Scioto County Medical Scioto County Medical SocietySociety

Grand RoundsGrand RoundsMarch 31, 2006March 31, 2006

Portsmouth, OhioPortsmouth, Ohio

Kathleen M. Koechlin, RN, MPH, Kathleen M. Koechlin, RN, MPH, PhDPhD

Hepatitis C CoordinatorHepatitis C CoordinatorThe Ohio Department of HealthThe Ohio Department of Healthkathleen.koechlin@odh.ohio.govkathleen.koechlin@odh.ohio.gov

The Epidemiology of The Epidemiology of Hepatitis CHepatitis C

Worldwide: Worldwide: Approximately 180 million people (3.0% of Approximately 180 million people (3.0% of

the world population) are infected with HCV.the world population) are infected with HCV. Approximately 130 million are chronic Approximately 130 million are chronic

carriers.carriers. Approximately 3-4 million people are newly Approximately 3-4 million people are newly

infected each year.infected each year. 70% of these will develop chronic HCV.70% of these will develop chronic HCV.

HCV is responsible for 50-76% of all liver HCV is responsible for 50-76% of all liver cancer cases and 2/3 of all liver transplants cancer cases and 2/3 of all liver transplants in the developed world.in the developed world.

Countries with low disease prevalence (<1%):Countries with low disease prevalence (<1%): AustraliaAustralia CanadaCanada Northern EuropeNorthern Europe

Countries with moderate disease prevalence Countries with moderate disease prevalence (around 1%):(around 1%): United StatesUnited States EuropeEurope

Countries with high disease prevalence (>2% Countries with high disease prevalence (>2% and many times as high as 5-10%):and many times as high as 5-10%): AfricaAfrica Latin AmericaLatin America Central and Southeastern AsiaCentral and Southeastern Asia

Countries with extremely high disease Countries with extremely high disease prevalence:prevalence: Nile delta of Egypt (up to 60% in 30 year olds)Nile delta of Egypt (up to 60% in 30 year olds)

http://www.who.int/vaccine_research/diseases/http://www.who.int/vaccine_research/diseases/viral_cancers/en/index2.html#disease%20burdenviral_cancers/en/index2.html#disease%20burden

Hepatitis C Virus Infection, Hepatitis C Virus Infection, United StatesUnited States

New infections per year 1985-89New infections per year 1985-89 242,000242,000

2001 2001 25,00025,000

Deaths from acute liver failureDeaths from acute liver failure RareRare

Persons ever infected (1.8%)Persons ever infected (1.8%) 3.9 million (3.1-4.8)*3.9 million (3.1-4.8)*

Persons with chronic infectionPersons with chronic infection 2.7 million (2.4-3.0)*2.7 million (2.4-3.0)*

HCV-related chronic liver diseaseHCV-related chronic liver disease 40% - 60%40% - 60%

Deaths from chronic disease/yearDeaths from chronic disease/year 8,000-10,0008,000-10,000

*95% Confidence Interval*95% Confidence Interval

Hepatitis C in OhioHepatitis C in Ohio

The hepatitis registry was established in The hepatitis registry was established in 2001 using tobacco industry settlement 2001 using tobacco industry settlement funds.funds.

The purpose of this registry is to provide The purpose of this registry is to provide population based data that accurately population based data that accurately describes hepatitis C in Ohio.describes hepatitis C in Ohio.

This information is used to target resources This information is used to target resources for planning and evaluating hepatitis for planning and evaluating hepatitis prevention, treatment, and service prevention, treatment, and service programs in the state. programs in the state.

Every Ohio county has reported at least one Every Ohio county has reported at least one hepatitis C diagnosis.hepatitis C diagnosis.

As of September 30, 2005, the hepatitis As of September 30, 2005, the hepatitis

registry contained over 48,000 cases, of which registry contained over 48,000 cases, of which just under 40.0% are confirmed hepatitis C just under 40.0% are confirmed hepatitis C diagnoses. The other 60.0% are potential diagnoses. The other 60.0% are potential diagnoses that are being investigated.diagnoses that are being investigated.

Approximately 500 reports of potential Approximately 500 reports of potential hepatitis diagnoses are received by hepatitis hepatitis diagnoses are received by hepatitis surveillance each week. These reports surveillance each week. These reports include new cases and updates to cases under include new cases and updates to cases under investigation.investigation.

Of all cases in the hepatitis registry, 64.8% Of all cases in the hepatitis registry, 64.8% are male, and 59.2% are ages 40 to 59 are male, and 59.2% are ages 40 to 59 years.years.

Nearly 70% of reported hepatitis cases are Nearly 70% of reported hepatitis cases are lacking race information.lacking race information.

Quarterly and annual summary statistics Quarterly and annual summary statistics are compiled from the cleaned data and are compiled from the cleaned data and released for public use on the ODH released for public use on the ODH website. website.

Challenges in ReportingChallenges in Reporting

Demographic Demographic informationinformation Hepatitis C Past or Present Cases Reported

to CDC, by Race, 2001-9/30/04 (n=7550)

White26%

Unknown62%

Other Race<1%

Black12%

Source: ODH Hepatitis Surveillance Program.

Challenges in ReportingChallenges in Reporting Risk factor Risk factor

informationinformation

Hepatitis C Past or Present Cases Reported to CDC 2001 through

9/30/2004 by Reported Risk (n=7550)

No Reported Risk87%

Reported Risk13%

Source: ODH Hepatitis Surveillance Program.

