Transcript MN HepatitIs Update

Presented by Cheri Booth, MPH
MN Department of Health
November 22, 2013
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What is it caused by
How is it spread
Who is most affected
What are the outcomes?
 Hepatitis
is basically inflammation of the
liver.
 (hepat-) = liver, (-itis) = inflammation
 Many things can cause hepatitis:
 Caused by viruses, alcohol, medications,
and other toxins
 Can also be caused by genetic conditions
or co-morbidities
 VIRAL
hepatitis is spread from person to
person or from the environment. Exactly how
depends on which hepatitis virus.
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Hepatitis A – food borne, and to a much smaller
degree sexual or IDU
Hepatitis B- blood, sex, perinatal
Hepatitis C (has 24 different genotypes!)
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Blood, and to a much smaller degree perinatal or
sexual
Hepatitis D- ‘piggy back virus’- blood, sexual
Hepatitis E- same as type A
Hepatitis G- very similar to ‘C’
HBV- In MN it is primarily persons born in
endemic areas who relocate here. Transmission
often occurs at birth. Or in early adulthood by
blood, sexual contact, or unsterilized/
contaminated medical supplies.
 HCV- Approx 5.5 million Americans infected.
Highest prevalence is among ‘Baby Boomers’.
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Related to blood exposures such as transfusion in the
days before the virus was isolated as well as military
exposures.
 Most aren’t aware of status.
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HCV- Greatest incidence is among persons who
inject drugs. More often in <30’s.
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Related to opioid addiction and injection use trends.
 HBV-
If infected at birth or in childhood
outcome is nearly always chronic infection.
Adults tend to clear the virus in 85% of
infections. High rates of cirrhosis and liver
cancer for chronically infected.
 HCV- Majority of those infected become
chronic cases (~70%). Greatest indicator for
liver transplant in the US. Most with lifelong
infection will develop some level of fibrosis
and or cirrhosis. Liver cancer rates rising
dramatically.
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How many Minnesotans are affected
by HCV
Which populations or locations are
experiences higher burden of
infection?
N=84,863**
39,303
Estimated
unidentified HCV
infected persons
HCV infected
persons* identified
through passive
surveillance
45,559
*Includes all acute, chronic, probable chronic, and resolved cases.
Data Source: MN Viral Hepatitis Surveillance System
**http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm
Median Age: 55
Data Source: MN Viral Hepatitis Surveillance System
*Includes anonymous methadone patients
Data Source: MN Viral Hepatitis Surveillance System
Afr Amer = African American /Black Asian=Asian or Pacific Islander
Amer Ind = American Indian
Other = Multi-racial persons or persons with other race
*Rates calculated using 2010 U.S. Census data
Excludes persons with multiple races or unknown race
Data Source: MN Viral Hepatitis Surveillance System
Young (under 30) people have had a significant
increase in rate of HCV infection.
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Future implications related to morbidity and
mortality, perinatal transmission of HCV, and
treatment costs.
Opioid addiction and heroin purity in MN
leading to greater issues of addiction, unsafe
injection behavior, and overdose.
 HCV
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Leading indication for liver transplantation
Leading cause of hepatocellular carcinoma
(HCC) (approx.50% of HCC incidence)
 Over
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is a major cause of liver disease
the next 40-50 years, a projected:
1.76 million with untreated HCV infection will
develop cirrhosis
400,000 will develop HCC
1 million will dies from HCV-related
complications
 Substantial
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1 McGarry
HCV-related costs1
Exceeds $5 billion annually
2010-2019 estimated costs total $54.2 billion
et al. “Economic Model of a Birth Cohort Screening program for Hepatitis C” Hepatology 2012; 55:1344-1355
The role of community planning/ HIV
advisory committees in the fight against
viral hepatitis
 Natural
cross-over between populations
affected and how prevention and linkage to
care work is done.
 Ability to enhance existing services rather
than recreate them. PCSI opportunity!
 Rapid HCV test allows alignment with current
HIV testing strategies and programs
 Advocacy/ provision of care around hepatitis
C testing and referral often strengthens
inroads into difficult to reach populations in
need of HIV services.
Many states have incorporated Hepatitis into
their HIV community planning groups.
 Logical fit based on population overlaps, funding
goals, and federal imperative to incorporate/
collaborate services.
 Challenging to operate even one advisory group.
Adding a second would be a burden to
communities already finding it difficult to
participate.
 Precedence and trend toward combining groups
is seen across the nation.
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CDC, NASTAD
 NY, CA, MA, TX, CO, DE, VT, etc………………………..
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