nat’l program epidemiologist, · hcv epi overview brigg reilley, npaihb, nat’l program...
TRANSCRIPT
In 20 minutes, we will cover
• Transmission/trends
• Screening
• HCV estimates: national, IHS, OK
(federal), Cherokee
Disclosures
• My powerpoint formatting skills are truly apalling
Risk Factors for Transmission of Hepatitis C
Injection Drug Use Male-Male Sex
Needlestick Injury Heterosexual Sex Mother to Child
Blood Products
Hepatitis C Prevalence (NHANES estimate)
Armstrong GL, et al. Ann Intern Med. 2006;144:705-14.;
Chak E, et al. Liver Int. 2011;31:1090-1101
3.2 Million HCV Antibody positive
Possibly up to 7.1 Million HCV Antibody positive in US
Source: Denniston M, et al. Hepatology. 2012:55:1652-61.
NHANES Survey, United States, 2001-2008
Awareness of HCV Infection Status
Unaware of HIV infection
21%
Knowledge of HCV Infection
NHANES Survey: United States, 1988-1994 and 1999-2002
Prevalence of HCV Antibody, by Year of Birth
Source: Armstrong GL, et al. Ann Intern Med. 2006;144:705-14.
Year of Birth
HC
V P
revale
nce(%
)
1910
1988–1994
1999–2002
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0
1920 1930 1940 1950 1960 1970 1980 1990
1945-1965
A 300% Increase in Hepatitis C –related
Hospitalization for AI/AN – 1995-2007
Byrd KK, et al Pub Hlth Rep 2011
HCV related mortality (CDC National Surveillance data, 2016)
• Rates nationally and among AI/AN
dropped slightly from 2015-2016
• But rates remain the highest of all race
ethnicities by far and double the national
rate (10.75/100,000 among AI/AN,
4.45/100,000 nationally)
OSDH recommends testing for the following
persons:
• Anyone born from 1945 through 1965.
• Anyone who has injected drugs, even just once or many years ago.
• Anyone with certain medical conditions, such as chronic liver
disease and HIV or AIDS.
• Anyone who has received donated blood or organs before 1992.
• Anyone with abnormal liver tests or liver disease.
• Anyone who has been exposed to the blood from a person who has
Hepatitis C.
• Anyone on hemodialysis.
• Anyone born to a mother with Hepatitis C
OK state data, 2015 acute HCV
• In 2015, a total of 92 cases reported and confirmed as
acute HCV in Oklahoma.
• 53.3% of these cases were among males, while 46.7%
were females.
• Age group 25-29 years of age had the most cases and
highest rates of all the diagnosed acute cases (21.7%).
• Whites made up 56.5% of the acute HCV cases were
White.
• 80.3% of acute HCV patients reported having two or
more sexual partners, while 62.5% reported using
needles for street drugs
Chronic Hepatitis C Infection Disproportionately
Affecting Oklahomans; OSDH Encourages Testing
For Release: April 26, 2017
• According to a newly released study, there are an estimated 94,200
Oklahomans living with Hepatitis C virus infection. Estimates were
developed by researchers at Emory University in conjunction with the
Centers for Disease Control and Prevention to better understand the
number of people in each state living with Hepatitis C.
• The Oklahoma State Department of Health (OSDH) is encouraging
residents to be tested for the virus as Oklahoma had the highest
estimated prevalence in the nation at 3.34 percent, while the national
prevalence was 1.67 percent. The report also indicates 523 Oklahomans
died due to Hepatitis C from 1999-2012, ranking our state among the
highest for Hepatitis C mortality.
Recommended Testing Sequence for Identifying
Current Hepatitis C Virus (HCV) Infection
Source: CDC. Testing for HCV infection: An update of guidance
for clinicians and laboratorians. MMWR. 2013;62(18).
* For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is
recommended. For persons who are immunocompromised, testing for HCV RNA can be considered.
