Craig Regis, MPH Infectious Disease Bureau

Boston Public Health Commission

Epidemiology of Hepatitis C Boston, 2015

Picture from http://hepcsupport.org/ 2014

• Case definitions • Local data

– Demographics – Rates by neighborhood

• Hepatitis C in youth

Overview

• The following case reports were included in the data

Confirmed • Tests were positive HCV by viral load testing or a significant

antibody level followed by a confirmatory test or a single antibody test at a cutoff defined as positive by the manufacturer

Suspect/Probable • Tests were positive for antibody, but additional laboratory

information unknown

• Additional Information – Data for Boston residents only and accurate as of 6/15/2016 – Data reflect rates of reporting, not disease transmission

Case Definitions

• In Boston, there were 803 cases of hepatitis C reported to BPHC in 2015 – This translates into an incidence rate of 130 cases per

100,000 people

Boston: Hepatitis C Overview

Boston 2015: Reported Cases by Year

0

200

400

600

800

1000

1200

2010 2011 2012 2013 2014 2015

Ca

se C

ou

nt

Year

• The majority of cases in 2015 occurred in men (65%)

Boston 2015: Gender

N=803

277

525

0 100 200 300 400 500 600

Female

Male

Case Count

<1% were unknown/other

• White residents represented the greatest proportion of cases in 2015 (47%)

Boston 2015: Race

N=803

Asian 2%

Black 24%

Latino 14%

Other 1%

Unknown 12%

White 47%

• Most cases were reported in the 30-39 (23%) and 50-59 (24%) age range

Boston 2015: Age

N=803

1%

19%

23%

15%

24%

14%

4%

0%

5%

10%

15%

20%

25%

30%

< 20 20-29 30-39 40-49 50-59 60-69 70+

Pe

rce

nt

of T

ota

l Ca

ses

Age Group (Years)

• Genotype 1 was the most common in Boston in 2015

Boston 2015: Genotype

N=209

78%

8%

10%

4%

<1%

Genotype 1

Genotype 2

Genotype 3

Genotype 4

Genotype 6

• ONLY 22% of all hepatitis C cases were diagnosed at a congregate setting, including homeless shelters, drug treatment facilities, and correctional facilities

Boston 2015: Diagnoses at Congregate Settings

N=803

3%

9%

10%

78%

0%

Correctional Facility

Drug Treatment Program

Homeless Shelter

Neighborhood

Other

HCV rates by neighborhood, Boston 2015

• South End had the highest HCV rate rate at 307 cases per 100,000 compared to any other Boston neighborhood

HCV excluding congregate settings, Boston 2015

• Roxbury had the highest HCV rate at 168 cases per 100,000 when congregate settings were excluded

Boston 2011-2015: Risk Factors

*Note: These risks are not mutually exclusive ^Based on data as of 6/15/2016 and subject to change

Risk* 2011 2012 2013 2014 2015^

Injection Drug Use (IDU)

54% 55% 50% 49% 41%

Household Contact 4% 5% 3% 4% 4%

Sexual Partner 4% 3% 4% 4% 3%

Transfusion prior to 1992

4% 3% 3% 3% 3%

Hemodialysis 1% <1% 1% <1% 1%

• 41% of 2015 hepatitis C cases reported injection drug use (IDU) as a risk factor – Unknown IDU risk for 44% of cases

Hepatitis C in Boston Youth 15-25 2011 – 2015

• Between 2011 and 2015, there were 488 cases of hepatitis C reported in Boston residents between the ages of 15 and 25. – This represents over 10% of all hepatitis C cases during

this time period in Boston. – About 10% of all hepatitis C cases in 2015 were between

the ages of 15 and 25.

Boston: Focus on Youth

Boston 15-25 Year Olds: Cases by Year

0

20

40

60

80

100

120

140

2011 2012 2013 2014 2015

Ca

se C

ou

nt

Year N=488

Boston 15-25 Year Olds: Gender, 2011-2015

• Whereas the majority of all 2015 cases were men, the gender breakdown in 15-25 year olds was evenly split from 2011 to 2015

N=488* *<1% cases categorized as “other/unknown”

244

242

0 50 100 150 200 250 300

Female

Male

Case Count

• From 2011-2015, the majority (72%) of the hepatitis C cases in this age group were in White residents

Boston 15-25 Year Olds: Race, 2011-2015

N=488

Asian 2%

Black 6%

Latino 7%

Other 1%

Unknown 12%

White 72%

• 83% of the 488 hepatitis C cases in this age group were between ages 21-25

Boston 15-25 Year Olds: Age at Diagnosis, 2011-2015

0

20

40

60

80

100

120

140

15-17 18 19 20 21 22 23 24 25

Ca

se C

ou

nt

Age (Years)

N=488

• Genotype 1 was the most common in this age group in from 2011-2015

Boston 15-25 Year Olds: Genotype, 2011-2015

N=125

64% 10%

24%

1% 1%

Genotype 1

Genotype 2

Genotype 3

Genotype 4

Genotype 6

• ONLY 37% of all cases in this age group were diagnosed at congregate settings, including drug treatment programs, homeless shelters, and correctional facilities

Boston 15-25 Year Olds: Diagnoses at Congregate Settings, 2011-2015

N=488

2%

21%

14% 63%

<1%

Correctional Facility

Drug Treatment Program

Homeless Shelter

Neighborhood

Other

• Charlestown had the highest HCV rate in this age group at 253 cases per 100,000 per year compared to any other Boston neighborhood

HCV in 15-25 Year Olds, Boston 2011-2015

• Charlestown still had the highest HCV rate in this age group at 242 cases per 100,000 per year with congregate settings excluded

HCV in 15-25 Year Olds, excluding congregate settings 2011-2015

Boston 15-25 Year Olds: Substance Abuse History

*Note: These risks are not mutually exclusive ^Based on data as of 6/15/2016 and subject to change

2011 N=94

2012 N=112

2013 N=119

2014 N=84

2015^ N=79

Route Injection 69% 68% 65% 79% 65%

Intranasal 10% 18% 18% 15% 10%

Drug Class

Opiates 65% 55% 59% 55% 31%

Cocaine 29% 27% 25% 26% 23%

Benzodiazepines 14% 10% 10% 6% 4%

• Consistently high rates of hepatitis C in Boston • High rates in young adults and baby boomers • Some neighborhoods disproportionately affected by

the epidemic • Driven by injection drug use

Conclusions

Contact: Craig Regis cregis@bphc.org

Questions?