OUT OF THE SHADOWS II: GOING ENDEMIC A NATIONAL …



OUT OF THE SHADOWS II: GOING ENDEMIC A NATIONAL HEPATITIS POLICY UPDATEJan 2016Written by Paul Desmond .uk .uk thetruthabouthepc.co.ukAfter audited research with 3400 patients and carers, 323 GP Practices, 20 Professions and over a hundred Stakeholder Meetings with principally the RCGP, HPA, NICE, BASL, BVHG, The Liver Tsar, The Commons APPG on Hepatitis, The Archer Inquiry into NHS Hepatitis, the RCM and the Foundation for Research into the Liver Critical ReadersProfessor Roger WilliamsHead UK Foundation for Study of the LiverDr Maurice Mann GP, “Premiership Blood Hygiene as an Olympic Legacy” for school sports, rugby and amateur boxingDr Shahid DadaBhoy BMSc, MBA, DIC FRCGP, DRCOG, DFFP, CHM CIPE, GP LondonTrainer Detection Diagnosis and Treatment of Viral Hepatitis Royal College of GP’sDr Hashi, Assistant GP LondonDr Joan M Block, President US Hepatitis B FoundationGoing Endemic for HBV by Paul Desmond 2016. In the UK up to a million citizens are infected with viral hepatitis and thousands are dying annually. The 10 million at high risk are often the least able to know, our children, our patients, our elders and most of all people often behind culture and language barriers from overseas. To date the Department of Health has shown no intention or material preparation for the targeted safety screening of persons with community, birth or medical transmission risks. In France, America, Spain, Pakistan, Italy, Canada, Japan and Australia, to name a few, you are ten times more likely to have had your hepatitis B and C risks safety checked and or be Hepatitis B vaccinated, than in the UK.Please read this report carefully, just 67 easy read text pages, outlining the 6 simple globally used Hepatitis Solutions which can protect our community and yourself from this deadly Pandemic.ContentsExecutive SummaryThe Explosion of Viral Hepatitis Infections Frightening facts about hepatitis 1 Infections2 DeathsProven Policies to Spend on Testing and Save on LivesReassuring new effective approaches to hepatitis 3. Information 4. International Benchmarks Education Proven Policies, Prevention Six hepatitis solutions / asksImmediate Actions – Safety Screening/Vaccination ChoicesAll 5 projects can be actioned in 3 months 5. Local Targeted NHS Testing Poster Projects 6. Community Testing Poster Projects Universal Vaccination Is Cost EffectiveBorder Testing Poster ProjectsPremiership Blood Hygiene/ Olympic Legacy ProjectEquality – Undoing decades of NeglectEqualityRemoving Failed Politically Correct and Cover Up PolicyPolicy: Citizen Rights/EmpowermentIndustry Reference Group Planned OutcomesSummaryWe need to fully diagnose our carcinogenic ally infected Hepatitis?B (HBV) and Hepatitis C (HCV)?patients. Our 80% failure to do this over the last two decades has greatly increased liver illness in the UK. A viral time bomb of preventable viral hepatitis fatality and morbidity is going off in our faces. The Increase of Liver Cancer has risen stratospherically to 3800 Annual Deaths in 2011.??The Increase of Cirrhosis and Bile Duct Cancers has done the same. To?help?get ahead of this increase of Death amidst our viral hepatitis infected citizens, we need to acknowledge their existence and simple diagnostic needs.? The Increase of numbers with long term undiagnosed Infection has also risen. Unscreened Birth Hepatitis B risks and Healthcare Hepatitis C risks have been run by more than 10 million citizens.??There is real national concern at not seeing the effective risk test message atlas’s for healthcare HCV and inherited HBV?in our GP's, schools and hospitals over the Nineties and NoughtiesWe have to seriously?affect the death rate and the diagnosis rate right now.? We have at least half a million members of the general public, in all walks of life, with a deadly undiagnosed carcinogen and?a booming?liver cancer death rate to match.? We are still to test enough people to?know how many citizens are HBV or HCV infected, alone in the EU we still 90% guess.??So we are watching an easily preventable quintupling liver cancer death rate, due to principally, the healthcare and birth risks of HCV and HBV not being published nationally.? At least 1 in 100 citizens are still completely unaware a standard prescription or 21 Units of alcohol?will kill them.? Up to ten people are now dying every day due to poor diagnosis. We?are grateful for?support for a de stigmatized general public risk poster and an educational 1 in 70 have?Hepatitis C/B educational Atlas, now is the time for actions, in every Clinical Commissioning Group in every locality to get testing.?We do feel with so many (1-200,000) patient lives at stake we?must do more.? All we ask for is the GP warning maps and our GP’s to start asking “Have you had your HBV/HCV safety check yet?” to the millions in dire need. In 2012 Sentinel Ward Surveillance noted London’s 1.2 million children were more HBV infected (1%) than its 40,000 addicts and alcoholics (0.7%)All the following projects are spend and save policies, aimed at a huge health inequality, with warnings that reach out virally through many target communities. Each Campaign Poster or Map, each project for GP’s and Stakeholders are scalable to begin locally and evolve nationally.The Increase of Undiagnosed HBV/HCVWe have had an increase in long term Undiagnosed Infections1970-2013. During the same period we have consistently year after year, gained more infections than we have diagnosed, at this rate many of our major cities will be HBV endemic at around 2020.We estimate that there are now more than 410,000 people in the UK with mainly long term undiagnosed HBV infection and a further 390,000 with mainly long term undiagnosed healthcare HCV motored by our dramatic population change. Allowing for factors such as under-reporting, the figures may be even higher.Up to 410,000 citizens have long term undiagnosed from childhood HBVUp to 390,000 citizens have long term undiagnosed mainly healthcare HCVThe Increase of Long Term InfectionsA virus to see if I have rather than one to just avoidWith 2 out of 7 people on Earth having been infected with HBV, the paradigm is not just avoiding infection, but knowing your Status. With birth driven/health care Pandemics the attitude is for the bulk of the world more “Heavens I have run a risk” than “That’s something to avoid”, healthcare and birth being unavoidable for most of us. Up to 1 in 20 UK citizens catch viral hepatitis and 1 in 70 stay infected, it’s that common and not knowing your liver status over decades can easily kill you. Our borders and our NHS must protect, test and warn millions with this attitude.For 1 in 3 humans knowing their liver status is a simple matter of knowing they had HCV or HBV. For 1 in 12 positive with lasting HBV or HCV it gets more complex.As a migration nation we must know such facts. These figures show that most chronic HBV infection in England and Wales results from the immigration of HBV carriers (Hahné et al, 2004). Hahné pointed out that immigrating HBV carriers are likely to have acquired the infection at an earlier age compared with carriers who are UK residents. This is significant because, in general, the outcomes of HBV infection acquired perinatally and in early childhood are much worse than HBV infection acquired in adulthood. It is logical to expect at least 2-300,000 more silently infected viral hepatitis patients to have migrated to the UK in the last decade. The danger is that with up to 800,000 now HBV & HCV undiagnosed, at least 100,000 will die slow expensive preventable deaths, principally from ignorance of their infection and common behaviours, such as binge medicating, 21 units use of alcohol or obesity. Since Dr Hahne wrote his article we have witnessed the largest migration from endemic areas in recent history, there follows a 3 chart breakdown of how our Localities & GP Practices and Cities are going endemic for HBV. Chart 1 National HBV Prevalencing - 561,000 UK HBV Positive The Prevalencing Update includes 6 million newcomers 2006 to 2016 @ 3% HBV+. Table 1 UK Sentinel Surveillance 2007-2010 The table below shows how our Ethnic Groups have tested about 3% HBV positive over 1 million ward and 250,000 maternity tests done to monitor HBV recently. HBV in Maternity HBV in Ward UK PopulationHBV PrevalenceChinese, Mixed3.8% 8.8% 1,900,0005.9% or 104,000 casesBlack/Black British3.1% 6.9%1,700,0005.0% or 85,000 casesAsian/Asian British 0.7% 2.8%4,100,0001.4% or 57,000 casesWhite, EU 0.28 0.88%56,000,0000.57% or 315,000 cases 561,000 casesThis is not so surprising with the EU average being much the same and our population rapidly becoming the EU’s most mixed. However, if we are to import endemic communities we owe it them and their children to provide first world medical care. These nationalities have a human right to public hepatitis information, safety tests, vaccination, treatment and publication of the HBV HCV atlases. These nationalities have a right to know about the WHO recommendations for universal vaccination for their newborns.A right to know that Globally and in the recent UK past and present, healthcare, schools and professions have been infectious to the tune of 30% of all humanity. Globally Viral hepatitis is killing more people than HIV and WW2 combined and 20 million UK residents don’t even know they have already seriously risked contracting it. The Prevalencing Update includes 6 million newcomers 2006 to 2016 @ 3% HBV+Table 2 WHO Sentinel Surveillance The following figures are easy to reference; hbv prevalence is from WHO, UK Migrant Community populations are from community leaders and ONS sources. Nation of OriginUK PopulationWHO PrevalenceHBV UK PopulationZimbabwe 250,000 6%13Nigeria 174,000 6%10Ghana 96,0006% 5 Somalia 208,000 6%12Uganda 60,0006% 3Local limited testing on nationalities has revealed similarities of prevalence to nation of origin in African UK communities the School of Tropical Medicine noted 5.6% among 423 Somali mums.China 430 8.6%40Hong Kong78 8.2%6Pilipino 220 10.5% 22Professor Bassendine noted our Chinese are more infected here than where they vaccinate an effect noted by Dr. Philipp Solbach Turkish5004.2%21Greek3004.5%13Romania1008%8Poland750 1.5%11Hundreds of helpline calls from these nationals have illustrated they are better served back home, many assume HBV vaccinations are done and are shocked realising their danger.India 2,000 1.5% 30Sri Lanka 200 2.5%5Bangladesh 500 2.5%12Pakistan 1,200 2.5%28Afghan706%4Chart 2 Prevalence by London Borough & GP Practice Wandsworth Demographics right has hbv carriers totaling 3952 or 1.4% positive, the Borough will become endemic by around 2025 at current migration levels. HCV will be much the same.Brent Demographics below with hbv carriers totaling 5309 or 1.8% positive, will see the Borough become endemic by 2020 at current migration levels. HCV again will be much the same.66.2% White British6002.6% White Irish3710.5% Other White6001.0% White & Black Caribbean300.5% White & Black African750.9% White & Asian300.8% Other Mixed303.1% Indian2001.9% Pakistani2400.7% Bangladeshi1301.4% Other Asian 2203.9% Black Caribbean1203.1% Black African10000.8% Other Black 2501.0% Chinese3001.5% Other90Total 3952 hbv positiveWhite British124,000 @.3% 410 carriersOther white background (please specify) EU14,000 @2% or 280 carriersIndian50,000 @2%or 1000 carriersPakistani12,500 @4% or 500 carriersCaribbean20,000 @1% or 200 carriersAfrican26,500 @8% 2,120 carriersChinese or other ethnic group22,000 @2% or 880 carriersTotal 5,309 hbv positiveHBV Prevalence by GP PracticeA Brent Practice averaging 3623 patients per surgery would average 72 HBV infections; in essence each Brent Practice is seeing long term without diagnosis often for decades 30 African 11 Pakistani 6 Gujarati 13 Chinese 4 East EU 5 British & 3 IDU Hepatitis B Patients!The big majorities of them are healthy and have never heard of their healthcare hepatitis b risk or run the sex drugs risks broadcast. GP Diagnosis is their only hope of avoiding accidental binge eating, drinking or medicating deaths. We herewith plead they are people at decimating risk of agonising slow deaths, which are easily prevented by timely testing, please, guided by clear data and patient helpline feedback, can our GP Practices have tools for finding and protecting them.Chart 3 UK Cities UpdateLondon the capital of the UK with the addition of the onward infections from those already infected in the different groups below is now endemic for Hepatitis B. This is not scare mongering or political posturing, it is basic mathematics with prevalence’s provided by the World Health Organisation and Statistics provided by the 2011 Public Census.Further the 766,000 HBV tests in the general population and the 263,000 HBV tests in our maternity units from 2008 to 2011 reported by the HPA confirm these high prevalence levels of HBV infection.It is a breath taking oversight that a Capital City of a developed nation spending more on healthcare than almost any other has literally sleepwalked into going endemic for a decimating, when undiagnosed carcinogen, without a single of its many agencies noticing. To date every premier NHS Institution is still publishing figures of just 0.1 to 0.5% for HBV prevalence.The tragedy is exacerbated by the absence of the simple solutions practiced globally, mass testing and vaccinating, we have a pitiful level of vaccinating and protecting our citizens, less than 3% of the most at risk group, our