A Cluster of Hepatitis C among Rural, Young Adults – Illinois, 2012

1. A Cluster of Hepatitis C among Rural, Young Adults – Illinois, 2012 Julia Howland, MPH CPH CDC/CSTE Applied Epidemiology Fellow Illinois Department of Public Health

2. Background: hepatitis C • Approximately 4.1 million Americans and 300 million people worldwide are infected with the hepatitis C virus (HCV) • Leading cause of chronic liver disease and liver transplantation and causes 10,000-20,000 deaths per year in the US • Male sex, black race, age 45-65, history of IDU, and receipt of a blood or soft tissue donation before 1992 are risk factors. Illicit, and specifically injection, drug use is the most common risk factor.

3. Hepatitis in young adults • Increased cases described in New York, Massachusetts and Wisconsin: • Young adults • White • Rural, suburban communities • Equal male and female • Injection opiate use (Onofrey, Church, Kludt et al, 2011)

4. Background: the outbreak • February 2012: a communicable disease nurse at a local health department (LHD) in a small, rural county in southern Illinois (county A) contacted the Illinois Department of Public Health (IDPH) to report four cases of acute HCV occurring within three months

5. Methods: case identification • Cases were defined as laboratory confirmed cases of HCV ages 15-34 (young adult) from January 2010 – present with a home address in County A • Cases were identified through provider reporting to the state reportable disease surveillance system and contact tracing • The LHD conducted initial interviews with the reported cases to determine risk factors and symptoms

6. Methods: data collection • Medical and public health records were abstracted for co-morbidities, risk behaviors, and HCV diagnosis • We interviewed cases for risk behaviors, symptoms, and contacts • Contacts were offered HCV testing and interviewed

7. Results: case characteristics • Thirteen cases were identified. Five met the case definition for acute infection • Ten (76.9%) were identified through surveillance, three (23.1%) were contacts • Four cases (30.8%) were interviewed • The mean age of cases was 25.2 (range 15-34) • All cases were white, non-Hispanic. Six cases were female. • Seven (53.8%) cases were symptomatic at the time of HCV diagnosis.

8. Results: co-morbidities • Eleven (84.6%) cases had a history of illicit drug use, ten (76.9%) of injection drug use • Six used methamphetamine and prescription opiates and five used heroin • Six of seven cases had mental health diagnosis • No cases had a history of HBV or HIV • Of the four cases interviewed, all reported sharing drug preparation equipment and drug snorting equipment. Three shared needles.

9. Case connections • Three interviewed cases identified contacts • Six of 13 cases connected to one another • Five through drug use • One through sexual contact

10. HCV in rural Illinois • In 2005, the state young adult rate was 8.4/ 100,000 young adults. By 2011, the rate was 28.0 • 50% female • 84.4% white • 2011 rate of HCV among young adults (age 15-34) in County A was 82.24/ 100,000 young adults

11. Conclusions • Hepatitis C is an emerging problem among young, rural adults • Enhanced surveillance may be warranted among young adults • Infection prevention efforts should focus on: • Safe injection practices • Provider awareness of HCV infection among young adults

12. Acknowledgments Dr. Yoran Grant Dr. Craig Conover The Illinois Department of Public Health The CDC/CSTE Applied Epidemiology Fellowship Program

13. Author contact Julia Howland Illinois Department of Public Health Division of Infectious Diseases 312-793-0098 Julia.Howland@Illinois.gov