hepatitis c program and data update - ky chfs...•hepatitis c infection in an infant or a child...
TRANSCRIPT
Dr. Jeffrey D. Howard, Commissioner
Hepatitis C Program and Data Update
Amanda Wilburn, MPH
August 15, 2019
Viral Hepatitis Program Overview
Prevention Coordinator
Surveillance Coordinator
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Viral Hepatitis Program Overview
Program Coordinator
Surveillance Coordinator
Epidemiologist Electronic Laboratory
Reporting
Perinatal Hepatitis C Prevention and Analysis
Specialist
Epidemiologist Special Projects
Prevention Coordinator
Linkage to Care Specialist
Education and Technical Assistance Specialist
Hepatitis B Prevention and Analysis Specialist
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Estimated Rate of People Living with Hepatitis C, 2016
43,000 in Kentucky1,250 per 100,000
Rosenberg ES, Rosenthal EM, Hall EW, et al. Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016. JAMA Network Open. 2018;1(8):e186371. doi:10.1001/jamanetworkopen.2018.6371
Reported Confirmed Acute Hepatitis C: Kentucky and US, 2005 ‐ 2016
0
1
2
3
4
5
6
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Rate per 100
,000
KY USSurveillance for Viral Hepatitis – United States, 2016. Centers for Disease Control and Prevention.
Reported Confirmed Acute Hepatitis C: Kentucky, US and High‐Rate States, 2005 ‐ 2018
0
1
2
3
4
5
6
7
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Rate per 100
,000
KY WV TN MA USSurveillance for Viral Hepatitis – United States, 2016. Centers for Disease Control and Prevention.NEDSSWest Virginia, Tennessee and Massachusetts Viral Hepatitis Programs
Case Counts and Rates of Confirmed and Probable Acute HCV Infection, Kentucky 2013‐2018
Case Definition Change
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
0
50
100
150
200
250
300
350
2013 2014 2015 2016 2017 2018
Case Rate pe
r 100
,000
Num
ber o
f Cases
confirmed probable rate
Case Rates of Confirmed and Probable Acute HCV Infection by County, Kentucky, 2017
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Perinatal Hepatitis C
• 902 KAR 2:020 Reportable Disease Surveillance – amended February 2015• Hepatitis C infection in a pregnant woman • Hepatitis C infection in an infant or a child aged five years or less• Newborns born to Hepatitis C positive mothers at the time of delivery
• KRS 214.160 amended to establish that all pregnant women be tested for hepatitis C and recommend testing for children born from a pregnant women who has a positive hepatitis C test result – July 2018
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Perinatal Hepatitis C Reporting Discrepancy
Perinatal Reports received by the Viral Hepatitis ProgramHepatitis C Infection reported on Birth Certificate ‐ Kentucky’s Office of Vital Statistics
0
200
400
600
800
1000
1200
1400
2014 2015 2016 2017
Num
ber o
f Rep
orts
Hepatitis C Reports for Pregnant Women and Mothers in Kentucky by Reporting Source
Reported to KVHPP Reported on Birth Certificate
Reported Hepatitis C Status of Mother among Kentucky Resident Births, 2010 ‐ 2018
0
5
10
15
20
25
0
200
400
600
800
1000
1200
1400
2010 2011 2012 2013 2017 2015 2016 2017 2018
Rate per 1,000
Live Births
Num
ber w
ith Rep
orted He
patitis C
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Hepatitis C Infection reported on Birth Certificate ‐ Kentucky’s Office of Vital Statistics
Rate of Hepatitis C Infection among Pregnant Women per 1,000 Live Births, by County – Kentucky 2014‐2016
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Perinatal Reports received by the Viral Hepatitis ProgramBirth Certificate Records ‐ Kentucky’s Office of Vital Statistics
Medicaid Recipients Tested and Treated for Hepatitis C, 2017 and 2018
13
70270
21322
499 325
79647
22342
1924 7710
10000
20000
30000
40000
50000
60000
70000
80000
90000
Recipients Screened Chronic HCV Diagnosis Treated Follow‐up Testing
2017 2018
Kentucky Department of Medicaid Services
Electronic Laboratory Reporting
• 902 KAR 2:020 Reportable Disease Surveillance – amended October 1, 2016
• Hepatitis C laboratory tests results reportable, whether positive or negative
• Reported through the Kentucky Health Information Exchange (KHIE)• Flows through National Electronic Disease Surveillance System (NEDSS)
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Electronic Laboratory Reporting
OPPORTUNITIES• Identify acute cases• Identify gaps in confirmation testing
• Estimate prevalence• Cascade of cure• Reinfection
LIMITATIONS• Not all labs onboarded at once• KHIE switched vendors – silent period
• Volume and capacity• IT infrastructure
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Positive Confirmatory Hepatitis C Virus Results by County, January 2017 – June 2019
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Cascade of Cure – Goal of ELREXAMPLE
40000
21000
3000
14000
18000
5000
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Diagnosed Confirmed Cured Subsequently Infected
90
110
RNA Unknown
RNA (+) RNA (+)
RNA (‐)
RNA (+)
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Positive Ab or RNA
RNA (‐)
CDA Foundation
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• Non‐profit specializing in the study of complex and poorly‐understood diseases in order to provide countries with data and information to create and implement successful elimination strategies
• ASTHO funded• Disease burden modeling for HCV in Kentucky
• Viremic Infections• New HCV Infections• Continuum of Cure
Vulnerability Assessment – Tennessee Example
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Behavioral Risk Factor Surveillance System
• Hepatitis Module added to the 2019 Kentucky BRFSS Questionnaire • Module created by CDC Division of Viral Hepatitis• Hepatitis C
• Told by Provider• Treated 2015 or later• Treated before 2015• Current infection
• Hepatitis B• Told by provider• Currently on treatment
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