children, are protected, less than 20% of at risk key workers with bodily fluids are protected and less than 10% of travelers are protected.Although the global prime source of onward HBV infections, contaminated healthcare, has been removed as a risk since the NHS adopted precautions in the mid 1980’s, we still lag dramatically behind most nations at practicing blood hygiene, with many agencies, even Local Education Authorities still failing to enact high vigilance plastering of all child and adult wounds and bleaching of blood spills and blood contaminated areas and tools.London Demographics Census 2011BreakdownHBV rate WHONumbers of Patients44.9% White British2.3% White Irish12.1% Other White5.0% Mixed6.6% Indian2.7% Pakistani2.7% Bangladeshi5.3% Other Asian4.0% Black Caribbean7.0% Black African4.6% Other Black1.5% Chinese1.3% Arab Illegal3,680,000188,000990,000410,000541,000221,000221,000434,000328,000656,000377,000120,000106,000430,000@.3 @.3 @1.5%@1% @2% @3% @3% @3% @1% @8% @2% @8% @2% @6%12,89356414,7004,10010,8206,6306,63013,0003,28052,0007,4009,6002,02026,000Totals8,630,0001.96 %169,200As an example of a city with a smaller demographic migration transformation Manchester including Greater Manchester is approximately 1% HBV Positive using the above modeling. However the Inner City like most is also well on the way to Going Endemic. This process now started is quite irreversible as new communities have of course every right to bring their partners and families over the coming decades from their endemic motherlands. We have planned our endemic communities and localities, now we must plan for their having access to correct healthcare namely access to HBV safety testing and HBV vaccinations.City Manchester Census 2011BreakdownHBV rate WHONumbers of Patients62.7% White British1.5% White Irish2.5% Other White1.0% White & Black Caribbean1.5% White & Black African1.2% White & Asian1.0% Other Mixed3.5% Indian7.9% Pakistani2.0% Bangladeshi1.0% Other Asian1.0% Black Caribbean7.2% Black African0.2% Other Black2.7% Chinese3.1% Other313,500 7,500 12,500 5,000 7,500 6,000 5,00017,50039,500 10,000 5,000 5,000 36,000 1,00013,50015,500@.3 @.3 @1.5%@1% @4% @1% @1% @2% @4% @4% @3% @1% @8% @2% @8% @1% 940221875030060503501580400150502880201080155Totals500,0001.65%8274Seeing 100 practices in Manchester City would give 83 hbv patients per practice, 8 of whom are going to die and 25 approaching serious liver disease. Adjusting demographics for Greater Manchester from 2005 estimates of ethnic groups to include their migrant growth would give a .85% prevalence and this would add 1700 more hbv infections giving 2774 as a total in Greater Manchester or a 1% plus total. This is ten times some still quoted HPA estimates, a prevalence which is mirrored in the only place we test there, maternityThe Increase of Viral Hepatitis DeathsGetting Ahead of the Curve was published by the Dept of Health in January 2002. By October 2013 we have diagnosed about 100,000 people with HBV from a cohort of 505,000 and about 100,000 with HCV from a cohort of 466,000. Up to 95% of these diagnoses are focused solely amongst the injecting drug user, the diagnosed with liver disease rather than saved from it and the HIV infected community. Subsequently we have had one of the Steepest Growths of Liver Disease in the EU. Percentage Movements in Mortality 1971-2008 Each year, the Curve of UK liver cancer deaths has increased reaching 3800 in 2011. Cirrhosis figures also mirror this trend. UK figures for Bile Duct Cancer have sky rocketed from just 50 in 1970 to 800 in 2004. Again this is a poor prognosis (life expectancy) cancer. These figures were predicted almost exactly in the 2002 Hepatitis Scandal Report. A booming Curve of preventable death is occurring to people with long term undiagnosed viral hepatitis, by 2013, someone dies of HBV/HCV Liver cancer or Cirrhosis complications and other Cancers every 3 hours. A Time Bomb of Hepatitis driven Morbidity and Mortality has been left undiagnosed to explode in our faces. Imagine at Hillsborough 96 fans died and we had 20 years of coverage, over the same period the entire of Anfield (40.000) has died with none.Estimated Annual UK Viral Hepatitis Related Deaths 2003 2013Liver Cancer HBV 450 760 @ 20% is the lowest EU level probable page 16Liver Cancer HCV 675 1140 @ 30% is the lowest EU probable level page 16Bile Duct Cancer HBV/HCV 300 350 @ 40% of total NHL WD Kidney Cancers 15 20Hepatitis Cirrhosis1100 1500 @30% of total Page 11 2590 3780 The Increase of Hepatitis Cirrhosis DeathsCirrhosis develops in 20-30% of undiagnosed HBV/HCV infections. With 57% of Cirrhosis globally having a viral hepatitis cause and approximately half of HBV/HCV deaths occurring from Cirrhosis, hepatitis cirrhosis is killing 1500 people a year. We call for more research into how often “drinking 21 units and binge medicating” contributes to these deaths in the UK. With undiagnosed hepatitis making alcohol 2-4 times more deadly, it is logical to “see” 1500 hepatitis (30% of total) deaths hidden behind alcohol as a cause. Even 5 years of social drinking 21 units can easily cause cirrhosis for the long term undiagnosed.Canada & the US note their hepatitis cirrhosis deaths at 20% and 40% of their totals respectivelyAlcoholic Liver Failure Death rates from Alcoholic Liver Disease in the UK rose by from 3,236 in 2002 to 4,400 in 2008, a 36% increase, during which alcohol use changed barely 4%. From 1990 until 2010 we drink just 18% more and yet are dying 118% more often. To presume alcohol is responsible for this growth is not medical inquiry, it is not even basic mathematics. From 1990-2010 the 118% extra increase in Cirrhosis deaths corresponds to the growth from 300,000 long term undiagnosed hepatitis infected citizens to 600,000 almost exactly. During the last years of recession alcohol use has declined 10%, yet the death toll is still rising. More than 6 million people in England drink above recommended low risk levels. A tenth of our Hepatitis infections equals 100,000 people; out there right now drinking, innocently on their way to this pointless death due to ignorance. The estimated financial cost of alcohol related illness is ?2.7 billion per annum. Drug Reaction Liver Failure It is estimated 10,000 people a year may be dying as a result of drug reaction liver failure. 6% of UK A&E Admissions are due to drug re action. To date our GP’s may forget to test for HBV & HCV, even when diagnoses of cirrhosis, fibrosis, liver failure, liver cancer or persistently high ALTs blood results are indicated. It is also very rare for them to include viral HBV or HCV tests when prescribing liver dangerous medicine or liver function blood tests. So it is important to ask for a test, sometimes repeatedly with the above situations/afflictions. The national hepatitis helpline consistently notes more hepatitis patients having A n E admissions due to prescriptions than from alcohol, drugs and obesity combined.The Increase of Viral Hepatitis Deaths Successful High Diagnosis Nations have tackled and recorded HBV/HCV together simultaneously, especially they all note their boom in Liver Disease and Death is viral hepatitis motored. They have 11 or 16 years more usage of in depth Death Certification of Viral Hepatitis than the UK, noting 10 to 20 times the UK rates of Death among hepatitis patients. Below EASOL, point out the need for medical management (diagnosis) of infections and the scale of the deaths in all nations. European Association for the Study of the Liver 2006 End-stage liver disease accounts for one in forty deaths worldwide. HCV/HBV usually accounted for more than 50% of HCC and cirrhosis, representing 929,000 deaths in 2002. Globally HBV and HCV cause 57% of Cirrhosis and 78% of HCC. Regionally causing, 446,000 cirrhosis deaths (HBV 235,000 and HCV 211,000) and483,000 liver cancer deaths (HBV 328,000 and HCV 155,000)Conclusions: HBV and HCV infections account for the majority of cirrhosis and primary liver cancer throughout most of the world, highlighting the need for programs to prevent new infections and provide medical management and treatment for those infected.Global Hepatitis Mortality RecordOur figure of approximately 3,780 UK Hepatitis Deaths a year is a best case scenario, at just 50% of HCC and 30% of Cirrhosis Deaths from HBV and HCV. The model of Drs Serag, Mason and Yoshizawa below would see 4 to 5,000 deaths. US EU JapanH. El Serag & A Mason 1999 Yoshizawa et al Oncology 2002 Yao P et al Oncology 2001 US Hepatitis Mortality Record (1982-1998)The WHO 1999 advice to count the deaths and back date them is used by the US to note 10-12,000 annual viral hepatitis deaths below. UK Clinicians and policy makers have not seen our Hepatitis Pandemic killing tens of thousands as they have never seen the data sets below. While undiagnosed HBV/HCV has killed a likely 25,000 in the Noughties and 15-20,000 in the Nineties. Of 40,000 deaths less than 6,000 have been noted. The Increase of Preventable CostsIt is better and far cheaper to diagnose patients and warn them, than to leave 33% or 250-330,000 of them accidentally approaching serious or fatal disease. This is the key paradigm demonstrated by all high diagnosis nations. At least 40% or ?4 billion plus of our current projected hepatitis costs can be saved over 20 years. Costs are drawn from the Journal of Gastroenterology below. Projected UK Hepatitis Costs in billions, with or without screening.2010-2030 Current costs projected over 20 years HBV Cirrhosis at 60,000 cases or 20% of infections ?50,000 each equals ?3.0 Bn HBV Fatality at 16,000 cases or 5% ?50,000 each equals ?0.8 Bn HCV Cirrhosis at 110,000 cases or 25% of infections ?50,000 each equals ?5.5 Bn HCV Fatality at 35,200 cases or 8% ?50,000 each equals ?1.7 BnHepatitis B Management Costs in France, Italy, Spain, and the United KingdomJournal of Gastroenterology: Dec 2004 - Volume 38 - Issue 10 - pp S169-S174 Results: 2001 average annual disease state costs per patient: Chronic Hepatitis B, €1,093-€3,396; Compensated cirrhosis, €1,134-€3,997; Decompensated cirrhosis, €5,292-€8,842; Hepatocellular carcinoma, €3,731-€9,352; Liver transplant surgery, €25,165-€84,568.Conclusion: The association of disease progression with increased cost of disease management suggests that measures to prevent or delay its progression would be economically beneficial.The Increasing Cost of Hepatitis Liver DiseaseHepatitis B Infections, Costs & Deaths Published 4 November 2004 Nicholas.beeching@rlbuht.nhs.uk, clinical leadIn the United Kingdom it is estimated each year that there are, 430 related hepatocellular carcinomas, 4500 acute cases of hepatitis B virus and 7500 + new cases of chronic infection with HBV (mainly in immigrants),With estimated NHS costs alone of up to ?375m per year.It is factual to say, “No-one should die of viral hepatitis” and to say “We can eradicate this disease in 30 years” Yet after decades of simple diagnostic tests and with HBV a Vaccine being available, viral hepatitis is predicted to kill up to 300,000 plus of the UK’s undiagnosed HBV & HCV patients over the coming 20-30 years. In an era when 500 swine flu fatalities is front page year long abject media terror, it seems strange 300,000 very real Pandemic Viral Hepatitis UK deaths, already happening one every few hours, and projected to get worse, are a matter almost completely hidden from most people’s and even doctors awareness. And viral hepatitis already infects at least 1 in 65 of us in the UK, mainly silently without symptoms or diagnosis. Or even chance of Diagnosis! A recent multi location London based street survey found 96% of the general public is still in complete ignorance of the most common birth, blood to wound and overseas healthcare viral hepatitis risks, 36% had run risks the WHO would recommend require safety HBV/HCV testing.NB. The US CDC note 60% of Americans have been audited for hepatitis risks.2. Background about Viral Hepatitis Dangers Would you imagine that drinking a couple of pints a day over 5 years or taking a paracetamol prescription is really odds on cirrhosis deadly? People don’t, and this is how HBV & HCV kills, it is not about drug abuse dangers; it’s not even about what modern medicine may do to help. Hepatitis is really about thousands of people who might end up down the pub with their mates, smiling like idiots, as they kill their 6 year old livers. There is someone in every busy pub in the UK doing this right now. Hepatitis is really about innocent old patients taking anti-psychotics with their frail long term silently infected livers and dying. After about 30 years, especially if you are using common prescriptions, the liver will fully scar and start to fail, leading to de-compensation of the liver or liver cancer. Basically, it is expected 10%-15% of the undiagnosed infected will die. The most dangerous thing about this virus is its ability to send your health into a fatal spin while you still feel well. Large portions of the newly diagnosed in the UK are at the cirrhosis and three hundred times the cancer risk stage and had no idea they were ill. Our big problem is when hundreds of thousands of people are long term unknowingly infected, and our culture is unwarned and suffering an obesity boom, cheap alcohol and “binge” and “parked” medicating from GP’s.Background about Hepatitis B Dangers Question What is the life expectancy of someone who has undiagnosed HBV?Answer There is no exact clinical data demonstrating life expectancy for an