Birth year distribution in reported hepatitis C cases in Switzerland
sanitization, and none in the movie theatre with manual sanitization. After the use, 20% of the samples were in the insufficient class in the cinemas with automatic sanitization system and 20% in the movie theatre with manual sanitization system. It should also be remarked that the TMC and COpS levels reported in our study are quite low and similar to the levels found on other hand-touch surfaces of public use.9,10 Among the microbiological indicators in this study, TMC was the most suggestive, showing differences between, before and after sanitation. More evidences on a larger sample of 3D glasses are needed to support microbiological risk evaluation to prevent false emergencies in public health.
References
Conflicts of interest: None declared.
Key points
1
Maino D. You can help your patients see 3-D. Rev Optom 2011;148:54–63.
2
Hecht J. 3-D TV and movies: exploring the hangover effect. Optics Photonics News 2011;22:20–7.
3
Howarth PA. Potential hazards of viewing 3-D stereoscopic television, cinema and computer games: a review. Ophthalmic Physiol Opt 2011;31:111–22.
4
Solimini AG, Mannocci A, Di Thiene D, La Torre G. A survey of visually induced symptoms and associated factors in spectators of three dimensional stereoscopic movies. BMC Public Health 2012;12:779.
5
American Public Health Association. A comparative microbiological evaluation of floor-cleaning procedures in hospital patient rooms. HIS 1970;7:256–64.
6
Li S, Eisenberg JN, Spicknall IH, Koopman JS. Dynamics and control of infections transmitted from person to person through the environment. Am J Epidemiol 2009; 170:257–65.
7
De Giusti M, Marinelli L, Aurigemma C, et al. Prevalence of Staphylococcus aureus colonization and antibiotic susceptibility: A survey among biomedical students. Public Health 2013;127:392–4.
8
Uhlemann AC, Knox J, Miller M, et al. The environment as an unrecognized reservoir for community-associated methicillin-resistant Staphylococcus aureus USA300: a case-control study. PLoS One 2011;6:22407.
9
Sexton T, Clarke P, O’Neill E, et al. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187–94.
10 Scott E, Duty S, McCue K. A critical evaluation of methicillin-resistant Staphylococcus aureus and other bacteria of medical interest on commonly touched household surfaces in relation to household demographics. Am J Infect Control 2009;37:447–53.
......................................................................................................... European Journal of Public Health, Vol. 25, No. 1, 141–143 The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cku095 Advance Access published on 24 July 2014
.........................................................................................................
Short Report
.........................................................................................................
Birth year distribution in reported hepatitis C cases in Switzerland Philip Bruggmann1, Jean-Luc Richard2, on behalf of the Swiss Hepatitis C Cohort Study Group3 1 Arud Centres for Addiction Medicine, Zurich, Switzerland 2 Federal Office of Public Health, Division of Communicable Diseases, Bern, Switzerland 3 Scientific committee: David Semela, Francesco Negro, Beat Mu¨llhaupt, Darius Moradpour, Raffaele Malinverni, Andreas Cerni, Meri Gorgievski, Markus Heim, Pierre-Yves Bochud, Martin Rickenbach, Nasser Semo, Thomas Fabbro Correspondence: Philip Bruggmann, MD, Arud Centres for Addiction Medicine, Konradstrasse 32, 8005 Zurich, Switzerland, Tel: +41 58 360 50 50, Fax: +41 58 360 50 19, e-mail: [email protected]
Data of the national hepatitis C virus (HCV) notification system and the Swiss hepatitis C cohort study have been analysed for birth year distribution. Persons born between 1955 and 1974 are disproportionally affected by HCV, accounting for 61% of all reported infections. Over the course of the reporting period from 1988 to 2012, the majority of affected persons were born in the mid-60s and a sharply increasing proportion between 1975 and 1984 (from 0.6 to 19.5%). To enhance the so far insufficient HCV detection rates in Switzerland, additional testing strategies such as birth cohort screening must be further evaluated and discussed.
.........................................................................................................
