In the past two years, the new crown has gradually become the protagonist of the prevention and control of infectious diseases, but other infectious diseases cannot be ignored because of this.
In China, hepatitis C has maintained an annual increase of about 200,000 cases in recent years, and many infected people have been pushed to the fate of liver cirrhosis and liver cancer.
In order to stop the spread of hepatitis C, a "elimination of hepatitis C" campaign jointly formulated by nine ministries and commissions is underway.
On September 15, 9 ministries and commissions including the National Health Commission jointly issued the "Work Plan for the Elimination of Hepatitis C Public Health Hazards (2021-2030)" (hereinafter referred to as the "Work Plan"), requiring the full implementation of national hepatitis C prevention and control measures and guarantees Measures to minimize new infections, effectively discover and cure patients, significantly reduce liver cancer and liver cirrhosis deaths caused by hepatitis C, and put forward specific action targets for 2021, 2025, and 2030.
The dangers of hepatitis C
Hepatitis C, a chronic disease caused by hepatitis C virus (HCV) infection, continues to progress and can develop into liver cirrhosis and liver cancer.
Hepatitis C is a blood-borne disease. Its transmission routes include transmission through blood transfusion and blood products, transmission through damaged skin and mucous membranes, transmission through sexual contact, and mother-to-child transmission.
According to the data of the National Research Report on Hepatitis C Infection Status and Prevention Countermeasures in 2018, the prevalence rate of anti-hepatitis C virus (HCV) in the general population in China is 0.6%, and there are about 10 million people infected with HCV in the country. Very few people have been discovered, and many have reached the stage of liver cirrhosis and liver cancer when they were discovered.
Hepatitis C has always been called a silent killer.
Shen Yingsheng, secretary of the China United Liver Health Promotion Center, explained to a reporter from China Business News that after a person is infected with hepatitis C virus, they usually have no obvious symptoms and signs, and they will not feel any discomfort in the early stage. Once they have symptoms, the disease will develop. To the stage of advanced liver cirrhosis and liver cancer.
According to survey data in 2014, 70% of hepatitis C patients received anti-HCV testing only after showing obvious symptoms.
"Although the country issued HCV infection screening and management standards in 2014, the active screening and consultation rate for hepatitis C in China is still very low, and treatment has been delayed. Many patients have developed liver fibrosis when they were first screened and diagnosed. , Liver cirrhosis, and even liver cancer.” said Jiang Rongmeng, chief physician of the infection center of Beijing Ditan Hospital affiliated to Capital Medical University.
People with hepatitis C infection can be treated even more.
According to speculation, patients with chronic hepatitis C currently receiving treatment account for less than 1.3% of the total infected population.
Most people infected with HCV are not aware of their condition and have not received corresponding treatment, and even effective drugs are not available in some places. This shows that the HCV prevention and control task is difficult.
In those patients with hepatitis C who have not been detected and treated, the infection factors in the body persist, leading to the continued occurrence of new infections, and the reported incidence of hepatitis C in China continues to rise.
The National Health and Medical Commission’s “Overview of National Epidemics of Notified Infectious Diseases” over the years shows that the number of hepatitis C cases has risen from 21,000 in 2003 to 201,600 in 2012. Since then, the annual number of cases of hepatitis C has exceeded 200,000.
Looking for
infected people
"Hepatitis C is an infectious disease that can be cured. The current problem is proactive discovery and insufficient treatment. After finding all the infected and conducting standardized treatment and management, hepatitis C can be eliminated." Shen Yingsheng believes.
As a kind of hepatitis C with drugs that can achieve a cure rate of more than 95%, compared with other infectious diseases, the prevention and control of hepatitis C has a unique advantage in elimination. The most critical part of its elimination is to find these infected persons.
Jiang Rongmeng believes that proactive discovery is relatively weak during the prevention and treatment of hepatitis C.
The first is that people infected with HCV are not aware of their condition and have not received corresponding treatment.