individual with hepatitis B. We can only state that the mortality age averages at 50 if you had it since birth. Alcohol doubles your risk of liver failure. John Thai, M.D. What is Hepatitis B?Hepatitis B is a virus that attacks the liver silently over many years, and in 5 -10% of the undiagnosed, progresses to fatal liver cancer or liver failure. In 2010, there are 400 million people worldwide and 360,000 in the UK, who are chronically infected with this disease. Annually 750,000 to 1,500,000 people die of hepatitis worldwide. How Do You Become Infected? The most common ways in which hepatitis B is spread is at birth in maternity (50%), from child to child (20%), sexual contact, transfusion with infected blood or blood products and sharing drug injection equipment with an infected person, account for the rest of infections. What happens after you become infected? (Chart)Ultimately 10% of the infected will die. The vast bulk will have been long term undiagnosed.How is hepatitis B treated? If hepatitis B or C become long-lasting, one should discuss treatment options with their doctor. Key to survival is to avoid toxins, especially many prescriptions, alcohol and obesity are often fatal dangers to the undiagnosed. Unfortunately, the available drugs do not usually cure hepatitis B. The aim of therapy is to keep the hepatitis B virus under control and to prevent liver damage such as cirrhosis and liver cancer. In Europe, there are 1 million new infections per year due to HBV, and 14 million people long term infected with HBV. Between 24,000 and 36,000 EU deaths are attributed to HBV every year. Background about Hepatitis C Dangers Question What is the life expectancy of someone who has undiagnosed HCV?Answer There is no exact clinical data demonstrating life expectancy for an individual with hepatitis C. We can only state that the mortality age averages at 55-60 if you have had it for 30 years. Alcohol doubles your risk of liver failure.What is Transfusion Hepatitis C?Hepatitis C is a virus that attacks the liver silently over many years, and in 5 -10% of the undiagnosed, progresses to fatal liver cancer or liver failure. In 2010, there are 200 million people worldwide and 460,000 in the UK, who are chronically infected with this disease. Annually 750,000 to 1,500,000 people die of hepatitis worldwide. How Do You Become Infected? Hepatitis C is only infectious in blood. The most common ways in which hepatitis C is spread is via transfusion during surgery, dialysis, re used inoculation syringes (90%). Blood workers, Drug injectors, maternity infections and blood spills account for the rest (10%). HCV is not infectious in sexual fluids.What happens after infection? The process below is almost identical to HBV. However, the average global annual death rate is 0.3% and 0.2% of total populations with HCV and HBV respectively. How is hepatitis C treated? If hepatitis C becomes long-lasting, one should discuss treatment options with their doctor. Key to survival is to avoid toxins, especially many prescriptions, alcohol and obesity are often fatal dangers to the undiagnosed. Unfortunately, the available drugs are only 50% effective at eradicating hepatitis C. The aim of therapy is to keep the hepatitis C virus under control and to prevent liver damage such as cirrhosis and liver cancer. Background about Viral Hepatitis and Children Newborns are 20 times less likely to fight off HBV than adults Under 10’s are 2 to 6 times more likely to stay infected with HBV.Only 1 in 20 adults stay infected with HBV8.7% of Somali under 5’s acquired hbv horizontally in a Liverpool StudyIt is logical to expect both HBV and HCV to be present in all our primary and secondary schools; however the UK has failed to note exact prevalence and, in particular, forgotten to check the levels in schools with high influxes of migrants from Pandemic areas. However, a snapshot of several nations’ single school spot checks reveals the danger. The Viral Hepatitis Helpline has had numerous school outbreak calls and has found issues at every school visited.HBV School infections snap shotsUS 0.60%, Pakistan 0.44%, Ukraine 1.0%,HCV School infections snap shotsSpain 0.36%, Pakistan 0.44%, Ukraine 1.0%,Brazil 4%, Ghana 5.4%, Cameroon 14.5%With our schools becoming filled with global representatives of world youth, we should expect both higher levels of infection and large numbers of children at risk from their undiagnosed playgrounds and parents from Pandemic areas. With such an enormous amount of silent at birth or childhood infections, many may be 30 or even 50 years away from the point of birth or inoculation/surgery infection, yet their danger is now. Our children need Premiership Blood Hygiene Precautions in schools as well as Infection Prevention in Maternity Units.With HCV research has revealed that lack of precaution by maternity units during birth is more often the reason for transmission, this awareness is kind to families. Mother to child infections, this terminology leaves some women unable to marry.6 Spend and Save Global Policies3. Basic Epidemic Control Procedure Has always been mass targeted testing of the “at risk” communities, yet the UK has still to publicise the risks to its people. Over 4 years of answering the HBV national helpline we have never had a report of an individual from an endemic country being asked to safety test his up to 1 in 10 risk of HBV infection by a single UK GP!Efforts must be made to identify those infected via birth, NHS healthcare, occupation and especially from such risks overseas, so that measures can be taken to prevent liver cancer and damage. Mr Dominique-Charles Valla (European Association for the Study of the Liver) “Writing in the last edition of the Parliament Magazine, Nadine Piorkowsky, president of the European Liver Patients Association drew attention to the extremely worrying trend, namely, the devastating effects of HBV and HCV on our patients. These diseases kill “silently” because for years, often decades, patients do not feel the symptoms of their illness and remain undiagnosed. In fact, as a rule, patients come to us only when the obvious manifestations of liver disease occur and an irreversible stage of liver damage has already been reached. If diagnosed in time, however, viral hepatitis patients can lead a perfectly normal and healthy life. This is why we support the European Liver Patients Association’s call for a council recommendation on hepatitis screening as a way to ensure that this disease is diagnosed and treated at an early stage.” New Effective PCT Information The Global Atlas’s Need Local UK PCT and Hospital Distribution creating: Real Transparency - Cross Culturality - GP and Patient EmpowermentAtlas Information saves lives, Let’s Spend and Save with them! Every pound spent on treatment saves 4 pounds in illness costs. A ?1 finger prick quick test can save you needing a ?100,000 transplant here. Real transparency saves lives. The public have a right to know if their health services have infected 100,000’s of them New Effective PCT Information Six billion injections are given globally with syringes or needles that are reused without sterilization. This represents 40 percent of all injections given in developing countries; in some countries, the proportion is as high as 70 percent of injections. The World Health Organization (WHO)6-10 million UK residents have had the above injections New Effective PCT Public EducationEducation for the Public and GP’s should be made availableDiagnosis markedly reduces mortality, while recent anti-viral therapy is helpful for those with active liver disease. Simple Hepatitis Risk = Test Manual Simple Liver Good Life Education New Effective Public Screening Services For millions of citizens, knowing their liver status is a matter of life and death. As Prof Mahan, lead Heptologist Spain mentioned “Patients are not dying of viral hepatitis; they are dying of ignorance of their condition.” Our improvements in ante natal screening and educating need to be mirrored with screening our migrants and at risk children with the care recommended below too. New Effective Prevention of Hepatitis MorbidityWe have to prevent 100,000 deaths and save 250,000 citizens from liver diseaseThis is only possible via 10 million hbv & hcv safety tests and universal hbv vaccinationAccording to Research every pound spent on treatment saves four in illnessAnd every pound on screening saves far more All blood workers have a right to HBV VaccinationTattooists are perfectly placed to add a HBV vaccination and a HCV safety test to their recommendations/services, two more pricks that really add value. Ditto piercing salons.Prevention of Infection – Blood Hygiene Education Blood Hygiene Precautions also need vast improvement, especially our children need to know open wounds, and wound to wound fighting will mean infections, that blood is infectious, not decorative. There is a risk of transmission occupationally and socially in many settingsThe World Health Organization (WHO) began an expert meeting to explore strategies aimed at promoting the use of safer needles. WHO said that "unsafe injections and needle stick injuries together cause 33 percent of new Hepatitis B infections and 2 million new cases of Hepatitis C in the world each year." 4. Policy Benchmarks Our Doctors need to start asking the 10 million at risk “Have you had your viral hepatitis safety checks and vaccination?”Our 10 million people at risk need to start asking their doctors, “Can I have my family and I have our viral hepatitis safety checks and vaccination?”If we study nations who admitted the scale of birth and healthcare HBV/HCV infections and tried to diagnose the infected from 1994, we note that they all show a plateauing or tailing off of deaths over the last decade and several key differences in policy and practice.France, Australia and the US all clearly targeted all the people at risk with highly public, highly honest health care look back messagesThey have all used vastly better practice at recording deaths and prevalenceThey all reached far higher diagnosis levels to dateThey all educate and safety check at their bordersThey all have vastly better records at HBV vaccinationThe US and France compulsory licensed the test kit with television advertisingFrance tested more people for HCV in 2001 than the UK in the entire NoughtiesAustralian Speed of ResponseThe Australians with a smaller Pandemic and population have achieved far more diagnosis per head and all this many years ago. Again their borders, death information and screening have been much more effective than the UK’s IDU efforts.Causes of death after diagnosis of hepatitis B or hepatitis C infection Amin J, Law MG, Bartlett M, Kaldor JM, Dore GJ.. jamin@nchecr.unsw.edu.auMETHODS: In the study population, 39,109 people had hepatitis B, 75,834 had hepatitis C, between 1990 and 2002. RESULTS: The number of deaths identified by the linkage were 1233 (3.2%) for hepatitis B, 4008 (5.3%) for hepatitis C.The US Curve of Hepatitis FatalitiesThe United States made broadcastingly clear the extent of viral hepatitis risk from healthcare in 1994, testing their annual 2.5 million surgery patients with look back screening and the sensible data below (Alter). Test kits were licensed for sale and used from 1999 and millions of get tested letters sent out. With the subsequent high diagnosis levels, the US curve of viral hepatitis death stopped in 2002.Mortality Due to Hepatitis C in the U.S.: Has the Worst Passed? 2008 WR KimPublic health authorities have warned that morbidity and mortality associated with chronic hepatitis C are likely to increase in the coming years. However, a study presented at the Digestive Disease Week 2008 conference last month in San Diego suggests that overall HCV-related mortality may have already reached a plateau.Results ? Between 1994 and 2003, 48,381 had HCV as the underlying cause of death. ? The mean age at the time of death was 55 years.? The overall HCV death rate was 1.2 per 100,000 persons per year in 1994.? This increased to 3.3 in 2002, but then leveled off at 3.1 in 2003. ? Overall non-HCC mortality increased though 2000, when it reached a plateau. Conclusion Researchers suggested that previous forecasts projecting that HCV mortality would continue to increase well into the second decade of the current century might be incorrect. "These data suggest that HCV death rate may have already reached a plateau, if not started a decline," they concluded. Published in Hepatology 2004Hepatitis C-related deaths in the United States have increased 123 percent in a decade, with mortality rates showing the most significant rise among middle-aged patients, according to new findings. The increases occur from 1995 through 2004, the most recent year for which data are available. Death rates peaked in 2002, then declined slightly overall, according to the report. The French Race against Time / Counting fatality The French Health minister was nearly blown up for trying to hide the infections in Paris. This led to the E U’s most comprehensive screening campaign, the French have pioneered over 50% diagnosis levels for over 10 years. Below they clearly see testing as a race against time to avoid accidental alcoholic deaths and expand the search for related deaths. In the UK up to 96% of fatality has been hidden with spin for 20 years.* Mortality related to HCV and HBV infections was estimated in France. J Hepatol. 