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Saotharlann Náisiúnta Tagartha Viris UCD

National Epidemiology Profile. Dr. Jeff Connell Assistant Director National Virus Reference Laboratory. Saotharlann Náisiúnta Tagartha Viris UCD. UCD National Virus Reference Laboratory. National Epidemiology Profile. Presentation Background

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Saotharlann Náisiúnta Tagartha Viris UCD

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  1. National Epidemiology Profile Dr. Jeff Connell Assistant Director National Virus Reference Laboratory. Saotharlann Náisiúnta Tagartha Viris UCD UCD National Virus Reference Laboratory

  2. National Epidemiology Profile • Presentation • Background • Needle-stick investigations performed at the NVRL • National Epidemiological Data for HIV, HBV and HCV infection • What information is available • Limitations of the data

  3. Risk of blood-borne virus (BBB) transmission • Risk of transmission is probably directly related to the concentration of the virus (viral load) in the blood of the source patient at the time of exposure

  4. Risk of blood-borne virus (BBB) transmission • Risk of transmission of a BBV to HCW from infected patient following a single open-bore needle-stick injury is; • 20-30 % - HB eAg POSITIVE • 3% for anti-HCV positive source • 0.3% for anti-HIV positive source

  5. NVRL needle-stick investigations • Crude data – includes • Source investigations • Recipient investigations

  6. NVRL Data - samples referred for needlestick investigation (n = 6904)

  7. NVRL Data - Hospitals in the Dublin Area 49 % (3388/6904) of total needle-sticks 2003-2005

  8. HIV infection

  9. HIV

  10. HIV Viral load

  11. HIV National Data – End of December 2000

  12. HIV National Data – End of June 2005

  13. HIV National Data – Q1 and Q2 2005

  14. Hepatitis B

  15. Hepatitis B – Electron micrograph

  16. Natural History of HBV infection

  17. Hepatitis B infection in Ireland • Nationally the numbers of HBV infected individuals is not known • - data sources are • Individual studies: IVDU, prisoners - underestimate the national problem • NVRL database • HPSC data • ESEN 2 – European Sero-Epidemiology Network • Antenatal screening

  18. HBV National Data – Oral fluid study • 0.29% (5/1,714) samples positive for antibodies to HBc • age range: 34-70 years • sex : 3 male, 2 female • location: 3 urban, 2 rural • Adjusted prevalence for study design, estimated Irish population prevalence of HBV = 0.51%

  19. HBV NVRL Data August 2004 to August 2005 • Non- acute HBV 459 • Acute HBV 44 • Total 503

  20. HBV NVRL Data – Refugee reception Centres

  21. HBV NVRL Data – Maternity Hospitals

  22. HBV NVRL Data – Hospitals

  23. HBV NVRL Data Acute infection: n=44

  24. HBV National Data – HPSC

  25. HBV National Data – HPSC Rate of notified hepatitis B by acute and chronic status, age and sex, 2004 Acute HBV Chronic HBV

  26. HBV National Data – HPSC Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)

  27. Acute HBV National Data – HPSC Risk factors for acute cases of hepatitis B, 2004 & 2005 (end Aug) *Enhanced form received but no known risk factor

  28. Acute HBV National Data – HPSC Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)

  29. Chronic HBV National Data – HPSC Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

  30. Chronic HBV National Data – HPSC Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

  31. HBV National Data – HPSC Recent data Rate of notified hepatitis B in Quarter 4 2005 ACUTE CHRONIC

  32. Hepatitis C

  33. Hepatitis C

  34. Natural History of HCV infection Persistent High viral load – reaches a stable baseline

  35. Hepatitis C infection in Ireland • Numbers of HCV infected individuals not known • NVRL – HPSC database • National HCV database (blood and blood products) • Individual studies: IVDU, prisoners - underestimate the national problem • NVRL data

  36. Problems in the detection of HCV infected individuals • Unknown modes of transmission outside the classic “risk factors” • Asymptomatic acute and chronic infection • Atypical anti-HCV response • Delayed immune response - long window period before anti-HCV develops

  37. HCV Genotypic investigations in Ireland 1994 –2005 – NVRL DATA

  38. HCV Genotypes in Ireland 1994 –2005 – NVRL DATA (n – 8812)

  39. HCV National Data – HPSC

  40. HCV National Data – HPSC Number of notifications of HCV Q1, 2004 to Q4 2005

  41. National Epidemiology Profile - Conclusions • Needle-stick injuries are a substantial problem • Changing demographics in Ireland – increased level of HIV and HBV • National data is improving

  42. National Epidemiology Profile Acknowledgments: Dr. Lelia Thornton, HPSC Lindsay Jones. IT, NVRL Staff at the NVRL

  43. National Epidemiology Profile Thanks for your attention Any questions ?

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