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Papatheodoridis G, Thomas HC, Golna C, Bernardi M, Carballo M, Cornberg M, Dalekos G, Degertekin B, Dourakis S, Flisiak R, Goldberg D, Gore C, Goulis I, Hadziyannis S, Kalamitsis G, Kanavos P, Kautz A, Koskinas I, Leite BR, Malliori M, Manolakopoulos S, Matičič M, Papaevangelou V, Pirona A, Prati D, Raptopoulou-Gigi M, Reic T, Robaeys G, Schatz E, Souliotis K, Tountas Y, Wiktor S, Wilson D, Yfantopoulos J, Hatzakis A. Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference. J Viral Hepat 2016; 23 Suppl 1:1-12. [PMID: 26809941 DOI: 10.1111/jvh.12493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/26/2022]
Abstract
In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
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Affiliation(s)
- G Papatheodoridis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - H C Thomas
- Hepatology and Gastroenterology Section, Department of Medicine, Imperial College, London, UK
| | - C Golna
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg
| | - M Bernardi
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - M Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Dalekos
- University of Thessaly Medical School, Karditsa, Greece
| | - B Degertekin
- Acibadem University Medical School, Istanbul, Turkey
| | - S Dourakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R Flisiak
- Medical University of Bialystok, Bialystok, Poland
| | | | - C Gore
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg.,World Hepatitis Alliance, The Hepatitis C Trust, London, UK
| | - I Goulis
- Medical School, Aristotle University, Thessaloniki, Greece
| | - S Hadziyannis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kalamitsis
- Hellenic Liver Patient Association "Prometheus", Athens, Greece
| | - P Kanavos
- London School of Economics, London, UK
| | - A Kautz
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - I Koskinas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - B R Leite
- National Parliament, Lisbon, Portugal
| | - M Malliori
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Manolakopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Matičič
- Viral Hepatitis Department, Infectious Diseases Clinic, University Medical Centre, Ljubljana, Slovenia
| | - V Papaevangelou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Pirona
- European Monitoring Center for Drugs and Drug Addiction, Lisbon, Portugal
| | - D Prati
- Alessandro Manzoni Hospital, Lecco, Italy
| | - M Raptopoulou-Gigi
- Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece
| | - T Reic
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - G Robaeys
- Department of Gastroenterology and Hepaatology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - E Schatz
- Correlation Network, Amsterdam, the Netherlands
| | | | - Y Tountas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Wiktor
- World Health Organization, Geneva, Switzerland
| | | | - J Yfantopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Souza VLD, Veras PST, Welby-Borges M, Silva TMC, Leite BR, Ferraro RB, Meyer-Fernandes JR, Barral A, Costa JML, de Freitas LAR. Immune and inflammatory responses to Leishmania amazonensis isolated from different clinical forms of human leishmaniasis in CBA mice. Mem Inst Oswaldo Cruz 2011; 106:23-31. [PMID: 21340351 DOI: 10.1590/s0074-02762011000100004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 11/04/2010] [Indexed: 11/22/2022] Open
Abstract
Leishmania amazonensis causes different diseases depending on the host and parasitic virulence factors. In this study, CBA mice were infected with L. amazonensis isolates from patients with localized (Ba125), diffuse cutaneous (Ba276) or visceral leishmaniasis (Ba109). Mice infected with Ba125 and Ba276 progressed rapidly and lesions displayed an infiltrate rich in parasitized macrophages and were necrotic and ulcerated. Ba109 induced smaller lesions and a mixed inflammatory infiltrate without necrosis or ulceration. Ba109 induced an insidious disease with lower parasite load in CBA mice, similar to human disease. Levels of IFN-γ, IL-4 and IL-10 did not differ among the groups. Because all groups were unable to control the infection, expression of IL-4 associated with low production of IFN-γ in the early phase of infection may account for susceptibility, but others factors may contribute to the differences observed in inflammatory responses and infection progression. Evaluation of some parasitic virulence factors revealed that Ba276 exhibits higher ecto-ADPase and 5'-nucleotidase activities compared to the Ba109 and Ba125 strains. Both Ba276 and Ba125 had higher arginase activity in comparison to Ba109. Finally, these data suggest that the differences in enzyme activities among parasites can account for differences in host inflammatory responses and infection progression.
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Affiliation(s)
- Valderes L de Souza
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brasil
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