2008 Feb;48(2):200-7. Epub 2007 Nov 20.METHODS: A random sample (n=999) of death certificates was obtained from all death certificates listing HBV, HCV, hepatitis, liver disease, possible complication of cirrhosis, bacterial infection, HIV, or transplantation (n=65,000) in France in 2001. Physicians who reported the deaths were sent a questionnaire to identify how many deaths were related to HBV/HCV infection. RESULTS: Estimated number of deaths attributable to HCV or HBV infection was 2646 and 1327, Deaths related to HBV or HCV infection occurred at an earlier age in patients with a history of excessive alcohol consumption.CONCLUSIONS: In France, 4000-5000 deaths related to HCV and HBV infection occurred in 2001. These data emphasize the need for ongoing, efficient public health programs that include screening, management, and counseling for HCV- and HBV-infected individuals*UK Spin, counting infections after 1991 screening completely hides the 100,000’s of viral hepatitis NHS infections post war from 1945 to 1985 when prison blood was a mainstay.The EU Race against TimeNations who got ahead of their curves of liver fatality via comprehensive HBV & HCV screening - Italy, France and Australia are clear examples of the correct cost and life saving approach proving Look back Safety Screening can and has achieved 50% plus diagnosis levels, yet we labour with 17-20% levels for HBV and HCV. UK Spin, a hidden death rate. From up to a million infections we have just 328 certified HCV deaths a year, with HBV suffering the same sort of under reporting also. If we were told 9 out of 10 smoking or alcohol deaths just didn’t happen? The results are obvious – far, far more deaths. Below an example of the standard non counting practice still used, a paltry 60 to 120 deaths are displayed boldly from 1996 to 2001 yet a potential 5,000 more are lost in the small print above. The Polish Honesty In Poland studies link 59-71% of HCV infections to medical care, with an admission that 3.7% of major surgery or transfusions were HCV infectious and an admission that HBV is also frequently a medically linked disease spread by Medicare in similar ways. Below left from a snapshot of 250 Polish infections reveals over 50% of their infections are from health care and just 8.8% from injecting drug abuse. While 13.6% are from occupational risks. Meanwhile on the right the terrifying extent of the Department of Health and the Health Protection Agencies focus on street injectors and their abject failure to screen endemic nationality and healthcare patients for viral hepatitis becomes clear. We have an admission of a 2.6% surgery infection rate for HCV, and clear data revealing hundreds of thousands of NHS and overseas health care infections are in the UK, and yet nothing has been done in 20 years to target test these people.Just 360 patients are recorded as diagnosed from 1996-2007. This leaves a balance of 250,000 undiagnosed long term HCV infected patients. In the UK 95% of the testing has focused on 30% of the infections, the IDU’s. Worse still just 13 infections a decade has been recorded occupationally, while 250 tests in Poland emerged 34 for the above study. The absolutely catastrophic failure to diagnose our HBV endemic origin infections, our HCV health infections and the HCV/HBV occupational infections has left them to infect and develop unchecked. We have simply pretended the Pandemic doesn’t exist and avoided counting either infections or noting deaths. It is important to see this is a planned and changeable policy of brochure happy new labour Spin that has at least doubled the death toll. That has occurred concurrently with the planned destruction of the nation’s 10 million transfusion records and all related Ministerial notes.The Six Standard Solutions to Viral Hepatitis 1. WHO Look Back HBV & HCV Disease Prevalence and Screening of targets “Finds” our 500,000 transfusion/endemic origin infected patients for safety testing 2. WHO Educational PCT Risk Test HBV/HCV Maps and Get Tested Posters Get 50% patient diagnosis levels over 60 months when used nationally 3. A WHO HBV Vaccination & HCV Diagnostic Message/Industry on TV 4. WHO Look Back HBV & HCV Death Certificate Usage Counts Viral Hepatitis decimating the undiagnosed over 25 years 5. Targeted Use of the HBV Vaccine at all from Pandemic AreasMirroring our mainly undiagnosed 390,000 carriers, especially throughout education and blood worker venues and 4%+ high prevalence communities6. Occupational Hepatitis Education – Olympic Blood Hygiene PrecautionWarns our one million blood workers that 1 in 12 people bleed hepatitis now. The 6 Hepatitis Asks are not a health campaign, they are basic human rights. A right to transparency about Hospital & Overseas Pandemics, a right to risk education about threats greater than HIV, a right to diagnostic inventions that save lives and a right to know if my job or country of birth carries a fatal threat. Finally, it is obvious that we should know the scale of infections and death, our health service has a moral duty and is paid to publicise not hide these matters of life and death.The 6 Hepatitis Asks have saved lives for 10-20 years overseas and form the backbone of global medical response. Each has been under or simply never used by the NHS to date. Simple screening of the known at risk, is still the task in hand. Deploying the tried and proven Asks to get 50% plus diagnosis levels can happen quickly and very cost effectively to save billions in liver morbidity over the coming decades. However, we are 20 years late in making a targeted testing effort, and our health professionals are still without the standard risk information or the testing posters, maps and targets to diagnose themselves or their patients.The 6 Hepatitis Asks are proven to step change our woeful performance in seeing, diagnosing and warning our population. After 20 years of spin underestimating viral hepatitis, we now require the truth of 700,000 undiagnosed infections and their possible decimation by liver cancer and disease to be admitted and treated in an honest way. Our doctors should have asked their patients and migrants to safety check their HBV (birth) and HCV (surgery/dialysis) risks in the early Nineties.It needs to be done now more than ever.5. Targeted Testing “Targeted Hepatitis Safety Testing is Crucial and Universal Vaccination is Crucial. We can spend pennies on diagnosis and prevention or pounds on illness.” Paul Desmond Executive Director.uk .uk thetruthabouthepc.co.uk HBV/HCV are not Aids people do not perform a risk and want a test the next day.HBV/HCV are not full of symptoms that need a test. Just look back risks usually. HBV/HCV Risks are not understood or recognised fast by the NHS GP or Hospital Trust. You are 10 times less likely to be tested in the UK than France or America. The fact is that millions of people just don’t know their risk. The fact is that millions of people get tested, because they have been told to. They are told their current lifestyle plus HBV or HCV will probably kill them, so they get tested. In the UK, we are in danger of ignoring?Healthcare HBV/HCV, Horizontal HBV/HCV and Occupational HBV/HCV.? That’s maybe 700,000 people.In the UK, we still have had no Public awareness campaign. Focusing on Street Injectors has made both doctors and the public ignore HBV & HCV as issues. It’s told the doctor it’s a clinic problem and the public it’s an addict’s problem. At a 100 deaths a year it sounds like no-one’s problem. As more people become aware, we will have to answer a question. Why on Earth, if we have a virus that kills in 20-30 years and if we’ve had a cheap finger prick test for 20 years. Why on Earth, did we wait 20 to 30 years to tell the known targets to get tested?The answer for the above will get a little harder with a dying nurse, or a dying war hero. It’s was hard for Anita Roddick who had ?170 million for a test for 34 years and now, she’s one of many who couldn’t get a new liver. As many as 700,000 infected people?will ask Why, before they are tested. With 7 - 10 million HBV/HCV tests outstanding, we have managed just 1-200,000 per virus a year over the last decade. Why not Target Test the 10,000,000 at risk now?We’re asking for targeted testing posters and maps right now.?There are up to 100,000 UK lives estimated to die this most preventable of deaths. With 1 in 70 infected, we need to test the 1 in 20 citizens at risk, if we are to diagnose our HBV & HCV Pandemics. It is that simple. We ask you the reader to think, of your closest 20 family members, who may need a HCV or HBV Test? That’s why our GP/General Public book is called “Hepatitis, what every family needs to know”. Simply that HCV and HBV do not discriminate; the problem is a general public, every extended family one.Targeted Testing is Crucial “Many with HCV have no reason to suspect they are infected - many of those at high risk are average people - middle-aged housewives who had a caesarean section delivery, young adults who had transfusions as high risk babies, or middle-aged men who served in Vietnam. The focus of the public health effort to date, however, has been on marginal populations (e.g. IV drug users, people with tattoos or body piercing). As a result, many average Americans with HCV infection do not suspect it and many may be discouraged from seeking medical attention if a stigma is attached to HCV infection.” Howard Koop, Former US Surgeon General.Although uttered by Howard in 1994, this statement above still rings true for the UK, with all its fatal implications.Target Test Patients – GP Testing Opportunities?Our GP’s need to start saying “You have run a risk” and “You are from an endemic area.” And start asking “Do you remember a period of jaundice or a liver cancer death in the family?” Our GP's use a low lying fruit approach, meaning they target groups up to one in four infected for HCV safety checks. This is principally, the HIV Positive, the Injecting Drug User and Rare Blood Disease Patient Cohorts.However they could target the up to one in a 100 infected groups to include all the patients below, but you have to convince them you are not being paranoid.? All Major Surgery & All Dialysis pre 92All C-sections & All TransplantsAll Overseas Inoculations and Transfusions (developing world)All persistent High ALTs Patients, Patients referred for liver function tests, especially those prescribed liver?wearing medicine and Blood WorkersUnfortunately, the GP's have simply not been warned hundreds of thousands of overseas and NHS patients have been infected, most have been given no?tools, neither the prevalence of UK HBV and HCV infections or the test risk posters or the WHO maps,?have been made available to them.? Most assume viral hepatitis means illegal injecting or unprotected sex. You however, have a common sense right to screen the above high risks for our own and our loved ones safety.Over 3,000 helpline calls to the H B Foundation reveals approximately one fifth of migrant HBV patients remembered a childhood period of jaundice. Often acute HBV symptoms are so common overseas that the helpline notes many nations have local terms for hepatitis such as “Zerick” means yellow eyes in Kurdish or “Agarshoe” means green eyes in Somalian. Professor Bassendine noted almost 1 in 5 HBV positive Chinese knew they had HBV when asked and yet had never been asked. It is a sign of how poor we have been at patient testing, that since 1989 the 10-30,000 patients already GP listed as non a non b or transfusion hepatitis in 1989 have not yet been in any structured file search. UCAS (semi legal) arbitration meetings in 2005 said doctors, particularly from overseas, are not expected to diagnose/understand these terms on file.??Throughout the 60’s, 70’s and 80’s, these notes were very common. As the arbitrator noted GP’s can be less than enthusiastic to dig up these forgotten HBV/HCV files 20-40 years later. ELPA Recommendations 2006, ELPA members made a number of suggestions on what should be done in each country to improve the situation: In the UK, a better public awareness campaign together with much more effort to educate GPs and reimburse them for case-finding. Target Test Illnesses – Hospital Test OpportunitiesOur Consultants need to start asking “What caused this illness? Have you run a risk?”Our hospital testing is just as busy testing only the low lying fruit again only one in four type risks. Basically just the Injecting Drug User, HIV Positive and the Major Transfusion or Hemophilia product user. However, you have a right to screen the following high risks, for your own and your loved ones safety. To date almost no NHS venues have testing information available for the Pandemics on display.In the Hospital Scenario Viral Hepatitis tests can be offered to Liver Cancer, Bile Duct Cancer, Non Hodgkins Lymphoma, Liver failure, Cirrhosis, fibrosis, Liver Fibrosis, Drug reaction liver failure, Fibromyalgia’s and non liver related illnessesGall bladder & kidney removals Liver Function Test PatientsViral Hepatitis Tests can be offered to from before 1991 NHS patients andAll Overseas Major Surgery and C-Sections All Overseas Dialysis All Overseas TransplantsAll Overseas Transfusions and Blood ProductsAll Overseas InoculationsAll Blood WorkersAll Persistent High ALTs Blood testsAll listed non a non b or transfusion hepatitis and All patients referred for liver function tests or liver wearing medicineIt is crucial that patients and doctors reclaim the language used to describe HBV/HCV from the papers and politicians. “100 times more infectious than HIV” doesn’t mention that unlike HIV HBV goes away by itself 95% of the time in adults, it doesn’t mention your partner can have a simple vaccination either or that 3 times less sexual partners get infected. “HCV is a Sex Disease” doesn’t mention that 8400 years of unprotected sex by HCV + partners in the EU shows no infections at all. “Get Tested Get Treated” can be barked at IDU’s but doesn’t say know your risks get tested. Our medical language needs to avoid language that can destroy lives. 