World Hepatitis Day 2013, 29 th July Establishing a framework for better data collection and surveillance of Hepatitis in South Africa N. Prabdial-Sing and J. Manamela

6 INTRODUCTION Hepatitis B infection 2 Billion people infected worldwide with Hepatitis B virus – 350 million live with chronic infection (5%) – persons die annually due to acute or chronic consequences of HBV Sexual contact Blood and blood products Vertical transmission -Perinatally: during birth (HBsAg – 20%; HBeAg – 90%) -Early childhood infections: inapparent infections due to close personal contact Occupational HBV genotypes (A-H) are distributed geographically, with genotype A and subtype A1 common in Sub- Saharan Africa. Genotypes associated with clinical progression, HBeAgseroconversion rates, mutational patterns, treatment responses

 Hepatitis C infection  Worldwide, million people are infected with HCV (~ 3%)  Intravenous drug use remains the most common risk factor (UK, US), however, in South Africa and other African countries, transmission risks are not known, although unhygienic injection practices and traditional scarifications may be possible routes of HCV transmission  HCV genotypes (1-6) are distributed depending on geography and route of infection but travel and migration are changing these patterns.  Genotypes have clinical importance as response to therapy differs and disease progression was shown to differ.

 The Hepatitis B surface antigen prevalence rates in South Africa ranges from 7.4 (urban) to 15% (rural) and with HIV co-infection, rates increase to 16-22%.  The seroprevalence of HCV in South Africa ranges from low ( %) in blood donors and health care workers to high (13-33%) in HIV positive individuals and patients with chronic active hepatitis, respectively  A database for NICD laboratory-confirmed cases for both hepatitis B and C has been set up whereby demographic data, viral load and genotypes are collated from all provinces in SA, except Western Cape, as they perform their own testing. Plans will be developed to include the data from the Western Cape so that the data is nationally representative. INTRODUCTION

 Samples were sent for viral load testing  The number of laboratory-confirmed cases of hepatitis B for the period was 1745 of the 2734 tests requested (63%).  Sample with 200IU/ml and >200ul were tested for genotype, N=526 ANALYSIS OF NICD LABORATORY-CONFIRMED HBV BY VIRAL LOAD

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 Number of HBV positive cases by gender

1 9 Age groupADE 6≤24weeks1%0% 2-4years0% 5% 5-9years1%0%10% 10-18years6%4%33% 19-25years10%4%5% 26-35years28%36%10% 36-45years20%14%29% 46-55years12%4%0% ≥56years6%18%0% Unknown15%21%10% Total100%

ANALYSIS OF NICD LABORATORY-CONFIRMED HCV BY VIRAL LOAD Samples were sent for viral load testing Of a total of 2360 viral hepatitis C requests received at the NICD from January December 2012, 1002 patient specimens tested positive on viral load (>15 international units/ml (IU/ml), 42%. Sample with 200 (IU/ml) and >200ul were tested for Genotype, N=886

Provinces No. of positives Communicable Disease Surveillance Bulletin, 2013

Genotypes/ SubtypesNo.% a b a a/2c b a a a/4c/4d e f h80.9 5a mixed Total Communicable Disease Surveillance Bulletin, 2013