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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Impact of COVID-19 pandemic on hepatitis C elimination from the clinical microbi...
Journal Information
Vol. 39. Issue 9.
Pages 475-476 (November 2021)
Vol. 39. Issue 9.
Pages 475-476 (November 2021)
Scientific letter
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Impact of COVID-19 pandemic on hepatitis C elimination from the clinical microbiologist perspective. Are we ready?
Visión microbiológica del impacto de la pandemia de COVID-19 sobre la eliminación de la hepatitis C. ¿Estamos preparados?
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Antonio Aguileraa, José María Eirosb, Federico Garcíac,
Corresponding author
fegarcia@ugr.es

Corresponding author.
a Complejo Hospitalario Universitario de Santiago de Compostela, Departamento de Microbiología, Universidad de Santiago de Compostela e Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
b Hospital Universitario Río Hortega, Valladolid, Spain
c Hospital Clínico Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
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Spain has been recognised as one of the best-placed countries in the world to achieve the goal of eliminating hepatitis C by 20301–3, in accordance with the World Health Organization's (WHO) 2016 directives4. This has undoubtedly been aided in particular by the near-universal implementation of one-step diagnosis in microbiology departments of the National Health System5, as well as the incorporation of alerts in the reports issued6, and also, without doubt, strategic initiatives including diagnosis via dried blood spot (DBS) testing in settings with vulnerable and difficult-to-access populations, capture of recently diagnosed and unreferred patients, and finally, recapture of already-known patients with HCV infection who were lost to follow-up. Through all of these contributions, clinical microbiology has positioned itself as a central pillar of the HCV elimination strategy in Spain.

The COVID-19 pandemic has become a huge obstacle to achieving the WHO's ambitious goal of eliminating hepatitis C by 2030. In our country, the pandemic caused by SARS-CoV-2 has presented an immense challenge for our National Health System, especially as Spain has been one of the most affected countries. In the absence of a vaccine or effective treatment, diagnosis is the only way of being able to contain the pandemic, by detecting contagious individuals, isolating them to avoid new infections and starting contact tracing. This challenge therefore particularly affects our hospitals' microbiology departments, which are experiencing an exponential increase in diagnostic testing for SARS-CoV-2.

The consequences of the COVID-19 pandemic are starting to manifest in the negative impact that it is having, to varying degrees, on HCV elimination in different countries as a result of the availability or resources and priorities7,8. As microbiologists, we are also witnessing with concern the paralysis or deceleration, to a greater or lesser degree and for various reasons, of most of the initiatives listed above, and we believe that if this continues we run a serious risk of starting to go backwards in our efforts to eliminate hepatitis C.

It is therefore necessary to try as far as possible not to abandon these lines of action that have been so successful, though always remaining within the bounds of realistic optimism and in the hope that the negative economic effects of the pandemic will not have an impact at an institutional level on the clear benefit of hepatitis C elimination. Clinical microbiologists are truly “slaves” to this pandemic. Our “new normal” has enabled us to “get back to” our work, with the addition of the enormous care load resulting from the pandemic. As professionals, we need to design strategies to – in the case of hepatitis C elimination, and in many other fields where clinical microbiology plays a fundamental role – enable us to minimise the impact of the COVID-19 pandemic. Although this is a difficult task, we must fight to obtain the resources we need to be able to continue.

Finally, in spite of the negative impact, a glimmer of opportunity has presented itself: the pandemic has thrust to the forefront the use of mass testing, contact tracing, etc., and in this sense, when we look to a future without coronavirus, it is important that we consider certain new possibilities for hepatitis elimination, such as sample pooling strategies for population screening, as well as highlighting the value of active screening protocols for infection9.

In conclusion, as the European Association for the Study of the Liver makes clear in its latest document10, we will continue to work towards the goal proposed by the WHO of eliminating hepatitis C by 2030, constantly adapting to the COVID-19 pandemic our important diagnostic role in the treatment cascade that is key to eliminating HCV.

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H. Razavi, Y. Sanchez Gonzalez, C. Yuen.
Cornberg MGlobal timing of hepatitis C virus elimination in high-income countries.
Liver Int, 40 (2020), pp. 522-529
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J. Crespo, A. Albillos, M. Buti, J.L. Calleja, J. García Samaniego, M. Hernández Guerra, et al.
Eliminación de la hepatitis C. Documento de posicionamiento de la Asociación Española para el Estudio del Hígado (AEEH).
Gastroenterol Hepatol, 42 (2019), pp. 579-592
[3]
European Centre for Disease Prevention and Control.
Monitoring the responses to hepatitis B and C epidemics in EU/EEA Member States, 2019.
ECDC, (2020),
[4]
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Combating Hepatitis B and C to reach elimination by 2030.
WHO, (2016),
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J. Crespo, P. Lázaro, A.J. Blasco, A. Aguilera, J. García-Samaniego, J.M. Eiros, et al.
Hepatitis C reflex testing in Spain in 2019: a story of success.
Enferm Infecc Microbiol Clin, (2020),
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A pilot study on the implementation of reflex testing for the diagnosis of active hepatitis C virus infection at two healthcare centres.
Enferm Infecc Microbiol Clin, 37 (2019), pp. 348-349
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The Lancet Gastroenterology Hepatology.
Eliminating viral hepatitis in the COVID-19 era: weighing challenge and opportunity.
Lancet Gastroenterol Hepatol, 5 (2020), pp. 789
[8]
S. Blach, L.A. Kondili, A. Aghemo, Z. Cai, E. Dugan, C. Estes, et al.
Impact of COVID-19 on global hepatitis C elimination efforts.
[10]
T. Boettler, T. Marjot, P.N. Newsome, M.U. Mondelli, M. Maticic, E. Cordero, et al.
Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic.

Please cite this article as: Aguilera A, Eiros JM, García F. Visión microbiológica del impacto de la pandemia de COVID-19 sobre la eliminación de la hepatitis C. ¿Estamos preparados? Enferm Infecc Microbiol Clin. 2021;39:475–476.

Copyright © 2020. Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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