Fighting hepatitis is a complex matter. Previous national measures focused on preventing infections among high-risk groups such as drug users and on vaccination. Other European countries, such as France and Scotland, have had a national strategy in place for years, showing promising results. Switzerland also needs to coordinate its efforts across the country, if it wants to minimise the consequences of hepatitis and prevent new infections.
A hepatitis strategy is needed because:
- awareness of chronic viral hepatitis is low in Switzerland,
- less than half of the people infected have been tested,
- only a fraction of the patients receive treatment and often not until very late,
- hepatitis C and B can have severe consequences if left untreated, such as liver failure and liver cancer,
- hepatitis C is the predominant reason for liver cancer and liver transplants,
- cases of liver cancer and liver cirrhosis caused by hepatitis have been on the rise and the number of cases is expected to increase further,
- a coordinated course of action across the country is needed to test, diagnose and treat patients in order to reduce the severe secondary diseases and associated costs.
Chronic hepatitis is a pressing public health problem and should be treated as such, in Switzerland too.
Hepatitis C is the most common reason for liver transplants. Cases of liver cancer and liver failure as a consequence of viral hepatitis have increased in the last few years and will increase further unless comprehensive measures to fight the epidemic are put in place quickly. At the same time, awareness of the consequences of hepatitis in Switzerland is low compared to other countries. Switzerland ranked 12th in the Euro Hepatitis Care Index, and when it came to tests only 17th, behind Poland and Portugal and before Romania and Lithuania. (See Euro Hepatitis Care Index 2012, PDF)
The paradox of today’s situation is that there are effective medicines available with only few side effects, which are easy to take, offer a short course of treatment and promise very high success rates. But because of their high costs of 40’000 to 120’000 Swiss francs per treatment, only patients with moderate liver damage or diagnosed cirrhosis (stages F2, F3 and F4) are covered by the general health insurance.
However, postponing treatment could lead to more deaths and infections. A study conducted by the universities of Zurich and Berne has found that the longer treatment is postponed, the higher the risk of liver failure, liver cancer and death. It also shows that the death rate could be reduced from 10 to 5 per cent if treatment could start sooner. It would also benefit the prevention of new infections. According to the study, patients would, on average, be contagious for five years as opposed to fifteen.
But even if the medicines were made available to everyone, the majority of people infected are not aware of their infection. A Swiss hepatitis strategy will coordinate the activities among all parties involved in hepatitis and allow for specific measures that will benefit anyone who is affected and lead to public health benefits.
Prevalence: Approx. 1.5 per cent of the Swiss population is infected with the hepatitis C virus
Hepatitis B: 40'000 people affected
Hepatitis C: 40'000 people affected
New diagnoses per year: 1’200 (HBV) and 1’500 (HCV) chronic cases are diagnosed each year. There are no reliable figures for new infections.
Most common ways of transmission are: intravenous drug use (still represents the majority of new infections, but with a continuing downward trend), blood transfusions (before blood could be tested for hepatitis C, that is before 1990. Infections via blood transfusions today are extremely rare) and sexual intercourse (sexually transmitted infections are on the rise among the newly infected, especially among men who have sex with men (MSM)).
Treatments: In 2017 approximately 3’000 hepatitis C treatments were performed.