Secondly, medical staff in the non-infectious department in medical institutions have a lack of awareness of hepatitis C, resulting in the failure to make early diagnosis of hepatitis C patients. Moreover, due to the lack of professional training for hepatitis C care and treatment, even for patients Once the diagnosis is made, standard treatment cannot be carried out.
Shen Yingsheng said that at present, doctors in the non-infectious department of medical institutions will screen for HCV during surgery and endoscopy. In theory, patients with positive HCV antibodies should be recommended to go to the infection department for further hepatitis C virus nucleic acid testing. To determine whether treatment is needed.
However, due to the lack of awareness of some medical staff about hepatitis C, some people infected with hepatitis C virus were missed.
In addition, many people with hepatitis C live in towns or villages. Some township hospitals have limited testing capabilities. In addition, people with hepatitis C infection have the habit of not seeking medical attention without symptoms. This has caused many patients with hepatitis C to lose their livers and missed them. The best treatment period.
In order to find people infected with hepatitis C virus, the "Work Plan" has formulated a related screening action plan to increase testing efforts and increase the detection rate.
The "Work Plan" requires that medical institutions implement the "all inspections" strategy. For people who are prepared to undergo surgery, blood transfusion, endoscopy, hemodialysis, and other special or invasive medical procedures, and those with unexplained abnormal liver biochemical tests, intravenous drugs People at high risk of hepatitis C virus infection, such as those with a history of addiction, former paid plasma donors, multiple sexual partners, or men who have sex with men, should carry out hepatitis C antibody testing in a timely manner.
Secondly, implement the strategy of “should check and do everything” for key populations.
According to the principle of informed voluntariness, medical and health institutions conduct hepatitis C antibody testing for drug maintenance treatment personnel, AIDS voluntary counseling and testing outpatients, HIV-infected persons and their spouses or sexual partners, and hepatitis C antibody tests for spouses or sexual partners of hepatitis C patients.
For the masses, the strategy of "willing to do all inspections" is implemented.
It is recommended that medical and health institutions explore to mobilize people over the age of 40 for testing, and encourage the inclusion of hepatitis C antibody testing in health check-ups and pre-marital medical examinations.
Implement the strategy of “full coverage of nucleic acid testing” for antibody-positive persons.
Medical and health institutions shall promptly carry out nucleic acid testing for those who are found to be antibody-positive. Those who do not have the conditions for nucleic acid testing shall promptly refer antibody-positive individuals to designated medical institutions.
Jiang Rongmeng believes that active screening is the main way to discover hepatitis C patients. In addition to the thorough examination of key populations, how to implement active screening for other populations will become the key.
In the "Work Plan", the implementation of "key populations" will be fully checked. However, compared with key populations, the risk population of hepatitis C is wider.
On July 13, Zhuang Hui, an academician of the Chinese Academy of Engineering and an epidemiologist, pointed out ten high-risk groups when interpreting the "Guidelines for Prevention and Treatment of Hepatitis C": The first is the people who have blood transfusions and use blood products, especially before 1993 People who have had blood transfusion or used blood products; the second is the history of paid blood donation; the third is the history of intravenous drug injection; the fourth is the history of acupuncture caused by other reasons, such as tattoos, piercings, acupuncture, etc.; The fifth is the history of iatrogenic exposure, including surgery, hemodialysis, oral diagnosis and treatment operations, and organ or tissue transplantation; the sixth is a history of high-risk sexual behavior, such as multiple sexual partners, male-to-male behavior; the seventh is hepatitis C virus Sexual partners and family members of infected persons; eighth are children born to mothers infected with hepatitis C virus; ninth are those with damaged skin or facial mask that have been in contact with the blood of persons infected with hepatitis C virus; and tenth are those with unexplained elevated serum transaminases.