Introduction epatitis C is a contagious liver disease caused by the hepatitis C
Hvirus (HCV). Chronic hepatitis C is a major cause of morbidity
and mortality.1 In Switzerland, the estimated prevalence of hepatitis C is 0.8–1.8%.2 Although hepatitis C is a curable disease, treatment uptake rates are low (8%).3 In view of these factors and potentially
fatal consequences of the disease, Switzerland faces a major public health threat: an epidemic of chronic hepatitis infections.4 New better tolerated HCV medication have the potential to cure the majority of those infected. To use this potential and to address the public health problem, one of the first steps is improving on detection rates. Detecting an infection early, followed by assessing and treating it if needed, has the potential to significantly improve
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
3D movie glasses microbiological safety; manual vs. automatic sanitation systems for glasses; type of contamination in 3D movie glasses A 3D movie can evoke visual discomfort, and visual symptoms are common in sensitive viewers. No evidence is reported about microbiological safety of 3D glasses. Total mesophilic count, coagulase-positive staphylococci and mould and yeast levels reported in our study on the 3D glasses after and before the use are quite low.
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secondary prevention of chronic hepatitis and to reduce HCV transmission.5 According to estimations in Switzerland, around 50% of those affected are not being tested and therefore not being aware of their infection.6 Until 2012 the official detection strategy in Switzerland has only covered a screening for blood donations.7 According to estimates by the US Centers for Disease Control and Prevention (CDC), persons born between 1945 and 1965 make up 27% of the American population, and account for 75% of HCV infections.8 Based on these insights, the CDC recommended in 2012 that in addition to risk-based and provider-initiated testing, every person born between 1945 and 1965 should be tested, irrespective of any risk behaviour. The aim of this study is to analyse the birth year distribution among hepatitis C positive cases notified to the Swiss Federal Office of Public Health (FOPH).
Methods Swiss Federal HCV notification system
Swiss hepatitis C cohort The Swiss hepatitis C cohort study (SCCS) collects prospective data on adults aged >18 years with confirmed HCV infections through standardized questionnaires, clinical examinations and laboratory investigations.9 From 1 September 2000 to 17 October 2012, a total of 3882 people have been enrolled into the cohort.
Analysis All cases reported by the mandatory hepatitis C notification system of the FOPH since its introduction in 1988 until the end of 2012
Results Between 1988 and 2012, 45 037 cases of hepatitis C have been reported to the FOPH. A total of 60.6% of all infections affected persons born between 1955 and 1974 (1955–1964: 30.4%; 1965– 1974: 30.3%). Individuals born between 1945 and 1954 made up 10.7% of the HCV reported cases in Switzerland, whereas those born between 1975 and 1984 made up 10.4%, and 15.8% of the hepatitis C cases were born before 1945. Figure 1 shows the birth year distribution during different reporting periods. All reporting periods show peaks of reported cases among people born in the mid-60s. Individuals born between 1975 and 1984 make up an increasing number of cases over the years: they represent 0.6% of cases reported between 1988 and 1992, 3.1% between 1993 and 1997, 10.2% between 1998 and 2002, 15.4% between 2003 and 2007 and 19.5% between 2008 and 2012. In the SCCS, of all included 3882 patients, 65% were born between 1955 and 1974 (1955–1964: 36%; n = 1124, 29%). In all, 25% of the cohort population were born before 1955, 9% after 1974.
Discussion In Switzerland, individuals born between 1955 and 1974 make up 30% of the current (2011) population. Over the reporting period from 1988 to 2012, the population with these birth years accounts for >60% of all reported hepatitis C cases. In comparison with the birth year distribution in the USA, the most affected birth year cohorts are on average 10 years younger in Switzerland. One reason for this discrepancy could be
Figure 1 Number of reported hepatitis C cases by year of birth (1900–2012 cohorts) and period of reporting of the mandatory notification system in Switzerland, 1988–2012 (n = 45 037)
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
Hepatitis C has been a notifiable disease in Switzerland since 1988. Every confirmed hepatitis C infection has to be reported to the FOPH, together with personal data of the affected person. A test is notified by a laboratory as confirmed positive if there is a positive antibody (confirmed by an immunoblot test), antigen or HCV RNA test.
were analysed. Only reports from persons living in Switzerland were included in the analysis. Further on, we evaluated the distribution of birth year among the different periods of reporting (at 5-year intervals). To validate the results of this analysis, we compared them with the participants in the SCCS on 17 October 2012.
