1 / 33

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review . BCCDC Hepatitis Services Site. 2000-2009. Site Investigator: Liza McGuinness. Overview. BCCDC EHSSS - Public Health Agency of Canada sponsored project Two major goals:

livvy
Download Presentation

Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review BCCDC Hepatitis Services Site 2000-2009 Site Investigator: Liza McGuinness

  2. Overview • BCCDC EHSSS - Public Health Agency of Canada sponsored project • Two major goals: • Obtain more accurate assessment of current infection levels • Track HBV & HCV transmission risk factors • BCCDC site in BC: • Responsible for province of BC (excludes City of Vancouver) • Coordinated out of BC Hepatitis Services • Follows all acute HBV and HCV

  3. Overview • Between 2000-2009 • 1060 individuals identified as of Feb 12, 2010 • 305 Acute HBV, 748 Acute HCV, 7 Acute HBV/HCV co-infection • HCV numbers increasing/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 • Future: federal & provincial corrections re: information access

  7. Demographics For all mono-infected cases 2000-2009 n= 305 acute HBV, n= 748 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 * * Vancouver Coastal Cases exclude the City of Vancouver

  11. Acute HCV Cases by Age

  12. Acute HCV Cases by Gender 83% (54/65) 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 † 6 cases not listed on chart originated in the Yukon

  14. Acute HBV/HCV Co-infection • 7 cases since 2000 (no new cases 2007-9) • 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 2000-2009 n=177/305 acute HBV, n=185/748 acute HCV

  16. Acute HBV Interviews by Year

  17. Acute HCV Interviews by Year * Includes 5 cases still in follow up

  18. Risk Factors For interviewed 2000-2009 acute HBV (n=177) and HCV (n=185)

  19. Acute HBV Risk factors 2000-09 In the previous 12 mo’s before diagnosis: Only 1 risk factor identified (74/177, 42%) • 69/177, 39% - only sexual risk factors • 3/177, 2% - only used injection drugs • 2/177, 1% - only used non-injection drugs

  20. Acute HBV Risk factors 2000-09 In the previous 12 mos before diagnosis: Risk factor combinations (43/177, 24%) • 20/177, 11% - non-injection drug & sexual risk factors • 9/177, 5% - injection & non-injection drug use & sexual risk factors • 6/177, 3% - injection & non-injection drug use, sex & incarceration risk factors (all) • 5/177, 3% - injection drug use & sexual risk factors • 3/177, 2% - injection & non-injection drug use (Other risk factors or combinations = 7/177, 7%; No risk factors = 52/177, 29%)

  21. Acute HBV Risk factors 2000-09 In the previous 12 mos before diagnosis: • 30/177, 17% - injection drug use – in only 3 cases was single risk factor • 13/177, 7% - incarcerated – all in combination with drug use(10 IDU & NIDU, 3 NIDU only)

  22. Acute HBV Risk Factors 2000-09 Lifetime risk factors: Different = sex with different gender; Same sex = sex with same gender

  23. Acute HBV IDU Proportions

  24. HBV Risk Factors 2000-09 • 16 cases did not report drug use, prison and/or sex risk factors • 3 – Medical exposure during travel to India • 2 - Travel to foreign country • 3 - No risk factors identified from interview • 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 2000-09 In the previous 12 mo’s before diagnosis: Only 1 risk factor identified (34/185, 18%) • 13/185, 7% - injection drug use only • 13/185, 7% - only sexual risk factors • 7/185, 4% - non-injection drug use only • 1/185, <1% - incarceration only

  26. Acute HCV Risk factors 2000-09 In the previous 12 mo’s before diagnosis: • 130/185, 70% - injection drug use (13/129 cases = single risk factor) • 27/185, 15% - had been incarcerated (1/27 case = single risk factor)

  27. Acute HCV Risk Factors Lifetime risk factors:

  28. HCV Risk Factors 2000-09 • 4 cases reported no lifetime drug use, prison or sex risk factors • 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:

  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 increasing • 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 and to our partners in public health who conduct interviews on behalf of the EHSSS

More Related