6. Targeted Test CommunitiesScreening should be offered in all health and community settingsIndividuals at risk should be screened and offered vaccination Good leaflets should be handed out with every diagnosisSupport numbers/contacts should also be recommendedGrass Roots outreach and communication initiatives should be formed to engage local migrant, patient and occupational communities in comprehensive screening/vaccinatingClinical Settings where Risk Test Vaccination Information should be availableGeneral Practitioner SurgeriesMental Health UnitsPrisonsSTI & HIV ClinicsWalk in Poly ClinicsDrug Abuse ClinicsBlood Transfusion CentresPolice StationsImmigration Offices (after decision process)Overseas Adoption AgenciesHospitals Out and In PatientsAccident & EmergencyPublic Settings where Risk Test Vaccination Information should be visibleChemistsTertiary educational VenuesHigh Prevalence Community VenuesSTI & HIV ClinicsLibraries CouncilsTransport Hubs Piercing VenuesSt John’s Ambulance First Aid and Red Cross Venues SchoolsContact Sport VenuesCommunities: Are more motivated in a race against time The Poster Kits and Map are for use in GP’s, Chemists and Schools respectively, but easily, Cultural Groups and Nationalities endemic for HBV are often quite desperate and far more motivated to protect their children. Further Release, Blood Donation, St John’s and Red Cross Venues, Veterans, Workers With Blood Unions, Councils, Travel and Trained Retail Outlets have all been used worldwide. In the US the Veterans Community has helped diagnose and counsel over 300,000 munities need “Disease Sensitive Counseling”The Hepatitis Pre-Test Discussion Should ask for informed consent for testing by the patient after explainingPrinted HVC/ HBV information about the annual global deaths due to poor diagnosis. This is rare in the UK, but available online and via charities.Assessment of Infection Risks and or Symptoms that need testing, Am I Number 12? Very few doctors know it’s so common, if you are refused a test for an overseas injection or past NHS Surgery by a GP, go to a GUM rmation about confidentiality and the notification process. Very rarely insurers and employers may access this information, so arranging insurances or work issues if you are a surgeon or a boxer can be important.On Occasion it is necessary, to assess support for a result, e.g. children, mentally ill and the elderly, and to reduce infection risks, e.g. Vaccination, safer injecting/sex. The Hepatitis Post-Test Discussion Should give the test result in a manner that is confidential, sensitive and appropriate to mental state, personally, coveringAn Understanding of HCV / HBV’s Disease Journey. With HCV explain it is not a sex disease but a Super Bug Pandemic affecting 200 million A Liver Friendly lifestyle, explain how HCV/HBV kills with pills or alcohol The Basics of Blood hygiene and Vaccination, people need to use plasters and bleach spills. Pre Vaccination HBV also requires safe sex precautions as that virus is in sexual fluids Medical Referral to a liver specialist and a source of disease information, such as the Hep C Trust or Hep B Foundation, for the person’s discretion.Assessment of mental state, I’ve seen people diagnosed with liver cancer and months to live and be very sensible and people diagnosed with a normal life expectancy and no damage have a breakdown and need a psychiatrist.On Occasion it is necessary to arrange Rehabilitation or Safer Injecting or Psychological counseling or therapy.Three Communities in deep needOur Prison & Asylum InmatesUK prisons are often 5-10% viral hepatitis infected, there are constant blood spill situations in all our prisons. Such an environment and all our prisoners need vaccinations and safety checks. Without such interventions there is every evidence this cohort use alcohol much more when released with the obvious consequences. Training for infected prisoners to become hepatitis B and C counselors should be made available, via the “Convicts become Carers Program”.UK asylums also demonstrate a high level of both viruses. With 25,000 violent incidents a year reported on our wards, a real need for vaccination and safety testing arises for both long term patients and staff. With mental patients the real danger is the extreme potency of their medicine, often even more toxic to the liver than alcohol. If as is expected 1-4% are long term HBV HCV infected, they are being prescribed liver damage or death in many instances. Our Children & MothersWith reports of onward infection issues from every city school we have visited. We cite a major concern that our UK schools and their children and and teachers are woefully prepared to deal with the risks of HBV. Blood Hygiene has been non existant in many of the venues visited and onward infections noted from contact sports to play, from accidents to teething.Mothers diagnosed at 3 months are often reduced to absolute panic and despair due to poor support and poor information, most are left googling for months in isolation, both suicide attempts and abortions have been dealt with on our helpline.Our EldersWith our prisons supplying our hospitals with highly infectious HCV/HBV blood from 1945-1985, published medical reports noted that 1% of our population had HCV in 1986 mainly from this infectious period. These ex-surgery patients are now often between 50-80 and often prescribed liver wearing medications. It is noted among several cohorts, especially Alzheimer’s patients, that 1 in a 100 dies with alacrity once medicated.A simple hepatitis check before prescription, as well as a liver function test, is indicated for many elders to be certain of safety.World Health Organisation on HBV Vaccination All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine. People in high risk groups should also be vaccinated, including:migrants from Pandemic areaspersons who frequently require blood or blood products;recipients of solid organ transplantation; those at occupational risk of HBV infection, including health care workers; andinternational travellers to countries with high rates of HBVpersons with high-risk sexual behaviour; partners and household contacts of HBV infected persons; injecting drug users; The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children. As of December 2006, 164 countries vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.The Foundation for Liver Research and HepB Positive call for our Vaccination Committee to allow HBV Universal Vaccination to start saving lives immediately. The Jade Ribbon Campaign offers the vaccination at 80 p, in the UK it costs up to ?150. Rather than a standard precaution for our high prevalence areas, it is offered at PCT’s as a tourist and travel vaccination. If, as we know children are 4-6 times more likely to be incurably infected, and our schools are experiencing a vast influx from overseas Pandemic zones. We need to HBV vaccinate all our under 18’s and all our blood workers, don’t we?The 20 years of neglecting expert advice from the worlds and own medical experts by our Vaccination Committee are explained by The British Medical Association overleaf.British Medical Association on HBV Vaccination 20 May 2010 BackgroundThere have been a number of BMA resolutions regarding hepatitis B vaccination, the most recent at the 2007 annual representatives meeting (ARM):That this Meeting acknowledges the call by the World Health Organisations to provide hepatitis B vaccines to all children and calls upon the Department of Health to introduce the hepatitis B vaccine into the childhood schedule without further delay. (ARM, 2007)The BMA Board of Science produced a briefing paper in 2005, Hepatitis B Vaccination in Childhood. The JCVI reviewed the case for universal hepatitis B vaccination in 2005 and 2009, and concluded that there was insufficient evidence for the cost-effectiveness of a national hepatitis B vaccination programme. In April 2010, Board of Science representatives met with Sir Michael Richards, National Clinical Director for Cancer, to discuss hepatitis B vaccination in children, and the feasibility of implementing local vaccination programmes, particularly in areas of high incidence, as a means of reducing local hepatitis B.On Universal vaccination WHO recommends universal Hepatitis B vaccination in infants, including in low prevalence countries as a significant proportion of chronic HBV infections are acquired through transmission in childhood. The UK is one of only a few countries in the world that does not have a universal Hepatitis B vaccination programme in the infant immunization schedule. There are also positive reasons for low-incidence countries such as the UK to implement a programme of universal vaccination, based on the ethical presumption that where a potentially devastating disease is easily preventable, those at potential risk should be protected, particularly where the infection is on the increase and will carry on in that direction unless a universal immunisation programme is introduced [see reference 17].On our current selective vaccination approach (it doesn’t work)Evidence from the HPA and JCVI indicate that the selective targeting approach in the UK is not effective in controlling HBV infection. There are difficulties in identifying and targeting people at risk of HBV infection in the UK on an individual and regional level. A significant number of new infections are not covered by the selective targeting approach, and the effectiveness of the selective approach varies significantly across PCTs [see reference 27]. Pregnant women at greatest risk of infection and transmission to their infants often fail to attend prenatal clinics, and their infants fail to complete the HepB vaccination course. Vaccination in other high risk groups is underused, and failure rates for completing the vaccination course are high. In 2005, 16 per cent of births registered in England were to mothers born in countries with high HBV prevalence, and four per cent to fathers from high prevalence countries (HPA). A quarter of PCTs in England have over 20 per cent of births registered to one or more parent born outside of the UK.4 Peer-reviewed Cost Effective HBV Vaccination studiesMost studies found that universal vaccination of either infants or children was the most cost effective option, compared to selective or no vaccination strategies, but results are heavily dependent on modelling assumptions [see reference 21]. Tilson et al in a 2008 study using data from Ireland concluded that universal vaccination would be cost effective, in particular if using the combination vaccines (€37,000 cost per life year gained) [see reference 22]. Fenn et al in a study using UK data, published in 1996, reported that 80 per cent of deaths from HBV infection could be avoided through an infant vaccination programme in the UK, using the Engerix B monovalent HepB vaccine. The researchers compared universal infant, child and adolescent vaccination strategies to the current selective strategy, and found that universal infant vaccination was the most cost effective option (?37,000 - 102,000 cost per life year gained, depending on the assumptions in the model). The authors noted that administrative saving from incorporating the vaccine into current infant immunization procedures might also contribute to cost effectiveness [see reference 23]. Harris et al in an Australian study, (2001) also found that a universal vaccination strategy using the combined Hib/HepB vaccine would reduce HBV infection by 77%, and was cost effective compared to selective vaccination ($12,000 cost per life year gained) [see reference 24]. Zurn et al (2000) compared several universal vaccination strategies (infants, children, adolescent, all) to selective vaccination and found that vaccination of children was the most cost effective option [see reference 25]. A Cost Effective Example from one of the 197 Nations that use the VaccineItaly was the first low prevalence country to introduce universal vaccination against HBV. Following the collection of epidemiological data on age-specific incidence rates of infection, a law was passed in 1991, which established mandatory immunisation of neonates and 12-year-old adolescents. The first data on compliance with vaccination, both in infants and in adolescents, indicated the success of the programme, which was helped by good vaccination delivery services and awareness of the risks of HBV both in physicians and the public [see reference 15]. After ten years of routine HepB vaccine introduction in Italy, evidence on the epidemiological impact of universal immunisation indicated that the universal immunisation strategy was successful. Coverage is on average >90% and is >or=95% in many areas of Italy. Incidence of acute HBV, already declining before 1991, was further decreased by the routine vaccination programme. Furthermore, passive surveillance of adverse events following HepB vaccination supported the excellent safety record of