Birth year distribution in reported hepatitis C cases in Switzerland
Acknowledgements The authors wish to thank the Swiss hepatitis C cohort study for providing the data evaluated in this study and the physicians and laboratories for reporting the data to the notification system. Conflict of interest: The authors did not receive any funding in relation with this manuscript. P.B. has received project grants from and has served as advisory board member and speaker for Abbott, Janssen, Gilead, Merck and Roche. J.L.R. has no conflict of interests to declare.
Key points 61% of all reported hepatitis C cases in Switzerland are persons born between 1955 and 1974. This most affected cohort is 10 years younger than the one in the USA. Birth year cohort screening in addition to current detection strategies could enhance detection rates of HCV-infected people in Switzerland.
References 1
Lavanchy D. Chronic viral hepatitis as a public health issue in the world. Best Pract Res Clin Gastroenterol 2008;22:991–1008.
2
Bruggmann P, Berg T, Ovrehus AL, et al. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat 2014;21:5–33.
3
Lettmeier B, Muhlberger N, Schwarzer R, et al. Market uptake of new antiviral drugs for the treatment of hepatitis C. J Hepatol 2008;49:528–36.
4
Razavi H, Waked I, Sarrazin C, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today’s treatment paradigm. J Viral Hepat 2014;21:34–59.
5
European Centre for Disease Prevention and Control. Hepatitis B and C in the EU Neighbourhood: Prevalence, Burden of Disease and Screening Policies. Stockholm, 2010. http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_ C%20_EU_neighbourhood.pdf (30 June 2014, date last accessed).
6
Sagmeister M, Renner EL, Mullhaupt B, Wong JB. Simulation of hepatitis C based on a mandatory reporting system. Eur J Gastroenterol Hepatol 2002;14:25–34.
7
Fretz R, Negro F, Bruggmann P, et al. Hepatitis B and C in Switzerland—healthcare provider initiated testing for chronic hepatitis B and C infection. Swiss Med Wkly 2013;143:w13793.
8
Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep 2012;61:1–32.
9
Prasad L, Spicher VM, Zwahlen M, et al. Cohort Profile: the Swiss Hepatitis C Cohort Study (SCCS). Int J Epidemiol 2007;36:731–7.
10 Liu S, Cipriano LE, Holodniy M, Goldhaber-Fiebert JD. Cost-effectiveness analysis of risk-factor guided and birth-cohort screening for chronic hepatitis C infection in the United States. PLoS One 2013;8:e58975.
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
a later peak of intravenous drug use in Switzerland as a major mode of transmission. For Europe, there are no comparable data published. Hepatitis C does not only seem to affect mainly one specific generation in Switzerland (people born between 1955 and 1974). In more recent reporting periods, there seems to also to be an increasing number of persons affected who were born between 1975 and 1984. This could point towards a correlation between the age of 20–40 years and an increased risk of infection, possibly due to increased risk of IV drug use behaviour in that age. Owing to insufficient detection rates, the strategy of health-care provider–initiated identification of HCV infection among defined risk groups has been implemented recently.7 Year of birth is not included as a risk in this strategy. If the recently implemented strategy of provider-initiated riskstratified testing fails to substantially enhance HCV detection rates in Switzerland, birth year cohort screening could be a valuable add-on strategy. Birth year cohort screening has the advantage of being easier to talk about to the patient and has, therefore, the potential to be more readily accepted by both, physician and patient. Looking at the birth year structure of the reported hepatitis C cases during the past 25 years, birth year cohort screening in addition to current detection strategies could be a way to enhance testing rates in a high-risk population in Switzerland. Cost-effectiveness studies are required to decide whether such a measure should be implemented and to determine how it should be orientated to achieve optimal success.10
143
sanitization, and none in the movie theatre with manual sanitization. After the use, 20% of the samples were in the insufficient class in the cinemas with automatic sanitization system and 20% in the movie theatre with manual sanitization system. It should also be remarked that the TMC and COpS levels reported in our study are quite low and similar to the levels found on other hand-touch surfaces of public use.9,10 Among the microbiological indicators in this study, TMC was the most suggestive, showing differences between, before and after sanitation. More evidences on a larger sample of 3D glasses are needed to support microbiological risk evaluation to prevent false emergencies in public health.
