1 / 30

Surveillance of hepatitis C Infection in France

Surveillance of hepatitis C Infection in France. JC Desenclos, Département des Maladies Infectieuses Institut de Veille Sanitaire. Outline. Background Ongoing Surveillance HCV screening activity newly treated patients in reference centres blood donors & residual risk

elani
Télécharger la présentation

Surveillance of hepatitis C Infection in France

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Surveillance of hepatitis C Infection in France JC Desenclos, Département des Maladies Infectieuses Institut de Veille Sanitaire

  2. Outline • Background • Ongoing Surveillance • HCV screening activity • newly treated patients in reference centres • blood donors & residual risk • indicators of arm reduction activities • nosocomial HCV infections • Repeated surveys • HIV-HCV co-infection • prevalence and % of HCV infected screened • HCV associated deaths • Other projects

  3. HCV national prevention and control plan • National plan initiated by the Ministry of Health • Planned at the regional level • Secondary and tertiary prevention • screening of at risk groups (goal : 70% in 2002) • early follow up, management and treatment • Primary prevention • blood (NAT, 2001) and organ donation safety • harm reduction policy among IV drug users • control of iatrogenic transmission • health care related (standard precautions…) • tattooing, piercing…

  4. 5 4 3 1 2 Epidemiolgical profile • Prevalence : 1.1%; 500 000 - 650 000 with HCV antibodies of whom 80% are HCV RNA+ (1994) • Source of past infection: • Blood transfusion : 1/3 • IV drug use : 1/3 • iatrogenic : ?? 10-15% • Genotype : • “0bservatoire VHC” • 2000-2001 • Incidence : • ?

  5. Prevalence of HCV serum antibodies in 4 regions, France, 1994 Fécamp: 1,9% Lyon : 1,3%

  6. Proportion of HCV positive subjects who knew their status when screened, Social security examination center, Région Centre, France, 1993-2000 % Year Source : Dubois et al, Concours Médical

  7. Objectives of HCV surveillance • Data for decision making • burden • trends • risk factors • Evaluate prevention and control programs • screening activities • blood safety • IVDU harm reduction • Disease control : outbreak detection, investigation and control • Link and interaction with public health research

  8. Surveillance of laboratory HCV antibody screening activity • RENAVHC : network of hospitals and public laboratories nationally distributed (N = 257) • Initiated in 2000 • Activity by quarter • monitor screening activities • number of serologic tests done and of positive • test confirmation activity • basic characteristics of positive tests • Analysis by quarter and region (n = 22)

  9. Screening activity by quarter, RENAVHC network (n=257), France 2000

  10. Newly referred patients in hepatitis C reference centers • 30 reference centers • hepatology or gastro-enterology centers • designated by the ministry of health • coordinate a regional network of clinical care, information, treatment, prevention, training… • National surveillance network • reference centers-InVS (23 in 2000; 25 in 2001) • trend overtime in patient characteristics • case definition : newly referred hepatitis C • data : clinical, epidemiological and virological

  11. Newly referred HCV patients, “pôles de référence, 2000” : mode of discovery of HCV

  12. Newly referred HCV patients, “pôles de référence, 2000” : clinical stage 9,8 * * 1991-1993 : 20%; F. Roudot-Thoraval et al. Hepatology 1997 ; 26 : 485-90

  13. 34* 38* Newly referred HCV patients, “pôles de référence, 2000” : source of infection Suspected source of Women Men infection n (%) n (%) Transfusion 359 46,2 281 27,1 IV drug use 183 23,2 518 49,5 Nasal drug use 37 5,1 131 4,1 Professional exposure † 35 4,5 20 1,9 Nosocomial exposure ‡ 146 18,4 136 12,9 Other factors ¶ 146 18,7 202 19,4 No risk factors 99 12,3 115 10,7 total >100%, > to more than 1 risk factorr; †health care related ; ‡ dialysis, surgery, endoscopy ; ¶ acupuncture, injections, piercing, sexual partner HCV+ * : in 1991-2003 : 34 and 25%, respectively HCV-HIV co-infection : 7%

  14. Surveillance of blood safety • Collaborative surveillance between blood centers & InVS • HBV, HCV and HIV markers • all donors • repeat donors • denominators • characteristics of positive patients • Incidence among repeat donors • Estimate of residual risk

  15. 6,0 5,0 4,0 3,0 2,0 HBV HIV 1,0 HCV 0,0 HTLV 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 Source : GATT, InVS, INTS Incidence of HIV, HBV, HCV and HTLV among repeat blood donors, France, 1992-2000 Cases per 100 000 person year 3 years moving period