HepB vaccines [see reference 16].Cost effectiveness of universal vaccination denied: The Joint Commission of Vaccination and Immunisation recognises universal HepB vaccination of infants over selective targeting as the optimal vaccination strategy for the UK, but do not recommend it due to its cost effectiveness. In 2005 the Commission reviewed the evidence on cost effectiveness of a universal HepB vaccine programme, and concluded that there was insufficient evidence. The committee reviewed the evidence again in 2009, and concluded that a universal infant or child vaccination policy would not be cost effective. Their view is that universal vaccination may become cost effective if it is delivered as part of the childhood vaccination programme, and if a suitable combined vaccine becomes available. Central purchase of vaccine would also further reduce costs. They also note that any factors perceived by the public as a possible risk (the link to MS, for example) had the potential to compromise the infant programme [reference 19]. The Hepatitis B Positive Patient Association Calls for our Vaccination Committee to allow HBV Universal Vaccination to start saving lives immediately. The 20 years of neglecting expert advice from the worlds and our own medical experts by our Vaccination Committee are explained by several ridiculous excuses, highlighted in blue above.The JCVI cite forgetting how to Bulk buy Vaccinate simultaneously Squash unfounded media scare stories Note other nation’s success for decades And sufficiently gather evidenceAs their reasons for leaving millions of our people at high risk, it is simply incompetence used to justify a fatal lack of care. An incompetence leaving 20% of UK births to face high Pandemic risks without modern medicine. Their ongoing set of incompetencies has left HBV to triple in the UK in terms of infections, liver disease and mortality over the last 20 years.We have to stop being 200th in the world at basic hepatitis vaccination care immediately, we are paying 10-50 times the money, we as a people have every right to expect cost effective medical advances, especially vaccinations for incurable ailments other nations deploy for 1.69 pence a unit. Dr Blumberg, the Nobel Laureate who invented the HBV Vaccine, notes that in the US 10-30% of total HBV infections were seen as originating from unvaccinated childhood. This correlates to 36,600-109,800 HBV infections due to poor vaccination from 1993-2011 in the UK and abroad. This is potentially larger than the entire HIV pandemic and entirely preventable amongst our infants and children.Vaccinating all under 18’s would have cost ?40 million (?5 per child). Not vaccinating may have cost between ?360-1,098,000,000 (?10,000 per infection)Left undiagnosed as 80% are, the infections cost up to ?30,000 each or more than ?3 billion. There is a simple reason why 200 nations use the Vaccine.The HBV Foundation has asked a range of UK experts and Dr Blumberg’s team to form a proper vaccination committee and write an open letter to our Prime Minister and also address the growing numbers of ever younger babies and children attending unvaccinated yet statistically infected schools and nurseries.7. Key Policy BordersOur borders could and should have diagnosed and protected 3-500,000 people over the last 23 years, basically they are far kinder to animals and plants than people with HBV and HCV “Cross Border Co-operation is essential in halting the spread of viral hepatitis, more than 23 million people in Europe are infected and shockingly, up to 90% of them are not even aware of their infection. In order to encourage people to find out whether they are affected and to Get Tested, 28th July is now Hepatitis Look Back “Am I Number 12?” Meditation Day.Despite its serious health risks, viral hepatitis is hardly on the radar of decision makers today. The main challenge for people suffering from hepatitis is to be diagnosed before it is too late.” Nadine Piorkowsky ELPAMigrating HBV – 300,000 Uncounted InfectionsMigrating Healthcare HCV – 250,000 uncounted infections-21465819402146569256UK testing and vaccination for HBV among migrants is amongst the poorest in Western Europe, the Immune Course is still charged for in many PCT settings with costs reaching up to ?250 for a complete course and certified immunity test. As with HCV GP’s have often been told HBV is far rarer than it is, and that it “belongs” to Street Injectors. We are constantly amazed how few understand in Africa and Asia more than half of citizens catch it and 1 in 20 keep it lastingly.Disease Migration has doubled our pools of HBV and HCV. For migrants from any high prevalence location for HCV or HBV, meaning Africa, Asia or Eastern Europe, it is urgent to get tested. As a deadly silent killer is likely to claim many more lives in the “toxic” West. The Global Method is simple and very effective for HBV. More than 200 million doses of hepatitis B vaccine have been administered in the United States and over two billion globally. In fact most countries we have drawn people from are recommended for Immunization and suffering from 2% plus national infection levels.Our borders need to educate and safety check, they need to play a key role as others in controlling the Pandemics disease and death toll.Once again as with the healthcare HCV Pandemic, the UK Media insists on making the HBV Pandemic, look like it’s merely an injector problem. The BBC below put an injector incongruously over their coverage of our migrating HBV Pandemic. Yet even with our new population make up, the UK is unique in not using this Vaccine or even knowing its HBV Population’s Infection Numbers. Be warned, a decade after clinicians called for the Vaccine, we are alone in Europe still worrying about side effects rather than the quadrupling liver cancer death rate8. Premiership Blood Hygiene Occupations Occupational Hepatitis Over 1 million UK workers run daily risks dealing with blood. Most of these professionals have no idea of the scale of their risk or their need for regular safety checks for HBV and HCV. Overseas, these very professions are often in the forefront of diagnosing, counseling and supporting others to get tested. The American Veterans Association, a single charity, has diagnosed twice as many people with viral hepatitis as the entire NHS.In 8 years I have yet to meet a UK Health Care Worker who knows a nurse dies every day in the US from HBV.Healthcare Workers are at risk of HCV and need routine testingIn June 2000, a US review found of 2136 health care workers, 3% tested HCV positive; twice the national average of 1.8%. In 1995, there were estimated 560 - 1,120 cases of HCV infection among health care workers in the U.S. There could be thousands and thousands of occupationally infected nurses who have not been tested and do not know it. The US Nurses Association introduced rigorous HCV needle stick testing in 1998 and safe needles are often now in use. The US CDC estimates that one in 50 workers will be infected with HCV after a needlestick.In 2001 a study of more than 10,000 UK Health Care Workers showed 1.4% of surgeons had HCV and 1% of physicians had HCV.[12] A 1% Nurse infection level (mainly long term undiagnosed) may be very optimistic. UK nurses are often still discouraged from screening needle sticks; very few are regularly safety screened, the matter is a choice for the nurse to request.Laura Moffatt MP 2003 stated: A needle stick injury is a puncture wound in which the needle is either whole or broken. Astonishingly, 100,000 such injuries are reported to occur in the NHS alone every year. It is important to remember, especially with UK nurses having HCV, that a nurse is a lot more likely to die of HCV, than say, infect her husband, never mind a patient. There is no record of nurses infecting patients, but there are 200 million records of transfusions and injections infecting patients. Nurses are selfless people who don’t need infectious stigma; they are removed from exposure prone procedure immediately when diagnosed. However, thousands of our nurses are from Pandemic areas and our screening of them is on a world’s worst level, most of our nurses do not screen their needle sticks for decades. HBV is twice as infectious in blood spills and needle sticks as HCV. A 2% as opposed to 12% risk. 10% of the long term undiagnosed infected can expect to die rather than retire. Over 100,000 nurses from the African, Asian and Eastern European Endemic areas work in the UK, below Uganda shows the scale of their HBV/HCV risk.HBV among health workers in Uganda: evidence of the need for health worker protection. 2006 Sep 5. WHO Office, Kampala, Uganda. rakaf@ug.afro.who.intHepatitis B exposure was assessed in 311 health workers in Uganda, a highly endemic country. Health workers were selected by random sampling from a categorized list of health workers at district level, proportionate to the population of each district. Whereas 60.1% of health workers have had hepatitis B, with 8.7% being chronic carriers, 36.3% are still susceptible and could benefit from vaccination. Only 5.1% reported having had at least one dose of hepatitis B vaccine and 3.5% were apparently immune through vaccination. Needle stick injuries reported by 77% of health workers were the most common mode of exposure to blood and body fluids. Trends suggested duration of service as a predictor while age and history of blood transfusion remained significant independent risk factors for hepatitis B infection. 98% of health workers are willing to be vaccinated. These results confirm the need for protection and vaccination of health workers in Uganda against hepatitis B.First Aid, Security & Care Workers are at risk and need routine testing Dr Ashley BrownSTOP!Premiership Blood Hygiene is needed for all workers in the health, contact sport and beauty industries. People who work with blood need to take professional precautions. Hepatitis Viruses live in spilt blood and are killed by bleach, rather than cleaned. Plasters need to be applied to wounds quickly and bloody personal or general equipment never shared. Workers need to observe rigorous “gloves and scrubs” and cross contamination bleach hygiene.CAUTION!Hepatitis B and C infect about 1 in 88 people in the UK, and an estimated 1 in 500 children, mainly silently. Our Tattooists and Contact Sportsmen seldom know this; neither do school bullies or domestically violent spouses. 1 in 3 people who try injecting drugs gets HCV and most of the addicted get HCV & HBV, whatever precautions they try. Blood Hygiene is needed.Long term undiagnosed viral hepatitis infection can kill.GET TESTED!If you have worked with blood and remember running a transfusable or needlestick risk. Especially, if your lifestyle is hard on your liver, or you have poor liver function tests, knowing your hepatitis c status can help safeguard your future. REMEMBER TO ASK YOUR DOCTOR.?“Fights, Needle Stick Injuries, Wound to Wound Spills, from an infected source, any such transfusion, represent a 2-5% hepatitis b & c risk. You have watched Premiership Blood Hygiene for 20 years on Match of the Day, and yet did you practice it with your razors, cuts, milk teeth? Did you enforce it in your Work, Home, or School? Have you safety screened your risk? ” We expect 100,000 more undiagnosed HBV/HCV infected citizens to arrive over the next 10 years for our nurses and blood workers to serveBeauticians, Cleaners & Sportsmen are at risk and need routine testing Billy Graham WWF wrestling Superstar feels blood spills in the ring are responsible for his HCV infectionA Further CDC Study stated Emergency medical and public safety workers, such as Fire fighters or Police officers, are at significant occupational risk of exposure to HCV.