References
Conflicts of interest: None declared.
Key points
1
Maino D. You can help your patients see 3-D. Rev Optom 2011;148:54–63.
2
Hecht J. 3-D TV and movies: exploring the hangover effect. Optics Photonics News 2011;22:20–7.
3
Howarth PA. Potential hazards of viewing 3-D stereoscopic television, cinema and computer games: a review. Ophthalmic Physiol Opt 2011;31:111–22.
4
Solimini AG, Mannocci A, Di Thiene D, La Torre G. A survey of visually induced symptoms and associated factors in spectators of three dimensional stereoscopic movies. BMC Public Health 2012;12:779.
5
American Public Health Association. A comparative microbiological evaluation of floor-cleaning procedures in hospital patient rooms. HIS 1970;7:256–64.
6
Li S, Eisenberg JN, Spicknall IH, Koopman JS. Dynamics and control of infections transmitted from person to person through the environment. Am J Epidemiol 2009; 170:257–65.
7
De Giusti M, Marinelli L, Aurigemma C, et al. Prevalence of Staphylococcus aureus colonization and antibiotic susceptibility: A survey among biomedical students. Public Health 2013;127:392–4.
8
Uhlemann AC, Knox J, Miller M, et al. The environment as an unrecognized reservoir for community-associated methicillin-resistant Staphylococcus aureus USA300: a case-control study. PLoS One 2011;6:22407.
9
Sexton T, Clarke P, O’Neill E, et al. Environmental reservoirs of methicillin-resistant Staphylococcus aureus in isolation rooms: correlation with patient isolates and implications for hospital hygiene. J Hosp Infect 2006;62:187–94.
10 Scott E, Duty S, McCue K. A critical evaluation of methicillin-resistant Staphylococcus aureus and other bacteria of medical interest on commonly touched household surfaces in relation to household demographics. Am J Infect Control 2009;37:447–53.
......................................................................................................... European Journal of Public Health, Vol. 25, No. 1, 141–143 The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/cku095 Advance Access published on 24 July 2014
.........................................................................................................
Short Report
.........................................................................................................
Birth year distribution in reported hepatitis C cases in Switzerland Philip Bruggmann1, Jean-Luc Richard2, on behalf of the Swiss Hepatitis C Cohort Study Group3 1 Arud Centres for Addiction Medicine, Zurich, Switzerland 2 Federal Office of Public Health, Division of Communicable Diseases, Bern, Switzerland 3 Scientific committee: David Semela, Francesco Negro, Beat Mu¨llhaupt, Darius Moradpour, Raffaele Malinverni, Andreas Cerni, Meri Gorgievski, Markus Heim, Pierre-Yves Bochud, Martin Rickenbach, Nasser Semo, Thomas Fabbro Correspondence: Philip Bruggmann, MD, Arud Centres for Addiction Medicine, Konradstrasse 32, 8005 Zurich, Switzerland, Tel: +41 58 360 50 50, Fax: +41 58 360 50 19, e-mail: [email protected]
Data of the national hepatitis C virus (HCV) notification system and the Swiss hepatitis C cohort study have been analysed for birth year distribution. Persons born between 1955 and 1974 are disproportionally affected by HCV, accounting for 61% of all reported infections. Over the course of the reporting period from 1988 to 2012, the majority of affected persons were born in the mid-60s and a sharply increasing proportion between 1975 and 1984 (from 0.6 to 19.5%). To enhance the so far insufficient HCV detection rates in Switzerland, additional testing strategies such as birth cohort screening must be further evaluated and discussed.
.........................................................................................................