According
to the
"Research Report on Current Status of Hepatitis C in China and Prevention and Treatment Countermeasures"
compiled by Wei Lai,
director of the Hepatobiliary and Pancreatic Center of Beijing Tsinghua Chang Gung Memorial Hospital affiliated to Tsinghua University
, the data shows that the anti-HCV positive rate of drug users is 48.67%, and that of intravenous drug subgroups The positive rate of anti-HCV was 80.00%.
The anti-HCV positive rate of hemodialysis population was 6.59%.
The anti-HCV positive rate of gay men was 0.84%.
Actively discovering potential hepatitis C virus infections will be the first step in eliminating hepatitis C.
Curable drugs
If hepatitis C is not properly treated and controlled in time, some patients may develop end-stage liver diseases such as cirrhosis and liver cancer. Compared with uninfected people, the corresponding medical and health expenditure will increase significantly.
According to the data from the “Research Report on the Current Status of Hepatitis C in China and Countermeasures for Prevention and Treatment”, if patients with hepatitis C do not receive appropriate treatment measures, according to the prediction model for the occurrence of cirrhosis and liver cancer in patients with chronic hepatitis C infection, it is expected that in the next 15 years, China’s liver cirrhosis and The number of liver cancer cases will reach 420,000 and 254,000 respectively, and the direct hospitalization costs for the treatment of liver cirrhosis and liver cancer will be as high as US$589 million and US$611 million.
Is there no cure?
But in fact, it's not.
Drugs for the treatment of hepatitis C have been marketed and entered the scope of medical insurance, with a cure rate of more than 95%.
Under such circumstances, why is there such a state of threatening life and health and causing a heavy economic burden?
Jiang Rongmeng said that according to statistics, the current diagnosis rate of hepatitis C in my country is less than 20%, and only 7% to 8% of confirmed patients receive regular treatment. Many patients do not know they have been infected with hepatitis C and progress to advanced liver disease leading to death.
Therefore, hepatitis C is often referred to as the "silent killer."
Behind the silent killer is a lack of cognition.
According to the 2012 Hepatitis Public Awareness Online Survey sponsored by the Wu Jieping Foundation, only 14% of respondents have a correct understanding of hepatitis C; most of the respondents do not distinguish between "hepatitis B" and "hepatitis C"; they think hepatitis C can be vaccinated Prevention; believes that daily contact can spread; believes that hepatitis C is incurable.
In fact, hepatitis C does not have accessibility issues from testing, diagnosis, or even treatment.
Pan-genotype cetonesha drugs have the characteristics of full treatment, simple detection, simple treatment, and high sustained virological response rate.
In patients with hepatitis C with different characteristics, the plan is unified, and the interaction of drugs is small, which can effectively reduce the detection before treatment and the detection during treatment. It is suitable for the treatment, implementation and management of chronic hepatitis C in hospitals at all levels.
"Although Bingtongsa has entered the medical insurance catalog, some hospitals have not purchased it. Secondly, due to the problem of outpatient control fees, there will be certain restrictions on outpatient clinics for three courses of Bingtongsa, which cost about 10,000. "Shen Yingsheng said.
However, in this "Work Plan", it is required that "the total amount of medical insurance control, the limit on the number of drugs used by medical institutions, and the proportion of drugs in medical institutions should not be used to affect the allocation and use of antiviral drugs for hepatitis C, and should not be used as the performance of medical institutions. Assessment indicators."
It is understood that there are many hepatitis C drugs currently entering the medical insurance catalogue or medical insurance negotiation, but only Bingtongsha can target the whole genotype of hepatitis C virus.
"The cost of treatment for Bingtongsha is relatively high, but after the medical insurance is reimbursed, the individual can also afford it. A course of treatment can be cured with a few thousand yuan. However, other drugs can also be used, but genetic testing is required before the drug can be used." The infection clinician said.
In order to allow standardized treatment of hepatitis C and increase treatment coverage and cure rate, the "Work Plan" proposes to establish a fixed-point medical service model and mobilize patients to "cure everything."
Author: Ma Xiaohua