Hepatitis B and C are notifiable infectious diseases
The number of diagnoses of chronic hepatitis B and C decreased by 40 percent during the Covid pandemic. This means that in the Netherlands hundreds of patients are walking around with a condition that can eventually lead to liver cancer or liver failure.
This is evident from a study by MDL doctors Dr. Milan Sonneveld and Adriaan van der Meer, who collaborated with researchers from the RIVM. Hepatitis B and C are notifiable infectious diseases. That is why a reliable figure could be made for the whole of the Netherlands of the number of missed diagnoses in 2020 compared to 2019. Sonneveld and van der Meer recently published their findings. online in het Journal of Hepatology, the magazine for European liver doctors.
WHO
In 2019, Dutch doctors were diagnosed with hepatitis B or C 1,700 times. In 2020 there were just under 1000. ‘Extremely bitter,’ says Sonneveld, ‘because if you make the diagnosis at a time when there is no serious liver damage, the disease can be treated very well with antiviral drugs. Hepatitis C can be completely cured within 8 to 12 weeks, and hepatitis B can be almost completely suppressed with medication. It prevents damage to the liver. ‘
“Because very effective treatment is possible for hepatitis B and C, the WHO wants to reduce the number of deaths caused by viral hepatitis by 65 percent by 2030 compared to 2015. But this decrease in diagnoses jeopardizes this goal,” says Sonneveld.
Coincidence
Viral hepatitis infections are usually discovered by accident in people who report to their doctor with symptoms such as fatigue or mild malaise. A blood test can then determine whether there is a viral hepatitis. Diagnoses are also made during a screening for STDs: hepatitis B and C are sexually transmitted diseases.
‘If people get really specific complaints: long-term yellowing, fluid in the abdomen or bleeding from varicose veins in the esophagus, it is often too late. Then there is often already serious liver disease, or even liver cancer, ‘says Sonneveld. ‘The problem is that in the past year people have reported much less often to their GP with mild complaints. This means that the chance of an early diagnosis may have been missed. ‘
Difficult
‘In our analysis you can clearly see that the number of diagnoses of viral hepatitis B and C decreased as the pressure on hospitals increased. The more hospital beds occupied, the fewer diagnoses were made. People probably did not dare to go to the doctor in times of great pressure. Perhaps out of fear of putting too much pressure on the GP, or because they were afraid of becoming infected with the corona virus. ‘
He therefore calls on people with complaints not to avoid healthcare. ‘Go to the doctor with complaints of fatigue and mild malaise. A lot of hepatitis is missed, but of course we also miss other diagnoses if people do not dare to go to the doctor. ‘
Sonneveld also has a message for all other Dutch people: ‘Let’s work together to ensure that the pressure on hospitals diminishes quickly and that it no longer arises in the future. Let’s adhere to all measures! This is the only way to keep sufficient care capacity available for non-Covid care and to prevent health damage in the future. ‘
Cancer diagnoses
It was already known that far fewer diagnoses were made in busy Covid times: last year the Integrated Cancer Center of the Netherlands calculated that 20 percent fewer cancer diagnoses were made in the spring of 2020. The dip in the number of diagnoses has now recovered.
Really sick
Sonneveld dares to doubt whether this will also happen with the number of diagnoses of hepatitis B and C. He fears that the people who did not go to the doctor last year with general complaints, and whose blood was therefore not tested, will never all go to the doctor after all. ‘I’m afraid they won’t come until they really get sick. And then damage has often already occurred to the liver, while this could be prevented with earlier diagnosis and effective treatment.
The point is also that the disease mainly occurs in people who find it more difficult to find the doctor anyway. ‘This infectious disease is relatively common in people with a non-Dutch background. Social disadvantage and language barriers play a role. It is therefore extra important that doctors also think about viral hepatitis when people with an increased risk of hepatitis B or C present themselves with fatigue or flu-like symptoms. ‘
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