5.12.5. Control tools and policies
A policy for the avoidance of cirrhosis and other chronic
liver diseases is based on the control of HBV vaccination (sse Chapter 6),
control of HCV transmission (see Chapter 6) and of alcohol drinking.
Thus, control of alcohol drinking is the most immediate
instrument to obtain a favourable impact on cirrhosis (mortality), and should
therefore be widely adopted in all European countries.
See Chapter 8 for what concerns prevention of alcohol
Universal vaccination against HBV and control of HCV
infection will also have favourable impacts to control this cause of disease
and death ( see also Chapter 6).
There is inadequate information on the prevalence and
trends of HBV and HCV in various populations; consequently, their contribution
to cirrhosis mortality trends is difficult to quantify. However, at least part
of the favourable trends observed in Southern European countries is due to the
declined prevalence of HBV infection in younger generations. In fact, HBV serum
markers have considerably declined since the late 1970s in Italy, as in several
other developed areas of the world (D'Argenio et al, 1989;
Shapiro and Margolis, 1990; Stroffolini, 2005). In the absence of a vaccine, the
control of HCV has been later and less effective, but HCV prevalence has
remained low in most of Northern and central Europe, ranging between 1-2% in
most Western European countries but up to 5-10% in Italy (Alter et al, 1999;
Armstrong et al, 2000; Negri et al, 2004; Shepard et al, 2005).
There is no clear secondary prevention for cirrhosis and
no diagnostic test or screening program which can be recommended at population
level to avoid cirrhosis.
In subjects with cirrhosis, it is possible to reduce complications
and related mortality through the reduction or avoidance of alcohol drinking.
Control of alcohol drinking is also the key measure of
secondary prevention of cirrhosis complication and death. This is of specific
importance in areas of central, Eastern and Northern Europe, where cirrhosis
incidence and mortality has been substantially rising over the last few
Since the rise of alcohol drinking in those countries is
essentially related to a fall in the real cost of alcoholic beverages, fiscal
policies to rise the price of alcohol should be adopted, together with adequate
information and education policies in order to increase social acceptability of