Epidemiology of Hepatitis C: Epidemiology of Hepatitis C


What is Epidemiology?: What is Epidemiology?


Ep-ardy: Ep-ardy


Answer: Epidemiology: Answer: Epidemiology What is 'The study of insects that cause inflammation of the skin'? What is 'The study of things that go bump in the night'? What is: 'The branch of medicine that deals with the study of the causes, distribution, and control of disease in populations'?


So then, what is Surveillance?: So then, what is Surveillance?


Choose the correct answer:: Choose the correct answer: Epidemiologic surveillance is: the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice closely integrated with the timely dissemination of these data to those who need to know all of the above


Today’s HCV Topics : Today’s HCV Topics Causes Risk factors Distribution Who and how many are affected Control


Just how Risky ARE these Risk Factors?: Just how Risky ARE these Risk Factors? Review of exposures known to be associated with Acute HCV Infections in the United States Injecting drug use Iatrogenic (unsafe injections) Transfusion, transplant from infected donor Occupational exposure to blood - Mostly needle sticks Birth to HCV-infected mother Sex with infected partner - Multiple sex partners


Injecting Drug Use & HCV Transmission: Injecting Drug Use andamp; HCV Transmission Highly efficient Contamination of drug paraphernalia, not just needles and syringes Rapidly acquired after initiation 30% prevalence after 3 years andgt;50% after 5 years Four times more common than HIV


Occupational Transmission of HCV: Occupational Transmission of HCV Inefficient Average incidence 1.8% following HCV-contaminated needle stick Associated with hollow-bore needles Case reports of transmission from blood splash to eye; one from exposure to non-intact skin Risk 10 times lower than for HBV infection HCW to Patient Transmission of HCV: RARE No restrictions for HCW Related to HCW substance abuse Prevalence 1-2% among health care workers Lower than adults in the general population


Perinatal Transmission of HCV: Perinatal Transmission of HCV Transmission only from women HCV-RNA positive at delivery Average rate of infection 6% Higher (17%) if woman co-infected with HIV Role of viral titer unclear No association with Delivery method Breastfeeding Infected infants do well Severe hepatitis is rare


Sexual Transmission of HCV: Sexual Transmission of HCV Occurs, but efficiency is low Low prevalence (1.5%) among long-term partners infections might be due to common percutaneous exposures (e.g., drug use), BUT Male to female transmission more efficient more indicative of sexual transmission MSM no higher risk than heterosexuals Factors that facilitate transmission unknown (e.g., viral titer) 15-20% of acute and chronic infections in US??? multiple opportunities for exposure! Large chronic reservoir Sex is a common behavior


Household Transmission of HCV: Household Transmission of HCV Rare but not absent percutaneous/mucosal exposures to blood Contaminated equipment used for home therapies IV therapy, injections Theoretically through sharing of contaminated personal articles (razors, toothbrushes)


Other Potential Exposures to Blood: Other Potential Exposures to Blood No or insufficient data showing increased risk: Intranasal cocaine use, tattooing, body piercing, acupuncture, military service No associations in acute case-control or population-based studies Cross-sectional studies in highly selected groups with inconsistent results Temporal relationship between exposure and infection usually unknown Couldn’t tell if the exposure occurred before disease Biologically plausible, but association or causal relationship not established Theoretically possible, but not proven


Distribution: Distribution


Hepatitis C Around the World: Hepatitis C Around the World Americas 13.1 million (1.7%) Eastern Mediterranean 21.3 million (4.6%) Africa 31.9 million (5.3%) Southeast Asia 32.3 million (2.15%) Europe 8.9 million (1.03%) Western Pacific 62.2 million (3.9%) World: 169.7 million (3.1%) prevalent cases


STATS: HCV Infection, USA: STATS: HCV Infection, USA # Persons ever infected (1.8%) 3.9 million (3.1-4.8) # Persons with chronic infection (0.96%) 2.7 million (2.4-3.0) # New infections per year 1985-89 242,000 2001 25,000 # Deaths from chronic disease/yr 8,000-10,000 from acute liver failure Rare


Incidence of Acute Hepatitis C, United States: Incidence of Acute Hepatitis C, United States Decline in transfusion recipients Decline in injection drug users


Reported Cases of Viral Hepatitis Infections, Arizona, 1994-2003: Reported Cases of Viral Hepatitis Infections, Arizona, 1994-2003


Slide20: Chlamydia 12,785 Gonorrhea 3576 Valley Fever 2695 Aseptic Meningitis 1516 VRE 1013 Genital Herpes Campylobacter 850 Salmonella 789 Inv Strep Pneumo 718 Shigella 572 Top 10 Reported Infectious Diseases of 2003, AZ


Slide21: Chlamydia 12,785 Gonorrhea 3576 Valley Fever 2695 Aseptic Meningitis 1516 VRE 1013 Genital Herpes Campylobacter 850 Salmonella 789 Inv Strep Pneumo 718 Shigella 572 Top 10 Reported Infectious Diseases of 2003, AZ Hep C 9744


Reported Cases of Acute HCV by Selected Risk Factors, US, 1982-2001: Reported Cases of Acute HCV by Selected Risk Factors, US, 1982-2001


HCV Prevalence by Select Groups, US: HCV Prevalence by Select Groups, US


The Face of Hepatitis C in Arizona: The Face of Hepatitis C in Arizona Caucasian Most cases Highest rates: African American Native American Male andgt;2/3 of cases 35-55 years old andgt;2/3 of cases


Breakdown by Race: Breakdown by Race


Disparities in Healthcare?: Disparities in Healthcare?


Co-Infection : Co-Infection 1154 prevalent HIV/AIDS cases coinfected with HCV (12%) 1447 total coinfected in database


Coinfection risk graph: Coinfection risk graph Coinfection: 1154 prevalent 1447 total


Control: Control


Reduce or Eliminate Risks for Acquiring HCV Infection: Reduce or Eliminate Risks for Acquiring HCV Infection Screen and test donors Virus inactivation of plasma-derived products Risk-reduction counseling and services Obtain history of high-risk drug and sex behaviors Provide information on minimizing risky behavior, including referral to other services Vaccinate against hepatitis A and/or hepatitis B Safe injection and infection control practices


Reduce Risks for Disease Progression and Further Transmission: Reduce Risks for Disease Progression and Further Transmission Identify persons at risk for HCV and test to determine infection status Routinely identify at risk persons through history, record review Provide HCV-positive persons Medical evaluation and management Counseling Prevent further liver damage Prevent transmission to others


Contributions to Epidemiology: Contributions to Epidemiology


Resources: Resources CDC http://www.cdc.gov http://www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm Slide set http://www.cdc.gov/ncidod/diseases/hepatitis/slideset/hep_c/slide_1.htm ADHS Hepatitis C Program 602-364-3658 ADHS HIV/AIDS Office 602-364-3610 bernsta@azdhs.gov