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Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review. BCCDC Hepatitis Site. 2000-2011. Site Investigator: Liza McGuinness. Overview. BCCDC EHSSS Two major goals: Obtain more accurate assessment of current infection levels Track HBV & HCV transmission risk factors

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Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

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  1. Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review BCCDC Hepatitis Site 2000-2011 Site Investigator: Liza McGuinness

  2. Overview • BCCDC EHSSS Two major goals: • Obtain more accurate assessment of current infection levels • Track HBV & HCV transmission risk factors • BCCDC site, province of British Columbia: • Responsible for most of BC (2000-2011 excluded City of Vancouver, 2012 → exclude Vancouver Coastal Health Authority) • Coordinated by Hepatitis, Clinical Prevention Services at BCCDC • Follow up all identified acute HBV and HCV

  3. Overview • Between 2000-2011 • 1180 individuals identified as of February 16, 2012 • 319 Acute HBV, 853 Acute HCV, 7 Acute HBV/HCV co-infection • HCV/HBV numbers decreasing

  4. Case Definitions • Acute HBV • HBsAg and HBcIgM reactive with compatible clinical history and symptoms • Acute HCV • Seroconversion from anti-HCV nonreactive to anti-HCV reactive within 12 months

  5. Challenges • Centralized acute HCV surveillance • Limited ability to contact acute HCV across the province from the BCCDC • Corrections • Restricted or no access to individuals who test positive in federal or provincial corrections

  6. Initiatives • Regular reconciliation process ongoing with lab, iPHIS & Vancouver EHSSS • Regional Health Authorities assuming EHSSS follow up for acute HCV (Interior, Fraser) • Future: federal & provincial corrections re: information access

  7. Demographics For all mono-infected cases 2000-2011 n= 319 acute HBV, n= 853 acute HCV

  8. Acute HBV Cases by Age

  9. Acute HBV Cases by Gender Infection predominates in males

  10. Acute HBV Cases by Health Authority * * Van Coastal cases exclude City of Vancouver (population 651,048 in 2011)

  11. Acute HCV Cases by Age

  12. Acute HCV Cases by Gender 82% (55/67) of those 19 or under diagnosed with acute HCV are female

  13. Acute HCV Cases by Health Authority * * Vancouver Coastal Cases do not include City of Vancouver † 8 cases not listed on chart originated in the Yukon

  14. Acute HBV/HCV Co-infection • 7 cases since 2000 (no new cases 2007-11) • 5 males 30-49 yrs; 2 females 20-29 yrs • 5 cases in VIHA, 1 in Interior, 1 in Fraser • 4 consecutive cases in Victoria from 2003-06 • 5 interviews • 2 had incarceration, sexual, IDU* & NIDU** risk factors • 2 had sexual, IDU and NIDU risk factors • 1 had been incarcerated & had sexual and NIDU risk factors * Injection Drug Use = IDU ** Non Injection Drug Use (Smoking crack pipes or snorting) = NIDU

  15. Interviews For all mono-infected cases for 2000-2011 n=191/319 acute HBV n=220/853 acute HCV

  16. Acute HBV Interviews by Year

  17. Acute HCV Interviews by Year * Corrections tracked starting in 2008

  18. Risk Factors For interviewed 2000-2011 acute HBV (n=191) acute HCV (n=220)

  19. Acute HBV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • 28% no risk factors identified (54/191) • 44% only 1 risk factor identified (84/191) • 41% - only sexual risk factors (79/191) • 2% - only IDU (3/191) • 1% - only NIDU (2/191)

  20. Acute HBV Risk factors 2000-11 In previous 12 mos before diagnosis: 28% had risk factor combinations (53/191) • 11% - NIDU & sexual risk factors (21/191) • 5% - IDU, NIDU & sexual risk factors (9/191) • 3% - IDU, NIDU, sex & incarceration risk factors (6/191) • 3% - IDU & sexual risk factors (5/191) • 2% - IDU, NIDU & incarceration (4/191) (Other risk factors or combinations = 4% (8/191))

  21. Acute HBV Risk factors 2000-11 In the previous 12 mos before diagnosis: • 17% - injection drug use (32/191) – in 3 cases was single risk factor • 7% - incarcerated – all in combination with drug use 13/191

  22. Acute HBV Risk Factors 2000-11 Lifetime risk factors: (84%) (39%) (14%) (26%) (24%) Different = sex with different gender; Same sex = sex with same gender

  23. Acute HBV IDU Proportions

  24. HBV Risk Factors 2000-11 • 17 cases did not report lifetime drug use, prison and/or sex risk factors • 3 - Medical exposure during travel to India • 2 - Travel to foreign country • 2 - Vertical transmission • 1 - Other horizontal transmission • 5 - Medical Related • 1 - Reported only medical procedure • 1 - Reported only surgery and acupuncture • 1 - Reported only blood transfusion • 1 - Reported only medical procedure and dental surgery • 1 – Reported injection from alternative practitioner

  25. Acute HCV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • No risk factors identified (10%, 22/220) • Only 1 risk factor identified (19%, 41/220) • 6% - injection drug use only (13/220) • 9% - only sexual risk factors (19/220) • 4% - non-injection drug use only (8/220) • <1% - incarceration only (1/220)

  26. Acute HCV Risk factors 2000-11 In the previous 12 mo’s before diagnosis: • 70% - injection drug use (153/220) (13/153 cases = single risk factor) • 15% - had been incarcerated (34/220) (1/34 case = single risk factor)

  27. Acute HCV Risk Factors Lifetime risk factors: (92%) (81%) (82%) (38%) (20%)

  28. HCV Risk Factors 2000-11 • 5 cases reported no lifetime drug use, prison or sex risk factors • 1 - Reported living with a son who was an IDU (2010) • 1 - Dialysis in India • 1 - Reported only medical procedure • 1 - Reported other exposure to needles & medical procedure (declined diff sex risk factor Q) • 1 - No risk factors identified from interview

  29. HBV & HCV Multiple Risk Factors • Number of participants reporting lifetime multiple risk factors for IDU, NIDU, • Different-Sex, Same-Sex and Incarceration: 46% 35% 25% 19% 18% 14% 13% 10%

  30. Increased % of acute HCV cases with multiple risk factors HBV & HCV Multiple Risk Factors Lifetime risk factor combinations

  31. Summary Acute Hepatitis B • Identified acute cases decreasing • Sexual exposure most predominant risk factor • Vaccination of those at risk in prison is important

  32. Summary Hepatitis C Virus • Identified acute cases now decreasing for last 3 years • Acute infections identified in youth occurring predominately in females • Unclear if due to testing bias or increased risk • Higher % of acute HCV clients present with multiple risk factors compared to acute HBV • IDU primary transmission mode reported • Incarceration remains an important correlate

  33. Acknowledgements • Thanks to Amanda Yu for her statistical expertise, Adrienne Pelton for data entry and interviewing, & our partners in public health who conduct interviews on behalf of the EHSSS

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