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[Laboratory requirements to diagnose viral hepatitis under the development of guidelines]
Hans Becker, Jona Theodor Stahmeyer, Michael P Manns1
1Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Germany.
Insights
Despite guidelines and awareness days, viral hepatitis screening in Germany saw minimal increases, except for Hepatitis D. New treatments for Hepatitis C necessitate intensified education and screening efforts.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Viral hepatitis (B, C, D) poses a significant health burden in Germany, with high rates of undiagnosed infections and severe sequelae like liver cirrhosis and hepatocellular carcinoma.
- Established S3-guidelines aim to improve diagnosis and treatment, but their implementation and impact on diagnostic trends remain challenging to evaluate.
Purpose of the Study:
- To analyze changes in diagnostic procedures and medical knowledge regarding viral hepatitis in Germany between 2005 and 2011.
- To assess the effectiveness of guidelines and awareness campaigns on screening practices for hepatitis B, C, and D.
Main Methods:
- Analysis of seven liver diagnostic parameters across four German federal states from 2005-2011.
- Evaluation of trends in HBs-Ag, HCV-Ab, HBV-DNA, HCV-RNA, and HDV-Ab testing.
Main Results:
- Hepatitis B (HBs-Ag) and Hepatitis C (HCV-Ab) screening showed only minor increases in adults.
- Molecular testing for HBV-DNA and HCV-RNA increased significantly (up to 200%) in some regions, potentially due to treatment monitoring or regulations rather than increased screening.
- Hepatitis D (HDV-Ab) testing showed the most significant increase but remains at a low overall level.
Conclusions:
- Nationwide initiatives and updated guidelines had a limited impact on increasing overall viral hepatitis screening, with the exception of Hepatitis D.
- The study highlights the need for intensified education and improved screening strategies, especially given new treatment options for Hepatitis C.
Abstract:
Infections with hepatitis B-, C- and D- viruses have a significant health burden. In Germany, the seroprevalence of HBs-Ag is calculated with 0.6 % and of HCV-antibodies with 0.3 %. However, most patients are not diagnosed. Sequelae are liver-cirrhosis and hepatocellular carcinoma. Several S3-guidelines for the diagnosis and treatment of viral hepatitis have been established. However, implementation of guidelines is not easy to evaluate. To estimate the changes of medical knowledge and diagnostic procedures about viral hepatitis, 7 parameters of liver-diagnostics were elected to analyze the requirements profile in the years 2005 - 2011 in 4 German federal states. GPT/ALT showed no important change except the influence of the laboratory-reformation. HBs-Ag and HCV-Ab show only a minor increase in adults. The molecular differentiation of HBV-DNA and HCV-RNA showed changes up to 200 % in some regions; however, this might not be explained by more screening but rather increased treatment monitoring or new region-specific regulations. The most significant increase was observed for HDV-antibodies, but the amount of testing is still at a low level. The development and update of guidelines, the World-Hepatitis-Awareness-Day, and other specific nationwide activities did not result in a major increase in the screening of viral hepatitis with the exception of HDV. The results and the new treatment options against hepatitis C should motivate to continue the education in the field of viral hepatitis in an intensified manor.
