1. Investigation of a Cluster of Acute Hepatitis C Infections in IDUs, Minnesota, 2001 Minnesota Department of Health

2. Acknowledgments Lynne Mercedes Immunization, TB & International Health Section Minnesota Department of Health (MDH) Tim Heymans - STD & HIV Section, MDH Jessie Saavedra - STD & HIV Section, MDH Jeanette Martimo Public Health Nursing Division St. Louis County Public Health Department Carol Hooker Epidemiology & Environmental Health Hennepin County Community Health Department

3. We are here Minnesota

4. Background (Tim) April 2001 – N. MN plasma center reported HCV seroconversions in 3 young donors Additional cases searched in database  Reported in previous 6 months  Young adults (< 31 yrs. of age)  Northern MN residents

5. Background (cont.) May 2001 – N. MN local HD contacted to follow up; results incomplete June 2001- DI in Greater MN asked by hepatitis surveillance staff to assist  IDU suspected  Hepatitis IDU cases usually unlocatable  DIs in STD & HIV section routinely do this

6. Background (Jessie) June 2001 – Metro local HD reported 2 acute HCV cases  Male, Spanish-speaking (23; 33 yrs.)  Seen in ER with Sx  One self reported IDU initiation w/in 6 mos.  Both roofers, per charts Metro Spanish-speaking DI asked by hepatitis staff to assist

7. Objectives Locate Interview  Establish risk  I.D. partners (sex, needlesharing)  Educate on hepatitis & STDs  Refer for hepatitis A & B testing, vaccine Local HD in N. MN made tests & vaccine available Hepatitis A & B tests, vaccine available in Metro area already

8. Hennepi n

9. Methods Field visits (Tim)  Element of surprise (face to face vs. phone)  Efficient use of travel (2-day goal) Day 1: 4 separate assignments Day 2: 3 additional assignments & return to Duluth  July 2001 - (+) case fails Ix appointment; cluster Ix from partner

10. Methods (cont.) Field visits (Jessie)  June 2001 Address noted in chart Post office DMV gave N. MN address Bar, parked car  June/July 2001 Homeless shelter Roofing company, construction sites

11. Results (Jessie) 2 assigned cases were confirmed acute SP of case #1 located; NA w/ties to Duluth  Confirmed IDU of case  Admitted possible source of #1’s infection (taught him to shoot)  Reported case #1 moved to UT SP tested for STDs  (+)HCV; HBV (-); started HBV vaccine  Other STDs (-) SP named as NS partner of one of Tim’s Ix Case #2 homeless; unlocatable; IDU??

12. Results (Tim) 5 of 8 assigned were confirmed acute 4 of 5 were Ix; SP of 5 th was cluster Ix Of completed Ix:  4 acute HCV; 1 partner of acute  2 chronic HCV  1 suspected acute ruled out as (-)

13. Results (cont.) 36 additional people named (NS, SP, suspects or associates)  6 previously reported in HCV database  1 new (+) moved to Oklahoma  20 reside on a reservation Social connections between NA & Latino cases; none between whites & others Cases on reservation led to MDH grant to tribal health for hepatitis education, intervention, prevention activities

14. Conclusion Because of the overlap of risk factors for acquiring HIV, HCV, HBV, HAV & STDs, hepatitis intervention activities can be successfully integrated into existing STD & HIV programs.