† To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV antibody assay can be
considered. Repeat HCV RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical
evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen.
HCV
RNA Not detected Detected + -
No current HCV infection No HCV antibody detected Current HCV infection
Link to care Additional testing as appropriate†
STOP*
+ -
Slide courtesy AASLD Curriculum & Training
HCV Screening 2012-2017,
IHS federal sites, persons born 1945-1965
0
10
20
30
40
50
60
2012 2013 2014 2015 2016 2017
Universal HCV Screening,
Cherokee Nation From 8/16-12/17, the program screened
38,591 persons ages 20-69 for HCV
HCV Ab+ test reflexes to RNA confirmation
By Age Category (CNHS)
3.2%
3.9%
1.2%
23534
14387
670
0
5000
10000
15000
20000
25000
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
Younger Baby Boomers Older
Percent Positive
Number Tested
By Sex (CNHS)
4.5%
2.7%
15924
22654
0
5000
10000
15000
20000
25000
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
Men Women
Percent Positive
Number Tested
HCV new diagnoses, IHS data
IHS HCV new dx by age group,
2005-2015, national
Age (Years) Number (rate per 100,000)
<15 150 (3.3)
15-24 2,085 (67)
25-39 8,302 (235)
40-54 14,234 (496)
55+ 5,032 (199)
IHS new HCV dx by birth
cohort, 2005-2015, national
Birth Cohort Number (rate per 100,000)
Born Before 1945 1,118 (101)
Born 1945-1965
(Baby Boomers)
15,900 (478)
Born After 1965 12,785 (105)
IHS new HCV dx by sex,
2005-2015, national
No. (Rate/100,000)
Sex
Male 15,362 (193)
Female 14,441 (166)
IHS new HCV dx by region 2005-2015,
(national data) Region
Number (rate per
100,000)
Rate Ratio, 95%
Confidence Interval
P value
Alaska 2,743 (179) 0.81 (0.77-0.84) <0.0001
East 1,051 (197) 0.89 (0.84-0.95) 0.0005
Northern Plains East 1,875 (166) 0.75 (0.71-0.79) <0.0001
Northern Plains West 4,801 (224) 1.01 (0.98-1.05) 0.4462
Southern Plains 7,986 (221) Reference Reference
Southwest 5,538 (98) 0.44 (0.43-0.46) <0.0001
West 5,809 (286) 1.29 (1.25-1.34) <0.0001
Total 29,803 (179)
Cascade of Care, OK sites
Site 1 Site 2 Site 3 Site 4 Psite 5 Site 6 Site 7 Site 8 Comments
HCV Ab+ 800 323 79 181 233 136 16 1768
Ab+, RNA
neg
172 101 5 17 110 46 1 452 No further clinical
follow up needed
Ab+, RNA
unk
228 57 30 50 0 7 6 378 Need RNA testing
RNA + 400 160 44 114 144 60 7 929 Need to be cured
RNA+ and
Metavir 3-4
76 44 4 2 11 0 137 Late stage disease
need treatment ASAP
RNA+ and
Metavir 0-2
230 111 15 65 13 5 439
RNA+ and
Metavir unk
94 5 25 47 144 36 2 353 Need to have metavir
calculated
Currently in
tx
8 5 4 7 1 2 2 0
Treatment
complete,
SVR
106 48 8 48 7 15 15 2 Cured. Excellent
numbers
Treatment
complete,
SVR pending
18 23 3 11 13 6 6 0
Summary
• OKC Area is doing well overall compared
to other Areas, but each site needs
support to address gaps in the Cascade of
Care, namely
• Linking HCV patients to care for RNA
testing and Metavir scoring
• Increasing number of HCV patients in
treatment to cure existing patients in a
timely manner
Barriers ranked by SUs
• SUs cited the main barriers to increasing
HCV services as 1) needing more time to
work on HCV clinical services, 2)
contacting historical HCV patients to return
to care for confirmation or treatment, and
navigating the drug acquisition process.