1 / 27

The Swiss Population In 2001

The Swiss Population In 2001. Resident population: 7,258,500 Population density: 176 per Km 2 Foreign nationals: 20.1% (~1,460,000) Excess of births over deaths: 13,000 per year [Immigration] – [emigration] = +41,500 per year. Registered Medical Laboratories. Cross-checking for duplicates.

aldis
Download Presentation

The Swiss Population In 2001

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Swiss Population In 2001 • Resident population: 7,258,500 • Population density: 176 per Km2 • Foreign nationals: 20.1% (~1,460,000) • Excess of births over deaths: 13,000 per year • [Immigration] – [emigration] = +41,500 per year

  2. Registered Medical Laboratories Cross-checking for duplicates Reporting of positive anti-HCV and HCV RNA tests (mandatory since 1988) Swiss Federal Office of Public Health (OFSP) Identification from test reporting Further clinical and epidemiological data Primary Care Physicians

  3. HCV infection in Switzerlandbased on a mandatory reporting systm • Total number of declarations received at OFSP: • all patients = 24,068 (~2,500 per year) • acute hepatitis C = ~600 (~60 per year) • Estimated prevalence (general population, based on a survey on pregnant women): • 0.7-1% (50,000-70,000) • Estimated incidence: 5 - 15 new cases per 100,000 per year, mostly (70%) due to IVDU OFSP, 2001

  4. Acute Hepatitis C Declarations Classes of Age

  5. Acute Hepatitis C in SwitzerlandRisk Factors • Intravenous drug use: 68.2% • Blood transfusion: 6.8% • Health care workers : 2.8% • Sexual contact: 2.8% • Contact with anti-HCV+ patients: 1.9% • Unknown: 15.7%

  6. All Declarations, Classes of Age

  7. The HCV Epidemics in Switzerland:Population-based Studies

  8. Indications to Screening for HCV - 1Swiss Recommendations (OFSP, 2001) • According to official estimates, about 50% of infected patients have been declared to Federal Authorities • Mandatory reporting often concerns diagnoses made well before the declaration • It is likely that more then half of HCV infected patients already know about their own status

  9. Indications to Screening for HCV - 2Swiss Recommendations (OFSP, 2001) • A general screening policy would be expensive, of limited usefulness, and out of proportion with respect to the expected results Bull OFSP, 2001;46:877

  10. Indications to Screening for HCV - 3Swiss Recommendations (OFSP, 2001) • Present or former IVDU • Individuals transfused with blood before 1992 or with blood derivatives before 1987 • Patients under dialysis • Children born to HCV-positive mothers • HCW after accidental exposure to blood • Patients with elevated transaminases

  11. The HCV Epidemics in SwitzerlandHow Many Are Infected? • Although the pregnant women study is representative in terms of ethnicity: • females account for only 40% of the HCV infected population • only 2.4% of pregnant women under survey (1.5% of HCV+) were in the >40 y class of age (vs. 39% of OFSP declarations) • Official estimates may have underestimated the HCV prevalence in Switzerland

  12. Prevalence of HCV in Switzerland • Model predictions (assuming a median 0.75% prevalence according to OFSP estimates) were compared with observed incidence of HCV related deaths and OLT • A revised prevalence of 1.25 – 1.75% provided the best fit to the assumed complications SAGMEISTER et al, Eur J Gastroenterol Hepatol 2002;14:25

  13. Predicting HCV Disease Burden(by Prevalence) • Future complications of a cohort of 77,595 HCV RNA positive patients were evaluated (age distribution was identical to that of the OFSP declarations) • In the next 15 to 25 years: • Annual HCC incidence will increase by 70% • HCV-related mortality will increase by 90% • Incidence of HCV-related cirrhosis will decline SAGMEISTER et al, Eur J Gastroenterol Hepatol 2002;14:25

  14. Trends in overall and truncated (35-64 y) age-standardised HCC death rates in Switzerland females males females, 35-64 y females, all ages LA VECCHIA et al, Eur J Cancer 2000;36:909

  15. Future complications of HCV infection in Switzerland SAGMEISTER et al, Eur J Gastroenterol Hepatol 2002;14:25

  16. Effect of Antiviral Therapy • Antiviral therapy will reduce the annual HCV-related mortality by a mere 5%, since: • According to new estimate, only a minority of patients have been diagnosed (~15%) • Antiviral treatment may cure only 40% of patients SAGMEISTER et al, Eur J Gastroenterol Hepatol 2002;14:25

  17. Future Costs of Hepatitis C in Switzerland • Annual direct costs for treating complications of HCV will double by 2020 (~32.9 million US $ per year) (vs. 801 million US $ of direct costs of CHD) • Indirect costs (loss of productivity) equals 25.9 million US $ per year (1998) SAGMEISTER et al, Eur J Gastroenterol Hepatol 2002;14:25

  18. Current recommendations may help to identify only 50-60% of patients with chronic hepatitis C • Extend screening to other groups at risk? • Propose anonymous testing/counseling?

  19. The Swiss Population In 2001 • Resident population: 7,258,500 • Population density: 176 per Km2 • Foreign nationals: 20.1% (~1,460,000) • Excess of births over deaths: 13,000 per year • [Immigration] – [emigration] = +41,500 per year

  20. Foreign Nationals Living in Switzerland • The foreign population is relatively young: • 8 persons of retirement age every 100 workers (Swiss nationals: 30 every 100) • More than half have been living in Switzerland for >15 years • Current net migration is positive, thanks to immigration from non-EU European countries • About 80% of foreigners (~1,100,000) are from countries where HCV infection is moderately prevalent and long-standing

  21. Austria other countries France Turkey Spain Germany former Yugoslavia Portugal Italy Switzerland: origin of foreign nationals (1999)

  22. Global Patterns of HCV Infection 3 = Egypt 2 = Spain, Italy 1 = US, Australia WASLEY and ALTER, CDC, 2000

  23. Risk factors for HCV transmission in Italy • Blood transfusions 2.9 • IV drug use 112 • Non-disposable needles within the family 1.6 • Non-disposable needles outside the family 3.8 • Hospitalization before 1970 2.1 • Hospitalization after 1970 0.9 • Previous tuberculosis 3.4 • Sexually transmitted diseases 1.1 • Surgical intervention before 1970 0.8 • Surgical intervention after 1970 0.5 • CHIARAMONTE et al, 1996

  24. HCV Infection in GenevaRisk factors, acute vs. total (%) DELAPORTE, 2001

  25. HCV Infection in GenevaRisk Factors Vs. Geographic Origin DELAPORTE, 2001

  26. HCV Infection in Geneva • Acute hepatitis Cpatients are more often young IV drug users, born in Switzerland • Chronic hepatitis Cpatients are more often of older age, and migrated to Switzeland from countries where the prevailing risk factor for HCV in the past decades was nosocomial / iatrogenic transmission

  27. Indications to Screening for HCV • Consider to extend screening to: • individuals exposed to non medical, invasive procedures? • individuals exposed in the past to potentially unsafe medical procedures / unsafe injections? • patients with extra-hepatic manifestations possibly linked to HCV?

More Related