  16. Residual risk of transmission of blood-borne viruses per million blood donations, 1992-2000(Transfusion; 2002, in press) Risk per 1 000 000 9,0 8,0 7,0 6,0 5,0 4,0 3,0 HBV 2,0 HCV 1,0 HIV HTLV 0,0 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 3 years moving period Source : GATT, InVS, INTS

  17. Harm reduction activities : SIAMOIS • National data-base, stratified by district • Delivery indicators • number of syringes sold • number of steribox kit sold • amount of subutex sold • methadone • Impact indicators • overdose deaths • arrests for drug offense • National and local monitoring • Sharp drop in 1ml syringe sale in last year

  18. Notification of nosocomial infection events • Introduced in 2001 • Nosocomial sentinel events • based on criteria; no positive nor negative list • HCV and HBV infection following medical care • Notification • to local district health offices • inter-regional nosocomial coordination centers • national coordination : RAISIN-InVS

  19. Examples of notification of HCV iatrogenic transmission since July 2001 • Outbreak in an haemodialysis center, 2001 • 22 new infections; incidence : 52%person years • 3 genotypes • major breaches in hygiene procedures • case-control study: infection associated with : • care by a nurse who had just cared for an HCV+ patient • not to dialysis on a machine used previously by an HCV positive patient • Seroconversions associated with : • endoscopy (1) • inappropriate use of a glucometer (1)

  20. Surveys • Seroprevalence and behavioral surveys of IV drug users (InVS, INED, ANRS) • multi-city (5 to 6 large urban area) • cluster (multi site) probability sample • blood (finger) taken for HIV, HCV and HBV • questionnaire • pilot done in Marseille (April 2002) • Prevalence of HIV-HCV co-infection • National seroprevalence survey

  21. HIV-HCV co-infection • National probability sample of HIV wards • one day survey (June 2001) • in- and out- HIV positive patients • basic epidemiological and clinical characteristics • Results • N = 1744 • co-infecion : 28% (25-30 000 patients) • Among HCV patients, HIV infection : 7% • New survey planned in 2003 • hepatitis B markers • include hepatology wards

  22. % HCV infection among HIV patients, France, June 2001

  23. Population survey • Aim : evaluate HCV prevention plan • prevalence by age (18-80), gender, region (5 inter-regions) and social status (low vs others) • % of HCV+ subjects who knew HCV status • % of HCV+ patient that are taken in charge • Stratified probability cluster sample of social security affiliated • N = 15 000 • HCV and HBV • Planned for last quarter of 2002

  24. Mortality associated with hepatitis C • Vital statistics • Specific viral hepatitis included in 10th ICD • Not available in the 9th ICD: • chronic hepatitis • cirrhosis • carcinoma • Survey of death certificates (CépiDC-InVS) • retrospective survey of certifiers and medical records • random sample of certificates with mention of liver conditions and HIV • done in 1997 and planned in 2003 for (HCV and HBV)

  25. Death associated with chronic hepatitis per 100 000 population, by gender, France, 1979-1998. Source : CépiDC-INSERM

  26. Representative sample of death certificates with mention of liver disease (N = 360), France, 1997 Source : CépiDC

  27. Estimate of the number of deaths associated with HCV in 1997 • By applying sampling fraction • Deaths : 1 837, 95% CI : 1 740 - 1 930 • Death per 100 000 : 3,2; 95% CI : 2,9 - 3,3 • Initial versus associated cause of death : • initial : 630 • associated cause : 1207 • major role : 564 • not major : 643 • Total : 1837 Source : CépiDC

  28. Death rate associated to HCV infection by age and gender, France, 1997 Death per 100 000 Age Source : CépiDC

  29. Disease registries • Cancer registriy (Francim) • all cancers (liver cancer included) • covers 10 districts (12% of population) • certified, coordinated and funded jointly by InVS and INSERM • being strengthened to monitor long term trends • Cirrhosis registry • no registry in France • interaction between HCV, HBV and alcohol

  30. Public health research conducted under the auspices of ANRS • Case control study of HCV seroconversions • plan to include 70 cases and 280 controls • ongoing • Cohort study of HCV- intravenous drug users • north and east of France • one year follow up • basic incidence rate : ~ 10% person year • Sociological research : perception, barriers to screening, follow up, treatment; quality of life... • Cost-efficacy studies...

More Related