Risk Behaviors Reported by Young Adults with Chronic Hepatitis C in Florida, March – July 2012

1. Risk Behaviors Reported by Young Adults with Chronic Hepatitis C in Florida, March – July 2012 Beth Ann Eichler MS, Catherine Lesko MPH, Janet Hamilton MPH - Florida Department of Health Background Results • Of the 897 eligible cases identified, 90% (n=804) were investigated, and 46% (n=373) of those were able to be contacted. Interviews were completed for 85% (n=317) of those contacted (Figure 1). • More than 80% of those interviewed reported using street drugs (n=248) and 71% reported abusing prescription drugs. The most commonly reported drugs used were marijuana/hash (88%), oxycontin/oxycodone (75%) and powder cocaine (71%). • More than 3/4 of illicit drug users reported injection drug use (IDU). Oxycodone/oxycontin (including roxycodone) was the most commonly injected drug. Of those reporting recent IDU (within 6 months), 97% reported sharing needles. • Twenty-eight percent of all people interviewed reported symptoms of acute hepatitis or elevated liver enzymes at the time of HCV testing. These cases likely represent acute infections. Extrapolating to all chronic hepatitis C cases in young adults equates to 447 acute cases incorrectly reported as chronic in Florida per year. Figure 1: Cases meeting eligibility criteria for chronic hepatitis C in young adults (18-30 years) enhanced surveillance protocol, Florida, March 1 – July 31, 2012 Table 1: Demographics of the young adult population (18-30 years), chronic hepatitis C cases reported between March 1 and July 31 2012 in participating counties, and cases interviewed, Florida, March 1 – July 31, 2012 • The rate of chronic hepatitis C cases among Floridians aged 18 to 30 years has been increasing since 2005. The majority of chronic hepatitis C virus (HCV) infections reported in Florida still occur among persons 45 to 64 years old (the “baby boomer” generation) but the rates of newly reported chronic infections in that population leveled off in 2008 while those in young adults have continued to increase. This trend is of concern because while older adults were likely infected years or decades ago, HCV infections in younger adults can be more recent, possibly acute infections, resulting from current risk behaviors. • Acute and chronic HCV cases have the same laboratory criteria for diagnosis and cannot be distinguished without symptom information. In 2011, 18,407 chronic hepatitis C cases were reported in Florida, compared to only 100 acute hepatitis C cases. • The Florida Department of Health (FDOH) undertook to: • Prospectively collect risk factor information for a sample of young adults with chronic HCV infection. • Identify cases of acute HCV infection misclassified as chronic. Figure 3: Most common risk factors reported by people with chronic hepatitis C aged 18-30 years eligible for inclusion in enhanced surveillance project, Florida, March 1 – July 31, 2012 Figure 2: Rates of newly reported chronic hepatitis C (confirmed, probable and suspect case classification), by sex and age group, Florida 2003-2012 Cases per 100,000 population Methods • Health department staff attempted to contact people aged 18-30 years with a chronic HCV infection reported between March 1 and July 31, 2012 in 14 participating counties. • An interview tool was developed to collect specific risk factor information. • Changes were made to the state’s reportable disease surveillance system to capture the data electronically. • Data were analyzed using SAS 9.3 (Gary, NC). • Final proportions were calculated using a denominator that excluded ‘Missing’ responses. Conclusions Acute hepatitis C is underreported in Florida. Many chronic hepatitis C cases reported in young adults are in fact acute infections. Despite being reportable by Florida law, symptom information and liver function tests for viral hepatitis cases are often not reported to FDOH, highlighting deficiencies in acute hepatitis C reporting by health care providers. Prescription drug abuse in Florida seems to be contributing to hepatitis C infections in a unique way compared with other states (Hepatitis C Virus infection among adolescents and young adults – Massachusetts, 2002-2009. MMWR, 2011; 60(17):537-541.).Prescription opioids were the most commonly named drugs by current injection drug users.