Scioto County Medical Society Grand Rounds March 31, 2006 Portsmouth, Ohio

1. Scioto County Medical SocietyGrand RoundsMarch 31, 2006Portsmouth, Ohio Kathleen M. Koechlin, RN, MPH, PhD Hepatitis C Coordinator The Ohio Department of Health kathleen.koechlin@odh.ohio.gov

2. The Epidemiology of Hepatitis C • Worldwide: • Approximately 180 million people (3.0% of the world population) are infected with HCV. • Approximately 130 million are chronic carriers. • Approximately 3-4 million people are newly infected each year. • 70% of these will develop chronic HCV. • HCV is responsible for 50-76% of all liver cancer cases and 2/3 of all liver transplants in the developed world.

3. Countries with low disease prevalence (<1%): Australia Canada Northern Europe Countries with moderate disease prevalence (around 1%): United States Europe Countries with high disease prevalence (>2% and many times as high as 5-10%): Africa Latin America Central and Southeastern Asia Countries with extremely high disease prevalence: Nile delta of Egypt (up to 60% in 30 year olds) http://www.who.int/vaccine_research/diseases/viral_cancers/en/index2.html#disease%20burden

4. Hepatitis C Virus Infection, United States New infections per year 1985-89 242,000 2001 25,000 Deaths from acute liver failure Rare Persons ever infected (1.8%) 3.9 million (3.1-4.8)* Persons with chronic infection 2.7 million (2.4-3.0)* HCV-related chronic liver disease 40% - 60% Deaths from chronic disease/year 8,000-10,000 *95% Confidence Interval

5. Hepatitis C in Ohio

6. The hepatitis registry was established in 2001 using tobacco industry settlement funds. • The purpose of this registry is to provide population based data that accurately describes hepatitis C in Ohio. • This information is used to target resources for planning and evaluating hepatitis prevention, treatment, and service programs in the state.

7. Every Ohio county has reported at least one hepatitis C diagnosis. • As of September 30, 2005, the hepatitis registry contained over 48,000 cases, of which just under 40.0% are confirmed hepatitis C diagnoses. The other 60.0% are potential diagnoses that are being investigated. • Approximately 500 reports of potential hepatitis diagnoses are received by hepatitis surveillance each week. These reports include new cases and updates to cases under investigation.

8. Of all cases in the hepatitis registry, 64.8% are male, and 59.2% are ages 40 to 59 years. • Nearly 70% of reported hepatitis cases are lacking race information. • Quarterly and annual summary statistics are compiled from the cleaned data and released for public use on the ODH website.

9. Challenges in Reporting • Demographic information Source: ODH Hepatitis Surveillance Program.

10. Challenges in Reporting • Risk factor information Source: ODH Hepatitis Surveillance Program.

11. Importance of Complete Reporting • Determine who is at risk • Allocation of public health dollars • Targeted prevention programs • Examine trends in the epidemic • Geography, race, sex, age • Data analysis • Determining if prevention efforts succeed • Providing information to health departments, organizations, educational programs Source: ODH Hepatitis Surveillance Program.

12. Know your ABCs • Class A Diseases • (1) diseases of major public health concern because of the severity of disease or potential for epidemic spread; report by telephone immediately ex: Plague • (2) diseases of public health concern needing timely response because of potential for epidemic spread- report by the end of the next business day ex: Hepatitis A • (3) diseases of significant public health concern; report by the end of the work week ex: Hepatitis B, C, D, E • Class B Diseases • Report by end of work week ex: influenza • Class C Diseases • Report outbreak or unusual incidence by end of next working day ex: Toxoplasmosis Source: ODH Hepatitis Surveillance Program.

13. Hepatitis C in Ohio • Health statistics can be found on the ODH website, http://www.odh.ohio.gov -Click on Health Statistics →Infectious Diseases →Reported Cases of Selected Notifiable Diseases- Ohio →Choose the year you are interested in • reports available by year and month of report, patient age, gender, and county of residence Source: ODH Hepatitis Surveillance Program.

14. Describing Hepatitis C in Ohio Source: ODH Hepatitis Surveillance Program.

15. Hepatitis C (past or present) in:

16. Chronic hepatitis C reported to CDC by Ohio in 2004* *Numbers may be incomplete due to underreporting, reporting delays, and/or missing information Source: Ohio Department of Health Hepatitis Surveillance Program

17. The Ohio Department of Health HIV/HCV Integration Project Why integration????

18. The Ohio Department of Health HIV/HCV Integration Project • Study Inception: May 2003 • Location: 15 HIV Counseling and Testing Sites throughout the state (will have 16 by the summer 2006) • Population: Individuals who seek HIV testing • Inclusion criteria: Presence of at least one of listed risk factors for HCV • Exclusion criteria: Insistence on anonymous testing

19. Summary of HCV Testing: 2005

20. Some words about risk assessment…….

21. ODH Hepatitis Contacts: • Surveillance/ODRS: Jessica Lietz, MPH 614-728-6975 Richard Thomas 614-644-1852 • Perinatal Hepatitis B: Ann Richardson, RN 614-995-1874 • Hepatitis C Coordinator (also can answer clinical questions): Kathleen Koechlin, RN, MPH, PhD 614-644-2714

22. Questions?????