Band C testing for over 35
As of 1 October, all people who have public health insurance in Germany are entitled to a free one-off test for viral hepatitis B and C as of the age of 35, as part of the general health check-up for those aged 35 and above. This regulation also applies retroactively to anybody took part in the general health check-up for those aged 35 and above since February 2018. These people are entitled to a separate viral hepatitis B and C test.
This general health check for the 35 + is fully paid for by all public sick funds every 3 years. It includes anamnesis, a clinical exam and laboratory tests, as well as a check on whether a patient has received all vaccinations for which they are eligible.
Why?
The Federal Joint Committee (Gemeinsamer Bundesausschuss) took the decision to include viral hepatitis B and C screening in this check-up 35 + in order to identify people with hitherto undiagnosed infections and enable their linkage to care and cure. This way the Committee also seeks to prevent potential follow-on diseases such as liver cirrhosis and cancer.
The Federal Joint Committee is Germany’s supreme decision-making body on healthcare provisions for all people with public health insurance in Germany. It comprises both representatives of both public sick funds (Krankenkassen) and of medical doctors. Whilst an independent body, government officials are responsible for the legal supervision of the Committee’s decisions and guidelines.
Viral hepatitis B and C are serious liver-related infections. They are rightly described as silent killers because they are symptomless for a long time and hence diagnosed late. People are often unaware of having been exposed to a risk of infection, such as through an unscreened blood donation, sharing of a needle, a needle prick injury with infected blood, through medical/ dental or cosmetic procedures in a non-sterile environment, or unsafe sex.
How?
People with public health insurance are offered a free test for viral hepatitis B and C. In a first step, the blood sample is tested for hepatitis B antigens and hepatitis C antibodies. If any of those is positive, a confirmatory diagnostic test is immediately performed using the same blood sample to identify hepatitis B virus DNA and/or hepatitis C virus RNA. Those people who tested positively are subsequently referred for the appropriate care and treatment is initiated.
Outcomes and Learnings / Recommendations
Whilst it is too early to discuss outcomes or learnings, the decision of Germany’s Federal Joint Committee to include viral hepatitis B and C tests in the free general health check up for those aged 35 and above is cognizant of the commitment made by the WHO in 2016 to eliminate viral hepatitis B and C as a public health threat by 2030. To date, the majority of people with a chronic infection are unaware of their diagnosis.
FUNDING
This one-off test for viral hepatitis B and C is free for all people with public health insurance who are 35 years or older. It is paid for by all public sick funds in Germany.
Contact
Markus Cornberg, Hannover Medical School
Cornberg.Markus@mh-hannover.de