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)