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Geo-epidemiology of Hepatitis C in Northeast Indiana
Shori Gerardot, Ashley Cross, Atit Patel, Kassidy Beck MS, Scott M. Stienecker MD, and Teresa A. Beam PhD
Hepatitis C (HCV)
• ~180 million worldwide• ~2.7-3.9 million in US• Often asymptomatic acute infection• Becomes chronic 75-85%• Progressive liver disease• Blood-borne• Surrogate indicator of opioid
injection drug use
https://www.cdc.gov/hepatitis/statistics/
http://www.hepatitisc.uw.edu/pdf/evaluation-staging-monitoring/natural-history/core-concept/all
Hepatitis C – Disease Transmission
• Direct contact with blood from an infected person
• Most common route-sharing of contaminated needles and syringes by injection drug users
• Less common-sexual contact with an infected partner, sharing select household objects
• Health care workers through needle stick
• Babies born to infected mothers
https://www.hhs.gov/opa/sites/default/files/hepatitis-c-fact-sheet.pdf
Hepatitis C – Testing Recommendations
• Persons born from 1945 through 1965
• Persons who have ever injected illegal drugs
• Recipients of clotting factor concentrates made before 1987
• Recipients of blood transfusions or solid organ transplants before July 1992
• Long-term hemodialysis patients
• All persons with HIV infection or abnormal liver function or disease
• Children born to mothers who are hepatitis C positive
https://www.hhs.gov/opa/sites/default/files/hepatitis-c-fact-sheet.pdf
New Infections and Injection Drug Use in US
Reported cases of acute HCVinfection increased more than 2.9-fold from 2010 through 2015
https://www.cdc.gov/hepatitis/statistics/
https://www.cdc.gov/vitalsigns/opioid-prescribing/infographic.html#infographic1
Indiana Drug Overdose Deaths2010 - 2015
Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1.
• 30 states significant increase• In 2015, 595 in Indiana-
overdose involving opioidshttp://www.in.gov/isdh/26689.htm
http://in.gov/isdh/files/CountyProfilesOfOpioidUse2017.pdf
http://in.gov/isdh/files/CountyProfilesOfOpioidUse2017.pdf
Hepatitis C in NE Indiana2012 – 2015 ISDH• Chronic and Acute
• Case reports by county and zip code
• 99 chronic, 0 acute in Wabash Co.
from 2011-2015
• 34 chronic, 0 acute in Wabash Co.
in 2016*
*provisional, I-NEDSS
Incidence Rates Hepatitis C in NE Indiana2012 - 2015• Incidence/Total county population*
• By county and zip code
• Not reported here by 100,000 population
• Wabash Co., pop. ~32,000
National HCV Acute Incidence Demographics
• Young
• White
• Non-urban
• Appalachia, Midwest, New England
https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm
HCV case reports in NE Indiana health system by Age Group 2012-2015 (n=787)
Age
HCV case reports in NE Indiana health system 2012 – 2015 (n=787)
# HCV positivecases
Year
2012 2013
2014 2015
NE Indiana Health System HCV Genotype Distribution for 2012 -2015 (n=284)
NE Indiana Health System HCV Genotype 3 Distribution for 2012 -2015 (n=54)
3360024
2863735
2429006.267
4801232.07
0
1000000
2000000
3000000
4000000
5000000
6000000
1a 1b 2b 3a
Infe
ctio
us
Un
its/
mL
GenotypesTiters were measured in 150 patients with genotype 1a, 24 patients with genotype 1b, 19 patients with genotype 2b, and 53
patients with genotype 3a and their mean values are displayed in the graph.
RNA Titers vs HCV Genotypes
HCV Genotype 3• Most treatment resistant
• Patients progress more rapidly to fibrosis and cirrhosis
• Higher prevalence of severe steatosis (fatty liver)
• Higher incidence of hepatocellular carcinoma (liver cancer)
https://www.dndi.org/wp-content/uploads/2016/04/GlobalDist_HCV_genotypes.jpg
CDC - GHOST
https://www.cdc.gov/ophss/chiic/forums/2016-08-16-proof-of-concept.pdf
Conclusion• HCV case count up 3X from 2012 until 2015 in Wabash Co.
• Of all NE Indiana counties, Wabash Co. has the highest rate of non-fatal ED visits due to opioid overdose
• Of all NE Indiana counties, Wabash Co. has the highest rate of soft tissue infections due to drug abuse
• HCV genotype 3 incidence is higher than genotype 2 incidence in NE Indiana (limited EHR dataset)
• HCV case reports increasing for 20-29 and 30-39 age groups
in NE Indiana (limited EHR dataset)
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