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Presented by Cheri Booth, MPH MN Department of Health November 22, 2013.

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Presentation on theme: "Presented by Cheri Booth, MPH MN Department of Health November 22, 2013."— Presentation transcript:

1 Presented by Cheri Booth, MPH MN Department of Health November 22, 2013

2 What is it caused by How is it spread Who is most affected What are the outcomes?

3  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

4  VIRAL hepatitis is spread from person to person or from the environment. Exactly how depends on which hepatitis virus.  Hepatitis A – food borne, and to a much smaller degree sexual or IDU  Hepatitis B- blood, sex, perinatal  Hepatitis C (has 24 different genotypes!) 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’

5  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’.  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.  HCV- Greatest incidence is among persons who inject drugs. More often in <30’s.  Related to opioid addiction and injection use trends.

6  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.

7 How many Minnesotans are affected by HCV Which populations or locations are experiences higher burden of infection?

8 **http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm *Includes all acute, chronic, probable chronic, and resolved cases. HCV infected persons* identified through passive surveillance Estimated unidentified HCV infected persons 39,303 45,559 N=84,863** Data Source: MN Viral Hepatitis Surveillance System

9 Median Age: 55 Data Source: MN Viral Hepatitis Surveillance System

10 *Includes anonymous methadone patients Data Source: MN Viral Hepatitis Surveillance System

11 Afr Amer = African American /Black Asian=Asian or Pacific Islander Amer Ind = American Indian Other = Multi-racial persons or persons with other race

12 *Rates calculated using 2010 U.S. Census data Excludes persons with multiple races or unknown race Data Source: MN Viral Hepatitis Surveillance System

13  Young (under 30) people have had a significant increase in rate of HCV infection.  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.

14  HCV is a major cause of liver disease – Leading indication for liver transplantation – Leading cause of hepatocellular carcinoma (HCC) (approx.50% of HCC incidence)  Over the next 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 HCV-related costs 1 – Exceeds $5 billion annually – estimated costs total $54.2 billion 1 McGarry et al. “Economic Model of a Birth Cohort Screening program for Hepatitis C” Hepatology 2012; 55:

15 The role of community planning/ HIV advisory committees in the fight against viral hepatitis

16  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.

17  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.  CDC, NASTAD  NY, CA, MA, TX, CO, DE, VT, etc………………………..


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