[9] Any job role that involves contact with blood is a real risk.? Many, many staff from beauticians to cleaners, from doctors to first aiders, are not taught enough about blood hygiene and the risks from viral hepatitis clearly. Very few such workers realise blood is infectious in one in eighty eight UK citizens, very few realise blood is every bit as potentially infectious as a used condom and finally even fewer have been made aware undiagnosed viral hepatitis is a decimating silent carcinogen.It’s time we all understood Viral Hepatitis infected blood is infectious to open wounds and 1 in 12 people bleed such blood. We need to get the hang of our premiership blood hygiene precautions and as well as our condoms, quick.When Tattoos and Piercings are a risk By 2000 Australian national guidelines for tattooists included-not re using needles, understanding cross contamination, understanding surgical timed hand washing practice and clinical understanding of Disinfection, Sterilization and Cross contamination, had all been taught and were being re taught overseas. In the UK, things are a tad different. Here people understand very little that one in a fifty European clients has viral hepatitis. However, the US Study and the French and Australian Studies?have revealed. Parlour Tattoos are responsible for infections and UK tattooists are still insufficiently trained?about Hepatitis or monitored at the below. Remember your tattoo and tic awayCross contamination. Tattooists touch their faces, tables, many areas while working contaminating environs and themselves, these movements are often repetitive, so your residue is then lifted from environs to the following clients. All 3 studies found hepatitis on tattooist’s cash tills. Hand washing some tattooists just used gloves without strict adherence to immediate scrub up on donning removing.Re – Use of needles logic - a new needle is 50pence and has no infection to get off at all! Many UK tattooists do not realise that this is an opportunity for infection the industry doesn’t need. Disinfection-killing the bug and sterilization- not putting it about, few tattooists understand this deeply, some use aerosols – spray airborne blood borne, equates to the room needing bleaching, some need advice on what density of bleach kills HCV and how to get it to all areas, how often. All are unaware of disease prevalence and fatality level, rather like Health Workers. Sharps Container practice needs applying. Finally, we are really short on?infected tattooists coming out. These are the people to clean up the industry. Any tattoo?parlour?is as safe as the client before you. Remember Pamela Anderson used a studio and still got infected. If you’ve had a UK tattoo, it’s a very rare risk, if you’ve had a few tattoo’s and you take alcohol too, it’s worth a test. 1 centimetre of hep c blood can infect 250,000 people. The Virus can live in a studio, piercing salon outside a body for 10-20 days. Finally street and prison tattoos/piercings need mentioning, these are found to be far, far more infectious, accounting in Australia for half of tattoo infections. One of these definitely needs a test. 9 EqualityThink of the desire you would have to be HIV tested if after 3 months with a partner and some 16 nights of sexual passion they confided they were HIV positive. At a transmission rate of 1 per 800 sexual events for HIV, you would be deeply concerned by your 50 to 1 risk of HIV infection and every agency in the UK would jump up and down to expedite and urge HIV testing.Table 1 shows how some 2 million UK migrants are running a 10 to 1 risk of HBV infection and a further 8 million are running from a 50 to a 20 to 1 risk of HBV infection. Yet almost none are safety tested and almost all our primary NHS staff has no notion of the scale of the risks experienced by these people or their desperate need for timely testing! Table 2 is from the US CDC manual for HBV vaccination and our model draws from their example in some areas.Table 1UK Population GroupHBV (%)Anti HBV (%)HighRiskSub Saharan Africans & Far East Asians1040-80Hemodialysis Patients3-1020-80Relatives/Household Contacts3-630-60Illegal Injectors760-80Gay men630-60Medium RiskAsians, Arabs, Eastern EU, North Africans & Mixed2-510-50Health Carers and workers with blood 1-25-20Prisoners1-55-20Heterosexuals with multiple partners 0.55-10Low RiskWhite British0.33-8Healthy Adults (first time blood donors)0.33-5 Table 2 Undiagnosed cannot lobby for their lives; the silently infected newborns cannot lobby for their lives. Migrants and health workers cannot combat a disease they are not warned about or safety tested for. The Strategy has always been to LOOK for them with screening and warn them of the dangers of infection plus innocent alcohol and medicine use.In 2009 we spent ?2 billion on 700 Swine Flu deaths and just ?2 million on the GET TREATED HCV (Drug Injectors campaign) for our annually rising 3,000 Viral Hepatitis deaths. 3431540-1712595Think of the number of messages aimed at the smoking carcinogen and ask yourself why you have never even once publicly seen television adverts detailing with how 1 in 4 humans have caught the equally deadly viral hepatitis carcinogens. How 1 in 65 UK citizens are infected? How being born and having an inoculation or surgery are the key risks we are simply not screening.“THE UK FUNDS GLOBAL HBV VACCINATION WHILST LEAVING MILLIONS AT RISK LOCALLY” Throughout the UK some 10 million migrants have out run their homelands hepatitis b immunisation programmes. With even war zones and failed states now rolling pentavalent 5 in 1 programmes with help from the British taxpayer. The UK fails to protect its children or even test for its vast half a million plus hepatitis b infected population or warn the 10 to 12 million citizens at very high risk of infection. The tragedy is massively compounded by ramped up extortionate pricing; while we are helping overseas vaccinations cost just ?1.69 per vaccine injection, GP’s and private clinics are charging up to ?70 at home for the same service. As the last government in Africa to implement the programme, the Somali government announced on 24 April 2013 its intention to vaccinate all children under the age of one with a new hepatitis b inclusive vaccine, funded by the GAVI Alliance. President Hassan Sheikh Mohamud, speaking at the new vaccine's launch in Mogadishu said “All Somali children deserve the good health that children from rich countries enjoy." Whilst in the UK after Dr Bernard J Brabin noted 8.7% of Somali under fives in Liverpool had caught hepatitis b horizontally in a 2002 Study, we have done absolutely nothing to vaccinate the tidal of wave of migrants from endemic areas or their children from horizontal infections. During the elapsed period over 90% of Afro Asian populations abroad have accessed vaccination for their at risk children.10. Removing politically correct & cover up policyAs Madam Jehan El Sadat states, “The innocence of being born or inoculated accompanies most of our viral hepatitis pandemic, not stigma.” Sadly, it has been politically correct to focus on rare risk behaviours among those who infect themselves, powerfully associating the Pandemics with Criminal Street Injecting, Filthy Tattooing, Unprotected Sex and Being Rare.As Christopher Kennedy Lawford states there is also a shame or stigma, a denial of the Pandemic by many associated with it. “Addicts are often in recovery and for many reasons do not look back, whilst many health services have struggled to document the scale of their infections. Both have shown a marked reluctance, for different reasons, to be honest about all their errors.” In the UK, it certainly has not been politically correct to admit 100,000’s of infections via our prison blood harvesting period from 1945-1985. However, the Blood Sera Report, presented to Health Whips in 2009, prevalenced approximately 100,000 HCV infected NHS Surgery Survivors, with a similar Curve for HBV UK prison blood infections on a lesser extent posited up until 1985.Both HBV and HCV are infections that were caused wholesale via NHS healthcare. Yet throughout the Nineties and Noughties, even when lives have depended on the Department of Health admitting and stating the opposite, it has been a political decision to see these Pandemics asRare in prevalence–our Blood Record confirmed 580,000 infections HCV in 1986Because of rare risks - injecting, rare blood disorder treatments, overseas tattoosNot so deadly – We have simply watched without counting deaths for 20 yearsRare from the NHS – 1 in 40 operations 1945-85 is actually very common1 in 70 humans got viral hepatitis from health jabs in the Noughties alone. WHOPolitical Decisions have kept this poster and safety vaccination hidden from the 5,000,000 plus UK Asians at high risk of HBV.Simple peer reviewed PUBMED articles have explained correct policies since 1993, yet most of our health policy makers do not read them. In an era where Justice Krever’s Inquiry arranged huge amounts of screening for HCV/HBV healthcare infections in Canada. The UK Compensation Culture has created a powerful NHS legal team that has consistently tried to downplay the pandemics and draw a line under their extent. Most healthcare infected callers are still amazed to find out hundreds and hundreds of millions have suffered healthcare infections, we are simply never telling them.Political Decisions have kept this poster and the safety test hidden from the 1,000,000 plus NHS patients at high risk of HCV. (Dr Calman Look Back Letter 1995) Without noting deaths no progress is or was intendedUniquely the UK has only 5-10% recording of Viral Hepatitis Deaths, for 20 years the Department of Health has not produced a clear record of the tens of thousands dying this most preventable of deaths. Globally, from1994 the International Agency for Cancer Research termed HBV/HCV Highly Carcinogenic and from 1999 the WHO classified HCV/HBV an underlying cause of death, recommended for counting with an urgent advice to look back and ascertain death numbers and their growth. This allows nations to study the numbers dying and the Increase upward of deaths per 100,000 infectionsThroughout the Noughties both the HPA & the D of H ignored basic Pandemic Control Procedure to note the figure for total deaths, instead creating the graph below and a dream figure of 90 annual deaths. They also avoided noting the CURVE figure for deaths per 100,000 infections. Yet with 3,000+ dying, we may well exceed any in the developed world at 0.50%+. We predict a 0.33 - 0.50% CURVE has and is occurring, yet farcically HPA & D of H spin about Hepatitis Deaths and Creative Prevalencing has completely hidden the Death Curve figure per 100,000 infections from Clinical and Public view for decades. If, as has been patently obvious for decades, poor screening has made viral hepatitis far more deadly in the UK, we are simply not allowed to know. In the US after a decade of target testing their curve peaked at .37% in 2002, they are of course, told by their health service and news anchors. Chillingly, our decades of ignorance about our CURVE of deaths per 100,000 infected are back dropped by the UK having one of the largest growths of liver cancer and cirrhosis death in the western world. Below, one of the most fatal cases of spin in medical history.11. Citizens Rights–Vaccinations/Tests/Facts/PlastersThe HCV test kit industry is diagnosing millions of people worldwide, except here. Diagnostic Industries empower citizen’s choices.Especially 100 prevalence spot checks in target communities get done within months. The Liver Trust and many worthies are arranging such tests in individual locations, they are incredibly empowering to mass targeted screening.One company HOME ACCESS has expertly pre and post test counseled and tested 600,000 people for hepatitis c in California since 1999. “J.D.” who runs the company needs a single office and a cohort of patients to do all this. As do the companies in Europe. The entire NHS, a ?100,000,000,000 a year outfit, has managed 950,000 tests since 1999. The HCV test kit industry is expertly counseling millions of people worldwide, except here. We have to change. The Kits are the nicorettes or condoms for a Hepatitis Pandemic, an ideal simple invention for a Look Back Pandemic. The Poster Kits and Maps are for use in GP’s, Chemists and Schools, Release and Blood Donation Venues, St John’s and Red Cross Venues. Veterans, Blood Workers Unions, Education, Council, Underground and Trained Retail Outlets have all been used worldwide. It is an every high street warning, an ethical trade addition for many retailers.Plaster and bleach manufacturers can educate on Blood Hygiene too.They use the key counseling, “Know Your Risks Get Tested”, as with all carcinogens, low diagnosis and long term low diagnosis, is a killer. They reinforce the standard care pathway and utilise an anonymous risk form. Anonymous screening via GUM Clinics and Distant Kit Screening can be recommended to those needing insurance. Finally the tests dovetail with far more evolving personalized information than is currently available, usually a medically trained patient or nurse. An essential tool our UK GP’s have yet to see or display 75% of infections are accounted for by the white star risks alone Arrows represent a rarer infection riskPlanned Outcomes50% HBV/HCV Diagnosis and 7 million tests by 202050% Less Death over 10 years - a Real EqualityUniversal HBV Vaccination on a developed world levelLocally Used Simple Working HBV HCV Test MessagesReal Patient, Border and HCW Educational EmpowermentPremiership Blood Hygiene seeing extent of infectionReplacing Ignorance and Stigma with Information and Safety ChecksClear Liver Good Life Direction given to our People and their children80% of population knowing birth and healthcare HBV/HCV Blood RisksA Call to ActionFact, by the time you get off a busy London escalator each morning, someone with undiagnosed viral hepatitis has got on. Fact, by the time you leave work 8 hours later each afternoon, 3 or 4 people with long term undiagnosed viral hepatitis will have died.Our Out of the Shadows Update tries to face frightening facts; The 6 Hepatitis Policies or Solutions it documents can and have changed them. The tens of thousands who have died are beyond our help, the 700,000 still undiagnosed are very much not, let us act calmly and quickly to safety screen our people at risk and warn and vaccinate their at risk children, and our at risk key workers at last.Pandemic Screening Maps and Risk Test warnings can be in every GP’s and Hospital by Christmas 2017, it is simply a question of desire.Appendix 1 Clinical Commissioning Groups are a huge opportunity to targetEaling Demographics WikiBreakdownHBV rateNumbers of Patients45.5% White British3.9% White Irish9.5% Other White1.0% White & Black Caribbean0.5% White & Black African1.3% White & Asian1.0% Other Mixed15.0% Indian3.9% Pakistani0.5% Bangladeshi3.9% Other Asian4.0% Black Caribbean4.1% Black African0.6% Other Black1.4% Chinese3.8% Other64 hbv patients per 79 practices155,00013,00032,0003,4001,7004,4003,40051,00013,0001,70013,00014,60014,2602,0005,10012,500@.3 @.3 @1.5%@1% @4% @1% @1% @2% @4% @4% @3% @1% @8% @2% @8% @1% 