savings. “This innovation is very important because it greatly reduces the possibility of extending an opportunistic screening strategy by age, such as the one that professionals have been demanding for years,” explains Dr. García-Samaniego.
Currently, only a few autonomous communities, such as Cantabria and Andalusia, in addition to Galicia, contemplate opportunistic screening by age and also from the Spanish Society for the Study of the Liver (AEEH) its president, the professor of Medicine at the University of Seville and The hepatologist at the HU Virgen del Rocío considers that “the diagnostic reduction that pooling allows could be the way for it to be extended to more communities and the Ministry to incorporate it into its document of recommendations, which now does not contemplate screening in the general population by age, rather it limits it to risk factors”. “Spain is very close to eliminating hepatitis C. We still have around 20,000 people to treat and cure. The data from the latest seroprevalence survey of the Ministry (2018) showed a prevalence of active infection of 0.22%. We think that it is even below, close to 0.1% in the general population. So we are very close, and with one more step to diagnose the cases that remain hidden, we will achieve it ”, affirms the president of the AEEH.
Along with the screening approach in the general population, the other challenge is represented by vulnerable populations and particularly homeless people, intravenous drug users, and men who have sex with men, who are the main sources of active infection. Important steps have also been taken in this direction in recent years through the commitment and collaboration of cities with these challenges, tested in the #HepCityFree program of the AEHVE. For hepatologist Manuel Romero, president of the Spanish Association for the Study of the Liver, AEEH, and coordinator of the local #HepCityFree committee in Seville, “the key role that local communities can play in the fight to eliminate the disease has been demonstrated. hepatitis C, especially through the screening of the most vulnerable populations, a field in which Seville has become with this program an international reference city, thanks to the exemplary way in which the local administration is collaborating with the regional authorities and with the NGOs that serve these populations”.
Extending opportunistic screening by age throughout Spain, as Galicia has already begun to do, and involving cities in the active search for cases in the population that usually does not access the health system, both the AEHVE and the AEEH consider a forecast ” more than reasonable” the disappearance of this public health problem in 2024 or 2025. “It would be the epilogue that deserves the success story that is the approach to hepatitis C by the Spanish health system”, affirms Manuel Romero, and García- Samaniego agrees: “a great success as a country that unites us, once again, around our public health system, which, with its imperfections, continues to give us reasons for pride.”
Viral Hepatitis Campaign
Our country is much further away, however, from the elimination targets set by the WHO for hepatitis B, which the Polaris Observatory does not expect to be reached before 2051. Precisely to report all viral hepatitis (A, B, C and D), both the AEHVE and the AEEH have joined the campaign promoted by the National Federation of Liver Transplant Patients FNETH and the NGO Apoyo Positivo, sponsored by the Gilead and Abbvie laboratories, which will take place tomorrow, Friday, July 28. , and through which the main Spanish train stations will wake up with a welcome greeting to all travelers so that they can enjoy their holidays without forgetting to protect their health against viral hepatitis.
The campaign will remind all travelers that hepatitis is “an infection that causes inflammation of the liver, causing possible damage” and that “the most common and significant are those known as viral hepatitis: hepatitis A, B, and CYD.” In relation to hepatitis A, he will point out that “it is associated with contaminated food and water, or deficient hygiene habits and certain sexual practices”, while hepatitis B, for its part, “is easily transmitted through sexual practices by the contact with blood and can lead to chronic disease, cirrhosis and/or liver cancer. In addition, “most adults who contract hepatitis B recover completely, but if the infection becomes chronic, there is no cure.” Regarding hepatitis C, he will report that it is “an infection that is asymptomatic until damage to the liver begins to cause symptoms, such as cirrhosis and liver cancer” and that “its early detection is essential to access treatment that cures the disease.” infection”. Finally, remember that “the hepatitis D virus is a satellite virus that needs the hepatitis B virus for its replication in the body” and that “depending on how the double infection occurs, it can cause liver damage.”
Likewise, the campaign will have a special impact on prevention, highlighting the importance of maintaining “good hygiene habits, washing hands well, washing food well or avoiding areas of contact with feces or blood without a preventive physical barrier, as in some sexual practices or clinics”, and to “avoid consuming injected drugs or minimize the risks of exposure and never share consumer material or paraphernalia”. Likewise, it recommends “accessing diagnostic or rapid tests to clear up doubts”, and, in case of a positive, “treatments and possible cure to prevent new infections”, and stresses the importance of vaccination against hepatitis A and B. In relation to hepatitis D, hitherto without drugs, the promoters of the campaign emphasize that the European Medicines Agency authorized a drug in 2020, not yet funded in Spain, despite the fact that there are between 5,000 and 7,000 people with this disease.