Transcript National Epidemiology Profile, Dr. Jeff Connell

National Epidemiology Profile
Dr. Jeff Connell
Assistant Director
National Virus Reference Laboratory.
UCD National Virus Reference
Saotharlann Náisiúnta Tagartha
Laboratory
Viris UCD
National Epidemiology Profile
Presentation
• Background
• Needle-stick investigations performed at the NVRL
• National Epidemiological Data for HIV, HBV and HCV infection
• What information is available
• Limitations of the data
Risk of blood-borne virus (BBB) transmission
• Risk of transmission is probably directly related to the
concentration of the virus (viral load) in the blood of the
source patient at the time of exposure
Risk of blood-borne virus (BBB) transmission
Risk of transmission of a BBV to HCW from infected patient following
a single open-bore needle-stick injury is;
• 20-30 % - HB eAg POSITIVE
• 3% for anti-HCV positive source
• 0.3% for anti-HIV positive source
NVRL needle-stick investigations
Crude data – includes
• Source investigations
• Recipient investigations
NVRL Data - samples referred for
needlestick investigation (n = 6904)
3000
2500
2000
1500
1000
500
0
2003
2004
2005
NVRL Data - Hospitals in the Dublin Area
49 % (3388/6904) of total needle-sticks 2003-2005
12
10
Percentage
8
6
4
2
0
1
2
3
4
5
6
Hospital ID
7
8
9
10
HIV infection
HIV
HIV Viral load
HIV National Data – End of December 2000
HIV National Data – End of June 2005
HIV National Data – Q1 and Q2 2005
Hepatitis B
Hepatitis B – Electron micrograph
Natural History of HBV infection
Hepatitis B infection in Ireland
Nationally the numbers of HBV infected individuals is not known
- data sources are
• Individual studies: IVDU, prisoners - underestimate the national
problem
• NVRL database
• HPSC data
• ESEN 2 – European Sero-Epidemiology Network
• Antenatal screening
HBV National Data – Oral fluid study
• 0.29% (5/1,714) samples positive for antibodies to HBc
• age range:
34-70 years
• sex :
3 male, 2 female
• location:
3 urban, 2 rural
• Adjusted prevalence for study design, estimated Irish
population prevalence of HBV = 0.51%
HBV NVRL Data
August 2004 to August 2005
• Non- acute HBV
• Acute HBV
459
44
Total
503
HBV NVRL Data –
Refugee reception Centres
40
35
30
25
20
15
10
5
0
1
2
3
4
5
HBV NVRL Data – Maternity Hospitals
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
HBV NVRL Data – Hospitals
50
45
40
35
30
25
20
15
10
5
0
1
2
3
4
5
6
7
8
9
HBV NVRL Data
Acute infection: n=44
30
25
20
15
10
5
0
MSM
ND
Hepatitis/jaundice
Fatigue
Renal Failure
HBV National Data – HPSC
HBV National Data – HPSC
Rate of notified hepatitis B by acute and chronic status, age and sex, 2004
Crude incidence rate per
100,000 population
Acute HBV
6
5
4
3
2
1
0
0-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65+
45-54
55-64
65+
Age group
Male
Female
Crude incidence rate per
100,000 population
Chronic HBV
50
40
30
20
10
0
0-4
5-9
10-14
15-19
20-24
25-34
35-44
Age group
Male
Female
HBV National Data – HPSC
Number of notifications of
hepatitis B
Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)
180
160
140
120
100
80
60
40
20
0
Acute (8%)
Chronic (73%)
Unknown (19%)
Q1
Q2
Q3
Q4
2004
Year and month
Q1
Q2
2005
Acute HBV National Data – HPSC
Risk factors for acute cases of hepatitis B, 2004 & 2005 (end Aug)
Risk factor
Men who have sex with men
Possible sexual exposure
Born in endemic country/Asylum seeker
Infection acquired abroad
Vertical transmission
Tatooing/body piercing/acupuncture
Surgery
Intravenous drug user
Household contact
Dental work
Percutaneous/mucocutaneous blood/body fluid exposure
No risk data available
No known risk factor*
Total
Number of
cases
Relative
frequency (%)
20
12
4
3
2
2
2
2
2
2
1
32
14
98
20.4
12.2
4.1
3.1
2
2
2
2
2
2
1
32.7
14.3
100
*Enhanced form received but no known risk factor
Acute HBV National Data – HPSC
Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)
Region of Birth
Western Europe
Sub-Saharan Africa
East Asia & Pacific
Eastern Europe
Central Europe
Total
Number of
cases
40
2
2
1
1
46
%
87
4.3
4.3
2.2
2.2
100
Chronic HBV National Data – HPSC
Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)
Risk factor or proxy for risk factor for all cases
Born in endemic country/Asylum seeker
Household contact
Vertical transmission
Resident intellectual disability institition
Intravenous drug user
Dental work
Men who have sex with men
Infection acquired abroad
Possible sexual exposure
Surgery
Renal Dialysis
No risk data available
No known risk factor*
Total
Number of
cases
219
6
5
3
3
3
2
2
2
1
1
713
6
966
Relative
frequency (%)
22.7
0.6
0.5
0.3
0.3
0.3
0.2
0.2
0.2
0.1
0.1
73.8
0.6
100
Chronic HBV National Data – HPSC
Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)
Region of Birth
Sub-Saharan Africa
East Asia & Pacific
Eastern Europe
Western Europe
South & South-East Asia
Central Europe
North Africa & Middle East
T ota l
Number of
cases
55
12
14
6
4
3
1
95
%
57.9
12.6
14.7
6.3
4.2
3.2
1.1
100
HBV National Data – HPSC Recent data
Rate of notified hepatitis B in Quarter 4 2005
ACUTE
CHRONIC
Hepatitis C
Hepatitis C
Natural History of HCV infection
Persistent High viral
load – reaches a stable
baseline
Hepatitis C infection in Ireland
Numbers of HCV infected individuals not known
• NVRL – HPSC database
• National HCV database (blood and blood products)
• Individual studies: IVDU, prisoners - underestimate the national
problem
• NVRL data
Problems in the detection of HCV infected
individuals
• Unknown modes of transmission outside the classic “risk factors”
• Asymptomatic acute and chronic infection
• Atypical anti-HCV response
• Delayed immune response - long window period before antiHCV develops
HCV Genotypic investigations in Ireland 1994 –2005
– NVRL DATA
1200
1000
800
600
400
200
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
HCV Genotypes in Ireland 1994 –2005 – NVRL DATA
(n – 8812)
1
2
3
4
80
70
60
50
40
30
20
10
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
HCV National Data – HPSC
HCV National Data – HPSC
Number of notifications of HCV Q1, 2004 to Q4 2005
National Epidemiology Profile Conclusions
• Needle-stick injuries are a substantial problem
• Changing demographics in Ireland – increased level of HIV and
HBV
• National data is improving
National Epidemiology Profile
Acknowledgments:
Dr. Lelia Thornton, HPSC
Lindsay Jones. IT, NVRL
Staff at the NVRL
National Epidemiology Profile
Thanks for your attention
Any questions ?