The program to eradicate hepatitis C was almost launched, but the corona stopped it • But an American study showed that the proportion of liver patients who became infected with corona and needed hospitalization was double • Now the Ministry of Health is expected to launch the program
A simple blood test. "It is important to locate patients"
Photo:
Getty Images
Israel can eradicate hepatitis C disease in less than a decade, according to the Ministry of Health, with the launch of a national program to test the presence of the virus in the population. HMOs will conduct screening tests for at-risk populations and offer drug treatment, and the Ministry of Health will maintain a national registry and monitor the data.
Today (Tuesday) marks International Day for Chronic Viral Hepatitis, and Health Minister Yuli Edelstein is expected to announce the implementation of the program.
It is estimated that about 2% of the population carry the virus. Of these, about 100,000 people are diagnosed as carriers of the hepatitis C virus, and another 75,000-70,000 carriers who do not know they are sick at all, as they do not feel any symptoms, but they are still contagious and need to be located to treat them.
• For the first time: the IPS will perform hepatitis C tests
• Hope for hepatitis C patients: a groundbreaking new drug
• In line: GPs will treat liver infections
Chronic viral hepatitis C has no symptoms and can be hidden for years until it breaks out acutely, which is difficult to treat. Some patients may develop a chronic infection and suffer from cirrhosis of the liver and its complications: liver failure to the point of needing a transplant, or liver cancer.
People who are at high risk for carrying the virus are people who received blood donations and blood products before 1992, when they began testing for the presence of the virus as well as populations like drug injectors, prisoners or immigrants from Russia, Lithuania, Ukraine and the CIS in general.
The national program for locating and treating all patients begins late: The State of Israel has pledged to eradicate the hepatitis C virus four years ago, as part of the World Health Organization's goals, but in practice, the Ministry of Health and HMOs do not proactively treat people at risk. The plan has not yet been budgeted and has not yet been implemented.
More than a third of the health basket budget in 2012 was devoted to eradicating hepatitis C, and in 2018 access to treatment for all patients and all degrees of severity of the disease was expanded. Now, eight years after patients in Israel can receive the treatment, without economic barrier and without stigma, because the treatment is given in the hospitals, an initiated program is expected to begin to locate tens of thousands of patients. "The implementation of a national program that includes screening tests to identify candidates for treatment, and appropriate treatment of them, is expected to cure most of the patients and significantly reduce the number of new infections until the virus is eradicated in Israel," the draft circular sent to HMOs said.
These days the public is exposed to the corona epidemic, a viral disease of a different kind. But it turns out that patients with chronic liver disease are at higher risk for respiration and mortality.
A study conducted last May in the United States and published in the journal LIVER found that nearly 20% of patients with a history of liver disease needed much higher rates of hospitalization, need for respiration and even mortality from coronary heart disease. The need for respiration was twice as high as in a person without liver disease.
The interesting fact is that the coronary heart disease of those chronic liver patients was severe, although most did not develop cirrhosis of the liver, which is a complication of liver disease. It can be concluded from this finding that even in less severe carriers and patients, without cirrhosis of the liver, who have hepatitis C, there is an increased risk of morbidity and mortality if infected with corona.
"Priority changed"
"It is important these days, when we are witnessing a significant increase in corona morbidity, to locate patients and give them the antiviral treatment that can cure them," says Julio Borman, CEO of Arrow, an Israeli liver health organization. "The Ministry of Health has recently begun testing Survey for corona patients. "Along with corona tests, the opportunity should be taken, especially during this period, to also treat hepatitis C patients, who are at high risk for serious illness and even mortality, if they become infected with corona."
Dr. Yuval Dadon, director of the national program to eradicate hepatitis C in Israel, from the Deputy Office of the Director General of the Ministry of Health, said: "We were ready with a national plan on the subject, and then came the corona and priorities changed. There is now a real challenge in launching the program."
"Israel is a very good candidate to succeed in eradicating the disease. The drugs are in the basket for all patients and that is a huge advantage, along with a great willingness on the part of the Ministry of Health and HMOs. Everyone sets this as a top goal. I believe Israel can join the leading countries in eradicating hepatitis C."
Meanwhile, a program has begun to locate the carriers of the virus in two places: in the prison service, which it is estimated that the proportion of patients among prisoners is about 15%, compared with 2% in the general population; In addition, the Maccabi HMO began conducting survey tests among women of childbearing age. This is because women carrying hepatitis C are at a significantly higher risk for pregnancy complications, such as fertility problems, preterm birth, gestational diabetes and more.
The program began in light of the recommendation of the Association of Obstetrics and Gynecology, after studies around the world have shown that conducting a survey for each woman before or during pregnancy is more effective than a survey intended only for women in risk groups. In addition, it is important to give the drug treatment before becoming pregnant, since it is not possible to carry out drug treatment during the pregnancy itself, so at Maccabi women are referred for a hepatitis carrier test along with routine tests performed at the checkout before and during pregnancy.
Leading IPS
The Prison Service indicates that they will begin in August with survey tests for the population at risk. The organization will allow those who want all prisoners, and not just at-risk populations, to be tested. The IPS will organize signage in clinics and disseminate information to prisoners about the tests. The state recently announced in the High Court, following a petition by the Physicians for Human Rights organization, that the IPS will begin testing in March 2021, and now the organization wants to advance schedules.
Dr. Liav Goldstein, the IPS's medical officer, said: "We are already treating patients and we thought we would start the screening operations when they instruct the HMOs. Since the HMOs are in an advanced process, the IPS decided to take on the screening and we will start in August. Assuming there will be nationwide action. A situation has arisen in which the IPS "leads the State of Israel."
According to Dr. Goldstein, “To date we have treated several hundred hepatitis patients. Since 2016 we have treated at least 200-150 prisoners, and we are going out to research this issue. Studies around the world claim that the rate of carriers among prisoners reaches 30-20 percent of prisoners, but we have no research that can indicate the figure within the IPS. When we start the survey and screening, we will be smarter. Patients with hepatitis C. We said we would be happy to treat patients, but we did not hear that anyone was 'born' sick at the IPS, but came from outside. Now, when the Ministry of Health instructs all the health funds to do so, we are also happy to join. "