5003848034684434102052068390146114440408125Totals340,0001.5%5059339,300 is about 1.5% hbv positive add in hepatitis c from healthcare and you have a scale of at least 1 in 40-50 citizens having the carcinogens long term undiagnosed in both Harrow and Ealing. The pool of hbv in particular is onward infectious to both Boroughs endemic community children. We have one Liverpool study finding rates of acute child infection echoing the community prevalence eg 5.7% positive communities infected about 8.7% of their under fives. All workers with blood are at high risk. Cleaners, security, sports, first aid, carers, retail beauty etc.Harrow Demographics WikiBreakdownHBV rateNumbers of Patients47.5% White British3.7% White Irish4.9% Other White0.7% White & Black Caribbean0.4% White & Black African1.0% White & Asian0.9% Other Mixed22.0% Indian2.5% Pakistani0.6% Bangladeshi5.5% Other Asian3.0% Black Caribbean3.5% Black African0.5% Other Black1.4% Chinese1.9% Other81 hbv patients per 43 practices113,0008,90011,8001,70010002,4002,20053,0006,0001,50013,2007,2008,4001,2003,4004,700@.3 @.3 @1.5%@1% @4% @1% @1% @2% @4% @4% @3% @1% @8% @2% @8% @1% 3402617717402422106024060396726722427247Totals240,0001.45%3489The deep concern for both Boroughs is the lack of any HBV or HCV “silent” risk test message and education for the Public and GP’s, further the lack of Blood Hygiene and HBV Vaccination at PCT, Work, School, Retail and Travel Venues. The figures above will increase year on year due to migration until 2022 and come with 20% error margins and substantially larger 50% by practice. In particular our awareness days and helpline have noted onward transmission in nurseries and schools in Brent, Harrow, Hillingdon and Ealing Boroughs. Islington Demographics WikiBreakdownHBV rateNumbers of Patients58.4% White British4.5% White Irish12.3% Other White1.2% White & Black Caribbean0.7% White & Black African1.1% White & Asian1.2% Other Mixed2.2% Indian0.8% Pakistani2.3% Bangladeshi1.0% Other Asian4.2% Black Caribbean5.2% Black African1.0% Other Black2.3% Chinese1.7% Other166,0009,00024,6002,4001,4002,2002,4004,4001,6004,6002,0008,80010,4002,0004,600340@.3 @.3 @1.5%@1% @4% @1% @1% @2% @4% @4% @3% @1% @8% @2% @8% @1% 3483024624562224886418460888324036834Totals200,0001.25%2508Shadow Public HealthDiane AbbottMP forNewhamNewham Demographics WikiBreakdownHBV rateNumbers of Patients32.6% White British1.1% White Irish5.4% Other White1.2% White & Black Caribbean0.8% White & Black African0.8% White & Asian0.9% Other Mixed12.1% Indian8.7% Pakistani9.0% Bangladeshi12.7% Other Asian6.7% Black Caribbean12.7% Black African1.1% Other Black1.4% Chinese2.4% Other64 hbv patients per 79 practices102,0003,20016,0003,6002,7002,7002,90038,00029,00029,50040,00019,00040,0003,2004,5007,000@.3 @.3 @1.5%@1% @4% @1% @1% @2% @4% @4% @3% @1% @8% @2% @8% @1% 3401124036108272976011601170120019032006436070Totals310,0002.9%8965Our addresses and trainings have gained great respect at many venues and from many GP’s. The Royal College of GP’s left most GP questions to us to answer during the GP training day and have requested our services in an ongoing fashion. Dr DadaBhoy (Chief Trainer - Certificate for Detection and Treatment HCV & HBV) in particular, he is now our prescriber for vaccinations across the UK to the 19 Industries which we have researched at high unvaccinated risk. We are thinking to add an open wounds on hands category chefs, builders, gardeners, mechanics all have higher call rates regarding hbv infections to our helpline. Synergy Health will also be offering free hbv testing on all vaccination titers and many newly empowered CCG boards are keen to prove their worth on this new and highly addressable viral hepatitis set of issues and see the usefulness of the Tools and their promotion.Finally although public knowledge, the following charts from the HPA is often a completely inspirational shock to GP’s and a handy tool. Other or mixed British tends to include Turks, Arabs, Eastern EU and Far East quite often.3 Hepatitis B HPA random tests 1.63% HBV positive nationally3.1 Trends in testing among ethnic groups Table S 5. Trends in individuals tested and testing positive for HbsAg by ethnic group$ (excluding antenatal screening trend centres 2008-2011)* 2008 2009 2010 2011 Total Asian or Asian British 2.78 % HBV PositiveNumber tested (% known) 21,102 (14.221,374 (14.7) 21,438 (15.2) 20,860 (15.5) 84,774 (14.9) Number males (% known) 10,246 49.710,821 (51.8) 11,217 (53.3) 11,203 (54.3) 43,487 (52.3) Median age in years (IQR) 32.3 (17.3) 32.3 (17.4) 32.8 (17.7) 32.9 (17.9) 32.6 (17.6) Number positive (%) 647 (24.1) 589 (24.5) 532 (24.4) 567 (25.9) 2,335 (24.7) % positive 3.1 2.8 2.5 2.7 2.8 Number males (% known) 416 (65.2) 422 (73.3) 380 (72.1) 424 (75.6) 1,642 (71.3) Median age in years (IQR) 35.4 (17.4) 34.1 (18.1) 34.1 (17.0) 32.7 (18.3) 34.1 (17.8) Black or Black British 6.9% HBV PositiveNumber tested (% known) 4,119 (2.8) 4,134 (2.8) 3,842 (2.7) 3,776 (2.8) 15,871 (2.8) Number males (% known) 1,688 (42.2) 1,778 (44.1) 1,767 (46.8) 1,857 (49.7) 7,090 (45.6) Median age in years (IQR) 33.6 (15.9) 33.8 (16.2) 34.5 (17.4) 34.5 (17.5) 34.1 (16.7) Number positive (%) 284 (10.6) 282 (11.7) 267 (12.3) 267 (12.2) 1,100 (11.6) % positive 6.9 6.8 6.9 7.1 6.9 Number males (% known) 156 (56.1) 168 (60.6) 169 (65.0) 185 (71.2) 678 (63.1) Median age in years (IQR) 34.7 (15.0) 36.0 (13.2) 36.8 (15.8) 36.0 (16.1) 35.8 (15.1) Other and/or mixed British 8.88% HBV PositiveNumber tested (% known) 5,965 (4.0) 5,988 (4.1) 5,990 (4.2) 5,622 (4.2) 23,565 (4.1) Number males (% known) 2,480 (42.9) 2,454 (42.0) 2,607 (44.4) 2,514 (45.3) 10,055 (43.6) Median age in years (IQR) 32.1 (15.5) 31.9 (15.8) 32.2 (15.8) 32.5 (16.7) 32.2 (15.9) Number positive (%) 560 (20.9) 511 (21.3) 497 (22.8) 521 (23.8) 2,089 (22.1) % positive 9.4 8.5 8.3 9.3 8.9 Number males (% known) 278 (51.7) 271 (54.2) 275 (56.6) 321 (62.6) 1,145 (56.2) Median age in years (IQR) 33.7 (16.3) 32.7 (14.6) 34.1 (16.5) 33.9 (14.8) 33.7 (15.6) White or white British 0.88% HBV PositiveNumber tested (% known) 117,252 79.0114,091 (78.4) 110,090 (77.9) 104,104 (77.5) 445,537 (78.2) Number males (% known) 55,838 (48.0) 54,812 (48.4) 54,140 (49.5) 52,483 (50.7) 217,273 (49.1) Median age in years IQR 38.4 (25.7) 38.6 (25.8) 39.0 (26.6) 39.4 (27.1) 38.8 (26.3) Number positive (%) 1,189 (44.4) 1,019 (42.4) 883 (40.5) 836 (38.2) 3,927 (41.6) % positive 1.0 0.9 0.8 0.8 0.9 Number males (% known) 767 (65.3) 602 (60.0) 553 (63.6) 535 (64.7) 2,457 (63.4) Median age in years (IQR) 38.3 (20.2) 37.4 (20.3) 37.0 (18.6) 36.7 (18.7) 37.3 (19.7) Unknown 1.55% HBV PositiveNumber tested 48,690 52,062 48,347 49,763 198,862 Number males (% known) 27,237 (57.4) 28,955 (57.4) 28,042 (60.2) 29,142 (60.8) 113,376 (58.9) Median age in years (IQR) 27.9 (14.6) 28.1 (14.4) 28.7 (14.3) 29.5 (14.5) 28.6 (14.5) Number positive 752 748 731 856 3,087 % positive 1.5 1.4 1.5 1.7 1.6 Number males (% known) 504 (68.9) 522 (71.5) 497 (70.1) 594 (70.9) 2,117 (70.4) Median age in years IQR32.1 (13.7) 31.8 (13.2) 32.5 (12.5) 32.4 (13.4) 32.2 (13.1) The reason why mums have half the standard prevalence is explained by the fact they are not retested with each pregnancy most mums having 2 to 3 children, the HBV positive are not tested as they are diagnosed on birth 1 usually. This would add 0.1 to 0.2% to the 0.55% noted. Also women have 50% lower infection rates than men due to boyhood wounds being twice as common. With 1 in 200 pregnancies now testing positive nationally and inner cities showing 1 in 50 - 100 many GP’s are dealing with this form of hbv infection the most. Trends in antenatal screening by ethnic group 0.55% HBV PositiveTable S 6. Trends women undergoing routine antenatal screening and testing positive for HbsAg by ethnic group$ ( 2008-2011)* HPA data 2008 2009 2010 2011 Total Asian or Asian British mums are 0.7% hbv positive Number screened (% known) 8,037 (11.9) 7,415 (12.0) 7,422 (12.0) 10,867 (15.1) 33,741 (12.8) Median age in years (IQR) 27.9 (7.8) 28.2 (8.0) 28.1 (7.7) 28.3 (7.6) 28.1 (7.7) Number positive (% known) 71 (18.8) 65 (19.2) 40 (12.0) 66 (20.4) 242 (17.7) % positive 0.9 0.9 0.5 0.6 0.7 Median age in years (IQR) 28.5 (8.3) 28.3 (8.6) 29.1 (10.0) 28.4 (8.9) 28.4 (8.6) Number tested for HBeAg (% HBsAg pos) 67 (94.4) 62 (95.4) 36 (90.0) 63 (95.5) 228 (94.2) Number HBeAg positive (% pos) 4 (6.0) 4 (6.5) 2 (5.6) 9 (14.3) 19 (8.3) Black or Black British mums are 3.1% hbv positiveNumber screened (% known) 1,725 (2.6) 1,601 (2.6) 1,588 (2.6) 1,687 (2.3) 6,601 (2.5) Median age in years (IQR) 29.3 (8.1) 29.2 (7.7) 29.5 (7.8) 29.3 (7.5) 29.3 (7.8) Number positive (% known) 65 (17.2) 49 (14.5) 60 (18.1) 33 (10.2) 207 (15.1) % positive 3.8 3.1 3.8 2.0 3.1 Median age in years (IQR) 28.9 (8.1) 29.9 (7.5) 29.4 (6.9) 28.8 (7.9) 29.5 (8.3) Number tested for HBeAg (% HBsAg pos) 64 (98.5) 48 (98.0) 60 (100.0) 32 (97.0) 204 (98.6) Number HBeAg positive (% pos) 2 (3.1) 2 (4.2) 3 (5.0) 2 (6.3) 9 (4.4) Other and/or mixed British mums are 3.8% hbv positiveNumber screened (% known) 2,322 (3.5) 2,365 (3.8) 2,473 (4.0) 2,629 (3.7) 9,789 (3.7) Median age in years (IQR) 29.5 (19.9) 29.3 (18.5) 29.5 (19.8) 29.6 (19.5) 29.5 (19.6) Number positive (% known) 102 (27.1) 99 (29.3) 93 (28.0) 79 (24.5) 373 (27.2) % positive 4.4 4.2 3.8 3.0 3.8 Median age in years (IQR) 26.6 (9.0) 26.2 (6.9) 27.1 (6.4) 26.9 (8.2) 26.8 (8.2) Number tested for HBeAg (% HBsAg pos) 101 (99.0) 94 (94.9) 89 (95.7) 78 (98.7) 362 (97.1) Number HBeAg positive (% pos) 35 (34.7) 24 (25.5) 31 (34.8) 21 (26.9) 111 (30.7) White or white British mums are 0.28% hbv positiveNumber screened (% known) 55,180 (82.0 50,411 (81.6 50,375 (81.4) 56,768 (78.9) 212,734 (80.9) Median age in years (IQR) 29.1 (9.6) 29.1 (9.4) 29.1 (9.2) 29.1 (9.1) 29.1 (9.3) Number positive (% known) 139 (36.9) 125 (37.0) 139 (41.9) 145 (44.9) 548 (40.0) % positive 0.3 0.2 0.3 0.3 0.3 Median age in years (IQR) 28.0 (8.3) 28.4 (8.7) 27.8 (8.4) 29.0 (8.6) 28.2 (8.6) Number tested for HBeAg (% HBsAg pos) 130 (93.5) 117 (93.6) 128 (92.1) 108 (74.5) 483 (88.1) Number HBeAg positive (% pos) 13 (10.0) 8 (6.8) 11 (8.6) 8 (7.4) 40 (8.3) Unknown mums are 2.64% hbv positiveNumber screened (% known) 524 623 676 1,339 3,162 Median age in years (IQR) 28.6 (7.5) 28.7 (7.8) 28.4 (8.0) 29.0 (7.9) 28.7 (7.9) Number positive (% known) 13 30 15 17 75 % positive 2.5 4.8 2.2 1.3 2.4 Median age in years (IQR) 29.2 (5.0) 27.6 (9.8) 22.5 (9.6) 31.9 (11.7) 28.0 (10.5) Number tested for HBeAg (% HBsAg pos) 13 (100.0) 28 (93.3) 15 (100.0) 15 (88.2) 71 (94.7) HBeAg positive (% pos) 2 (15.4) 5 (17.9) 2 (13.3) 1 (6.7) 10 (14.1) The reason why the HPA Chart below is of interest is we have excluded the testing for HBV in the health care areas one would expect or be more likely to find it, namely Renal Units, Liver Units, A n E Units, in the Drug & Sex Clinics, or via GP referrals, Prison Services, Occupational Services and also the fertility and Maternity Units. Below are the results of HBV testing on average normal UK wards.What we are seeing is that average UK patients meaning people who had accidents, people with heart trouble, people who need a hip replacement, standard average citizens are testing 1.9% HBV positive. This means that when you go to a ward to visit someone who has a bad attack of eczema, you are in a place that averaged over more than 100,000 tests over the last 4 years, you are in a place that is just about endemic for HBV.The vast bulk of these patients will be stunned by their diagnosis; we get many such calls on the helpline. This prevalence level is one of the few we have to indicate general public levels of infection in 2016 in the UK.3.3 Trends in testing by service type S 7. Trends in individuals tested and testing positive for HBsAg by service typeGeneral Wards (110,464 HBV tests)Child Wards (10,121 HBV tests)20082.5%0.5%20091.8%0.9%20101.6%0.8%20111.6%0.8%Total HBV Prevalence1.9%0.7%Of equal concern is the fact that our children when hospitalised for whatever reason, are showing a general HBV rate of 0.7% over the last few years averaged over more than 10,000 tests, a 1 in 140 infected rate. This reflected across our highly racially divided school system indicates that a large number of our inner city mainly ethnic schools may already be endemic for HBV also. A 0.7% lasting HBV infection rate will mean towards a 3% plus actual HBV rate of infection is present, this level represents a child in every classroom in the UK catching HBV if we factor a class size of 30. With an audited report of 8.7% of Somalian under fives catching hbv horizontally in Liverpool as almost our only targeted test data to work with, there is very real fear that one of the world’s most infectious child epidemics is simply being left to infect at will in the only nation yet to understand the value of universal hbv vaccination for endemic communities.This in turn is something noticed constantly on our help line. The greatest concern is children are more likely, between 4 and 20 times more likely, to develop lasting and incurable HBV infections. To date almost none of those at high risk in inner city schools or their parents and teachers, have any access to the facts, to HBV vaccinations or even as decreed by many Education Authorities, blood hygiene precautions or plasters. The last two schools we visited in the Watford locality, teachers professed “air” to be good for wounds and “touching” children with plasters to be avoided. ................
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