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Enhanced Hepatitis Strain & Surveillance System (EHSSS) in Review

Explore the BCCDC's Enhanced Hepatitis Strain & Surveillance System from 2000-2009, analyzing data on HBV and HCV infections, transmission risk factors, case definitions, challenges, and future initiatives.

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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 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

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