1 / 33

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review. BCCDC Hepatitis Site. 2000-2011. Site Investigator: Liza McGuinness. Overview. BCCDC EHSSS Two major goals: Obtain more accurate assessment of current infection levels Track HBV & HCV transmission risk factors

crete
Télécharger la présentation

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

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. Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review BCCDC Hepatitis Site 2000-2011 Site Investigator: Liza McGuinness

  2. Overview • BCCDC EHSSS Two major goals: • Obtain more accurate assessment of current infection levels • Track HBV & HCV transmission risk factors • BCCDC site, province of British Columbia: • Responsible for most of BC (2000-2011 excluded City of Vancouver, 2012 → exclude Vancouver Coastal Health Authority) • Coordinated by Hepatitis, Clinical Prevention Services at BCCDC • Follow up all identified acute HBV and HCV

  3. Overview • Between 2000-2011 • 1180 individuals identified as of February 16, 2012 • 319 Acute HBV, 853 Acute HCV, 7 Acute HBV/HCV co-infection • HCV/HBV numbers decreasing

  4. Case Definitions • Acute HBV • HBsAg and HBcIgM reactive with compatible clinical history and symptoms • Acute HCV • Seroconversion from anti-HCV nonreactive to anti-HCV reactive within 12 months

  5. Challenges • Centralized acute HCV surveillance • Limited ability to contact acute HCV across the province from the BCCDC • Corrections • Restricted or no access to individuals who test positive in federal or provincial corrections

  6. Initiatives • Regular reconciliation process ongoing with lab, iPHIS & Vancouver EHSSS • Regional Health Authorities assuming EHSSS follow up for acute HCV (Interior, Fraser) • Future: federal & provincial corrections re: information access

  7. Demographics For all mono-infected cases 2000-2011 n= 319 acute HBV, n= 853 acute HCV

  8. Acute HBV Cases by Age

  9. Acute HBV Cases by Gender Infection predominates in males

  10. Acute HBV Cases by Health Authority * * Van Coastal cases exclude City of Vancouver (population 651,048 in 2011)

  11. Acute HCV Cases by Age

  12. Acute HCV Cases by Gender 82% (55/67) of those 19 or under diagnosed with acute HCV are female

  13. Acute HCV Cases by Health Authority * * Vancouver Coastal Cases do not include City of Vancouver † 8 cases not listed on chart originated in the Yukon

  14. Acute HBV/HCV Co-infection • 7 cases since 2000 (no new cases 2007-11) • 5 males 30-49 yrs; 2 females 20-29 yrs • 5 cases in VIHA, 1 in Interior, 1 in Fraser • 4 consecutive cases in Victoria from 2003-06 • 5 interviews • 2 had incarceration, sexual, IDU* & NIDU** risk factors • 2 had sexual, IDU and NIDU risk factors • 1 had been incarcerated & had sexual and NIDU risk factors * Injection Drug Use = IDU ** Non Injection Drug Use (Smoking crack pipes or snorting) = NIDU

  15. Interviews For all mono-infected cases for 2000-2011 n=191/319 acute HBV n=220/853 acute HCV

  16. Acute HBV Interviews by Year

  17. Acute HCV Interviews by Year * Corrections tracked starting in 2008

  18. Risk Factors For interviewed 2000-2011 acute HBV (n=191) acute HCV (n=220)

  19. Acute HBV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • 28% no risk factors identified (54/191) • 44% only 1 risk factor identified (84/191) • 41% - only sexual risk factors (79/191) • 2% - only IDU (3/191) • 1% - only NIDU (2/191)

  20. Acute HBV Risk factors 2000-11 In previous 12 mos before diagnosis: 28% had risk factor combinations (53/191) • 11% - NIDU & sexual risk factors (21/191) • 5% - IDU, NIDU & sexual risk factors (9/191) • 3% - IDU, NIDU, sex & incarceration risk factors (6/191) • 3% - IDU & sexual risk factors (5/191) • 2% - IDU, NIDU & incarceration (4/191) (Other risk factors or combinations = 4% (8/191))

  21. Acute HBV Risk factors 2000-11 In the previous 12 mos before diagnosis: • 17% - injection drug use (32/191) – in 3 cases was single risk factor • 7% - incarcerated – all in combination with drug use 13/191

  22. Acute HBV Risk Factors 2000-11 Lifetime risk factors: (84%) (39%) (14%) (26%) (24%) Different = sex with different gender; Same sex = sex with same gender

  23. Acute HBV IDU Proportions

  24. HBV Risk Factors 2000-11 • 17 cases did not report lifetime drug use, prison and/or sex risk factors • 3 - Medical exposure during travel to India • 2 - Travel to foreign country • 2 - Vertical transmission • 1 - Other horizontal transmission • 5 - Medical Related • 1 - Reported only medical procedure • 1 - Reported only surgery and acupuncture • 1 - Reported only blood transfusion • 1 - Reported only medical procedure and dental surgery • 1 – Reported injection from alternative practitioner

  25. Acute HCV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • No risk factors identified (10%, 22/220) • Only 1 risk factor identified (19%, 41/220) • 6% - injection drug use only (13/220) • 9% - only sexual risk factors (19/220) • 4% - non-injection drug use only (8/220) • <1% - incarceration only (1/220)

  26. Acute HCV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • 70% - injection drug use (153/220) (13/153 cases = single risk factor) • 15% - had been incarcerated (34/220) (1/34 case = single risk factor)

  27. Acute HCV Risk Factors Lifetime risk factors: (92%) (81%) (82%) (38%) (20%)

  28. HCV Risk Factors 2000-11 • 5 cases reported no lifetime drug use, prison or sex risk factors • 1 - Reported living with a son who was an IDU (2010) • 1 - Dialysis in India • 1 - Reported only medical procedure • 1 - Reported other exposure to needles & medical procedure (declined diff sex risk factor Q) • 1 - No risk factors identified from interview

  29. HBV & HCV Multiple Risk Factors • Number of participants reporting lifetime multiple risk factors for IDU, NIDU, • Different-Sex, Same-Sex and Incarceration: 46% 35% 25% 19% 18% 14% 13% 10%

  30. Increased % of acute HCV cases with multiple risk factors HBV & HCV Multiple Risk Factors Lifetime risk factor combinations

  31. Summary Acute Hepatitis B • Identified acute cases decreasing • Sexual exposure most predominant risk factor • Vaccination of those at risk in prison is important

  32. Summary Hepatitis C Virus • Identified acute cases now decreasing for last 3 years • Acute infections identified in youth occurring predominately in females • Unclear if due to testing bias or increased risk • Higher % of acute HCV clients present with multiple risk factors compared to acute HBV • IDU primary transmission mode reported • Incarceration remains an important correlate

  33. Acknowledgements • Thanks to Amanda Yu for her statistical expertise, Adrienne Pelton for data entry and interviewing, & our partners in public health who conduct interviews on behalf of the EHSSS

More Related