PilotingHCVGHOSTinMichigan

November29,2017 JoeCoyle,MPH

www.michigan.gov/hepatitis

Outline

¨ MDHHSHCVSurveillance

¨ BasicsofHCVGHOST

¨ ExampleofGHOSTinAction

¨ ImplicationsforPublicHealthSurveillance

MDHHSHCVSurveillance

HCVReportinginMDSS,2016

NewHCVCasesbyYearofBirth,2016

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1925 1932 1939 1946 1953 1960 1967 1974 1981 1988 1995 2002 2009 2016

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bero

fCases

YearofBirth

NewHCVDiagnosesamong18-29YearOlds

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Num

bero

fCases

Year

Epidemiologyof2016YoungAdultHCVCasesAge(n=2060)

Median 25Mean 24.96Range 18- 29

Sex(n=2057) Rateper100,000Female 967(47.0%) 124.92Male 1090(53.0%) 138.09

Race(n=1524) Rateper100,000White 1351(88.6%) 110.60Black 139(9.1%) 54.04AmericanIndian 22(1.4%) 178.43Asian 12(0.8%) 24.38

HispanicEthnicity(n=1163) Rateper100,000HispanicorLatino 40(3.4%) 45.77NotHispanicorLatino 1123(96.6%) 71.83

HistoryofIVDU(n=978)Yes 823(84.2%)No 155(15.8%)

Howdoyouidentifyanoutbreak?Wheretofocusresources?

ChronicHCVCaseAcuteHCVCase

HCVinYoungAdults(2010-2015)

ChallengeswithTraditionalHCVSurveillanceAlone

¨ Largevolumeofcases¤Whichcasesmightreallyberelatedtoeachother?

¨ Largenumberofundiagnosedcasesduetoasymptomaticinfection¤ “Missinglinks”

¨ Timefromexposuretodiagnosis(acutevs.chronic)¤ E.g.anewcasein2016couldbeanepilinkofacasereportedin2012

¨ Geo-spatial-temporalrelationshipsbetweencases???

HCVGHOSTBasics

GlobalHealthOutbreakSurveillanceTechnology

GlobalHealthOutbreakSurveillanceTechnology

HCVGHOSTinpracticeHCVGHOSTinpractice

HCVMSMCluster

EpidemiologicInfo

CaseEpiInfoMedianAge:31AgeRange:21– 48yearsSex:Male(29)Race:AfricanAmerican(28),Hispanic(1)HCVGenotype:1a(16/16)Residence:Detroit(19),Wayne(5),

Oakland(3),Macomb(2)

CaseRiskFactorsIVDU:No(28)“Uppers”:No(28)HIV:Positive(29)SexualHistory:MSMorBi(29)PreviousSTDs:

Syphilis(21)LGV(6)GC(19)CT(16)

Other(HepatitisA,Giardia,Shigella,Cryptosporidium)

¨ 5acutecases,24chroniccasesperCDC/CSTEHCVcasedefinitions

“EpiCurve”

0

2

4

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Q12014

Q22014

Q32014

Q42014

Q12015

Q22015

Q32015

Q42015

Q12016

Q22016

Q32016

Q42016

Coun

t

Quarter-Year

DateofFirstPositiveHCVLab

Case(n=29)SuspectCase(n=10)

Howlargeisthecluster?

Arethecasespartofthesametransmissionnetwork?

HCVGHOSTTransmissionCluster

ImpactofGHOST

¨ Epidemiological,demographic,riskandpartner/contacttracingstillcruciallyimportanttocommunicablediseaseinvestigation¤ Butsometimesthisisn’tenoughfordeterminingpatientrelatedness

¨ Moleculardatacanhelppiecetogetherdisjointedorunrecognizedtransmissionnetworks¤ Forthisclusterinparticular,anonymoussexusinggeosocialnetworkingappswascommon(i.e.partnerswerenotoftenknown)

ImplicationsforPublicHealthSurveillance

ATheoreticalPublicHealthResponse

¨ Contacttracing¨ Education¨ Co-locationofservices:

¤ Referraltosubstanceabusetreatment¤ Patientcounseling¤ Cleanneedles¤ Overdoseprevention¤ HCV/HIVtesting¤ HepatitisA/Bvaccinations

¨ HCVTreatment?¨ InformingotherCD/Preventionareas(STD,HIV,etc.)

ATheoreticalPublicHealthResponse

ApplicationofGHOSTinMichigansofar

¨ PilotingHCVGHOSTtechnologyin-houseonconveniencesampleofHCVRNA+specimensreceivedbytheMDHHSBOL¤ 115specimenshavecurrentlyundergoneGHOSTanalysis¤ 1largeclusteramongtheHIV-infectedMSMpopulation¤ Handful2-3personclustersamongsuspectedPWIDs

¨ Inprocessofdevelopingprotocolsforinvestigation/follow-up¤ Howtorespondtoacluster?¤Whoresponds?

Thanks!

¨ CouncilofStateandTerritorialEpidemiologists:¤ ProjectstoAssessEmergingSurveillanceIssuesinSubstanceAbuseandMentalHealth

¨ AssociationofPublicHealthLaboratories:¤ PilotofGlobalHepatitisOutbreakandSurveillanceTechnology(GHOST)forMolecularSurveillanceofHCVInfection

¨ CDCDivisionofViralHepatitisLaboratory

¨ MDHHSBureauofLaboratories

¨ NationalAllianceofStateandTerritorialAIDSDirectors

THANKS!

JoeCoyle,MPHMichiganDepartmentofHealthandHumanServicesE-mail:MDHHS-Hepatitis@michigan.govPhone:517-335-8165Website:www.mi.gov/hepatitis