Introduction epatitis C is a contagious liver disease caused by the hepatitis C
Hvirus (HCV). Chronic hepatitis C is a major cause of morbidity
and mortality.1 In Switzerland, the estimated prevalence of hepatitis C is 0.8–1.8%.2 Although hepatitis C is a curable disease, treatment uptake rates are low (8%).3 In view of these factors and potentially
fatal consequences of the disease, Switzerland faces a major public health threat: an epidemic of chronic hepatitis infections.4 New better tolerated HCV medication have the potential to cure the majority of those infected. To use this potential and to address the public health problem, one of the first steps is improving on detection rates. Detecting an infection early, followed by assessing and treating it if needed, has the potential to significantly improve
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
3D movie glasses microbiological safety; manual vs. automatic sanitation systems for glasses; type of contamination in 3D movie glasses A 3D movie can evoke visual discomfort, and visual symptoms are common in sensitive viewers. No evidence is reported about microbiological safety of 3D glasses. Total mesophilic count, coagulase-positive staphylococci and mould and yeast levels reported in our study on the 3D glasses after and before the use are quite low.
141
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European Journal of Public Health
secondary prevention of chronic hepatitis and to reduce HCV transmission.5 According to estimations in Switzerland, around 50% of those affected are not being tested and therefore not being aware of their infection.6 Until 2012 the official detection strategy in Switzerland has only covered a screening for blood donations.7 According to estimates by the US Centers for Disease Control and Prevention (CDC), persons born between 1945 and 1965 make up 27% of the American population, and account for 75% of HCV infections.8 Based on these insights, the CDC recommended in 2012 that in addition to risk-based and provider-initiated testing, every person born between 1945 and 1965 should be tested, irrespective of any risk behaviour. The aim of this study is to analyse the birth year distribution among hepatitis C positive cases notified to the Swiss Federal Office of Public Health (FOPH).
Methods Swiss Federal HCV notification system
Swiss hepatitis C cohort The Swiss hepatitis C cohort study (SCCS) collects prospective data on adults aged >18 years with confirmed HCV infections through standardized questionnaires, clinical examinations and laboratory investigations.9 From 1 September 2000 to 17 October 2012, a total of 3882 people have been enrolled into the cohort.
Analysis All cases reported by the mandatory hepatitis C notification system of the FOPH since its introduction in 1988 until the end of 2012
Results Between 1988 and 2012, 45 037 cases of hepatitis C have been reported to the FOPH. A total of 60.6% of all infections affected persons born between 1955 and 1974 (1955–1964: 30.4%; 1965– 1974: 30.3%). Individuals born between 1945 and 1954 made up 10.7% of the HCV reported cases in Switzerland, whereas those born between 1975 and 1984 made up 10.4%, and 15.8% of the hepatitis C cases were born before 1945. Figure 1 shows the birth year distribution during different reporting periods. All reporting periods show peaks of reported cases among people born in the mid-60s. Individuals born between 1975 and 1984 make up an increasing number of cases over the years: they represent 0.6% of cases reported between 1988 and 1992, 3.1% between 1993 and 1997, 10.2% between 1998 and 2002, 15.4% between 2003 and 2007 and 19.5% between 2008 and 2012. In the SCCS, of all included 3882 patients, 65% were born between 1955 and 1974 (1955–1964: 36%; n = 1124, 29%). In all, 25% of the cohort population were born before 1955, 9% after 1974.
Discussion In Switzerland, individuals born between 1955 and 1974 make up 30% of the current (2011) population. Over the reporting period from 1988 to 2012, the population with these birth years accounts for >60% of all reported hepatitis C cases. In comparison with the birth year distribution in the USA, the most affected birth year cohorts are on average 10 years younger in Switzerland. One reason for this discrepancy could be
Figure 1 Number of reported hepatitis C cases by year of birth (1900–2012 cohorts) and period of reporting of the mandatory notification system in Switzerland, 1988–2012 (n = 45 037)
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
Hepatitis C has been a notifiable disease in Switzerland since 1988. Every confirmed hepatitis C infection has to be reported to the FOPH, together with personal data of the affected person. A test is notified by a laboratory as confirmed positive if there is a positive antibody (confirmed by an immunoblot test), antigen or HCV RNA test.
were analysed. Only reports from persons living in Switzerland were included in the analysis. Further on, we evaluated the distribution of birth year among the different periods of reporting (at 5-year intervals). To validate the results of this analysis, we compared them with the participants in the SCCS on 17 October 2012.