Importance of Complete Importance of Complete ReportingReporting

Determine who is at riskDetermine who is at risk Allocation of public health dollarsAllocation of public health dollars Targeted prevention programsTargeted prevention programs

Examine trends in the epidemicExamine trends in the epidemic Geography, race, sex, ageGeography, race, sex, age

Data analysisData analysis Determining if prevention efforts succeedDetermining if prevention efforts succeed Providing information to health departments, Providing information to health departments,

organizations, educational programsorganizations, educational programs

Source: ODH Hepatitis Surveillance Program.

Know your ABCsKnow your ABCs Class A DiseasesClass A Diseases

(1) diseases of major public health concern because of the (1) diseases of major public health concern because of the severity of disease or potential for epidemic spread; report by severity of disease or potential for epidemic spread; report by telephone immediately ex: Plaguetelephone immediately ex: Plague

(2) diseases of public health concern needing timely response (2) diseases of public health concern needing timely response because of potential for epidemic spread- report by the end of because of potential for epidemic spread- report by the end of the next business day ex: Hepatitis Athe next business day ex: Hepatitis A

(3) diseases of significant public health concern; report by the (3) diseases of significant public health concern; report by the end of the work week ex: end of the work week ex: Hepatitis B, C, D, EHepatitis B, C, D, E

Class B DiseasesClass B Diseases Report by end of work week ex: influenzaReport by end of work week ex: influenza

Class C DiseasesClass C Diseases Report outbreak or unusual incidence by end of next working Report outbreak or unusual incidence by end of next working

day ex: Toxoplasmosisday ex: Toxoplasmosis

Source: ODH Hepatitis Surveillance Program.

Hepatitis C in OhioHepatitis C in Ohio

Health statistics can be found on the ODH Health statistics can be found on the ODH website, website, http://www.odh.ohio.govhttp://www.odh.ohio.gov

-Click on Health Statistics-Click on Health Statistics→→IInfectious Diseasesnfectious Diseases

→→Reported Cases of Selected Notifiable Reported Cases of Selected Notifiable Diseases-Diseases- OhioOhio

→→Choose the year you are Choose the year you are interested ininterested in

reports available by year and month of report, reports available by year and month of report, patient age, gender, and county of residencepatient age, gender, and county of residence

Source: ODH Hepatitis Surveillance Program.

Describing Hepatitis C in OhioDescribing Hepatitis C in Ohio

Source: ODH Hepatitis Surveillance Program.

Hepatitis C (past or present) Hepatitis C (past or present) in:in:

  2003 20041st Quarter

2005

Adams County 3 4 0

Jackson County 9 3 6

Lawrence County 20 21 8

Pike County 9 5 4

Ross County 17 15 20

Scioto County 58 156 41

       

Ohio 4516 5426 2470

Chronic hepatitis C reported to Chronic hepatitis C reported to CDC by Ohio in 2004*CDC by Ohio in 2004*

*Numbers may be incomplete due to underreporting, reporting delays, and/or missing information

Source: Ohio Department of HealthHepatitis Surveillance Program

The Ohio Department The Ohio Department of Health HIV/HCV of Health HIV/HCV Integration ProjectIntegration Project

Why integration????Why integration????

The Ohio Department of The Ohio Department of Health HIV/HCV Integration Health HIV/HCV Integration

ProjectProject Study Inception: May 2003Study Inception: May 2003 Location: 15 HIV Counseling and Testing Location: 15 HIV Counseling and Testing

Sites throughout the state (will have 16 by Sites throughout the state (will have 16 by the summer 2006)the summer 2006)

Population: Individuals who seek HIV Population: Individuals who seek HIV testingtesting

Inclusion criteria: Presence of at least one Inclusion criteria: Presence of at least one of listed risk factors for HCVof listed risk factors for HCV

Exclusion criteria: Insistence on Exclusion criteria: Insistence on anonymous testinganonymous testing

Site# of anti-HCV

tests# of positive anti-

HCV tests (%)

Total tested who were confirmed positive for

HCV (%)

AVOC 8 2 (25.0) 2 (25.0)

Allen County 195 11 (5.6) 10 (5.1)

Canton City 49 4 (8.2) 4 (8.2)

Columbus City 471 59 (12.5) 49 (10.4)

Erie County 34 2 (5.9) 1 (2.9)

Free Medical Clinic of Cleveland 187 17 (9.1) 14 (7.5)

Highland County Health Dept. 8 3 (37.5) 1 (12.5)

J. Glen Smith Health Ctr 681 27 (4.0) 18 (2.6)

Mansfield/Richland County 79 10 (12.7) 10 (12.7)

Meigs County Health Department 4 0 (0.0) 0 (0.0)

Newark City 338 30 (8.9) 26 (7.7)

Portsmouth City 278 33 (11.9) 25 (9.0)

Thomas McCafferty Health Ctr 1208 36 (3.0) 26 (2.2)

Washington County 98 7 (7.1) 6 (6.1)

Youngstown City 14 1 (7.1) 0 (0.0)

       

Total 3652 242 (6.6) 192 (5.3)

Summary of HCV Testing: 2005Summary of HCV Testing: 2005

Some words about Some words about risk assessment…….risk assessment…….

ODH Hepatitis Contacts:ODH Hepatitis Contacts: Surveillance/ODRS:Surveillance/ODRS:

Jessica Lietz, MPH 614-728-6975Jessica Lietz, MPH 614-728-6975

Richard Thomas 614-644-1852Richard Thomas 614-644-1852 Perinatal Hepatitis B:Perinatal Hepatitis B:

Ann Richardson, RN 614-995-1874Ann Richardson, RN 614-995-1874 Hepatitis C Coordinator Hepatitis C Coordinator

(also can answer clinical questions):(also can answer clinical questions):

Kathleen Koechlin, RN, MPH, PhD 614-Kathleen Koechlin, RN, MPH, PhD 614-644-2714644-2714

Questions?????Questions?????