5.12.5. Control tools and policies

Primary prevention

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 drinking .

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).

Secondary prevention and European policies

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 decades.

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 such measures.