Birth year distribution in reported hepatitis C cases in Switzerland
Acknowledgements The authors wish to thank the Swiss hepatitis C cohort study for providing the data evaluated in this study and the physicians and laboratories for reporting the data to the notification system. Conflict of interest: The authors did not receive any funding in relation with this manuscript. P.B. has received project grants from and has served as advisory board member and speaker for Abbott, Janssen, Gilead, Merck and Roche. J.L.R. has no conflict of interests to declare.
Key points 61% of all reported hepatitis C cases in Switzerland are persons born between 1955 and 1974. This most affected cohort is 10 years younger than the one in the USA. Birth year cohort screening in addition to current detection strategies could enhance detection rates of HCV-infected people in Switzerland.
References 1
Lavanchy D. Chronic viral hepatitis as a public health issue in the world. Best Pract Res Clin Gastroenterol 2008;22:991–1008.
2
Bruggmann P, Berg T, Ovrehus AL, et al. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat 2014;21:5–33.
3
Lettmeier B, Muhlberger N, Schwarzer R, et al. Market uptake of new antiviral drugs for the treatment of hepatitis C. J Hepatol 2008;49:528–36.
4
Razavi H, Waked I, Sarrazin C, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today’s treatment paradigm. J Viral Hepat 2014;21:34–59.
5
European Centre for Disease Prevention and Control. Hepatitis B and C in the EU Neighbourhood: Prevalence, Burden of Disease and Screening Policies. Stockholm, 2010. http://ecdc.europa.eu/en/publications/Publications/TER_100914_Hep_B_ C%20_EU_neighbourhood.pdf (30 June 2014, date last accessed).
6
Sagmeister M, Renner EL, Mullhaupt B, Wong JB. Simulation of hepatitis C based on a mandatory reporting system. Eur J Gastroenterol Hepatol 2002;14:25–34.
7
Fretz R, Negro F, Bruggmann P, et al. Hepatitis B and C in Switzerland—healthcare provider initiated testing for chronic hepatitis B and C infection. Swiss Med Wkly 2013;143:w13793.
8
Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep 2012;61:1–32.
9
Prasad L, Spicher VM, Zwahlen M, et al. Cohort Profile: the Swiss Hepatitis C Cohort Study (SCCS). Int J Epidemiol 2007;36:731–7.
10 Liu S, Cipriano LE, Holodniy M, Goldhaber-Fiebert JD. Cost-effectiveness analysis of risk-factor guided and birth-cohort screening for chronic hepatitis C infection in the United States. PLoS One 2013;8:e58975.
Downloaded from http://eurpub.oxfordjournals.org/ by guest on November 15, 2015
a later peak of intravenous drug use in Switzerland as a major mode of transmission. For Europe, there are no comparable data published. Hepatitis C does not only seem to affect mainly one specific generation in Switzerland (people born between 1955 and 1974). In more recent reporting periods, there seems to also to be an increasing number of persons affected who were born between 1975 and 1984. This could point towards a correlation between the age of 20–40 years and an increased risk of infection, possibly due to increased risk of IV drug use behaviour in that age. Owing to insufficient detection rates, the strategy of health-care provider–initiated identification of HCV infection among defined risk groups has been implemented recently.7 Year of birth is not included as a risk in this strategy. If the recently implemented strategy of provider-initiated riskstratified testing fails to substantially enhance HCV detection rates in Switzerland, birth year cohort screening could be a valuable add-on strategy. Birth year cohort screening has the advantage of being easier to talk about to the patient and has, therefore, the potential to be more readily accepted by both, physician and patient. Looking at the birth year structure of the reported hepatitis C cases during the past 25 years, birth year cohort screening in addition to current detection strategies could be a way to enhance testing rates in a high-risk population in Switzerland. Cost-effectiveness studies are required to decide whether such a measure should be implemented and to determine how it should be orientated to achieve optimal success.10
143
