1. Hepatitis C Virus Program in Chicago
Corinna Dan, BSN, RN
Hepatitis C Virus Program
Chicago Department of Public Health

2. Where We Started

3. Hepatitis C Program Funded
CDC Division of Viral Hepatitis funded a Hepatitis C Coordinator in May 2001.
Dedicated staff to coordinate program activities
Previous hepatitis C activities were sporadic including:
Basic count of HCV reports received
Volunteer intern completed 3 months data entry
Application for HCV Coordinator
No education or prevention activities
No screening for hepatitis C in CDPH clinics
No vaccinating for HAV or HBV

4. Hepatitis Activities ~ 2001
Communicable Disease Program
Hepatitis A surveillance, case investigation, contact prophylaxis
Hepatitis B surveillance, case investigation, contact prophylaxis
Hepatitis C reports received & counted
Immunization Program
Hepatitis B vaccination (VFC only)
Perinatal hepatitis B prevention
Hepatitis A & B vaccine available upon request for agencies working with high-risk adults

5. Chicago Facts Major urban area
hepatitis C virus reports every month- reports often incomplete & inaccurate

6. CDC National Hepatitis C Prevention Strategy
Program Goals Developed From:
CDC National Hepatitis C Prevention Strategy
Healthy People 2010 Goals:
Reduce hepatitis C
Target: 1 new case per 100,000 population/year
(Chicago target = 29 new cases/year)
Increase the proportion of persons with chronic hepatitis C infection identified by State and local health departments.

7. Challenges & Accomplishments

8. Hepatitis C Program Development 2001-2002
Surveillance
Screening
Immunization
High-risk Adolescent & Adult Outreach
Education
Treatment

9. Surveillance Acute HCV cases: Chronic HCV cases:
Case definition updated
Improved reporting by infection control practitioners encouraged
Case investigation to determine mode of transmission/detect outbreaks
Chronic HCV cases:
Completed entries for 2001 in database

10. Surveillance Barriers
No funding received for hepatitis C surveillance
Personnel required for high volume of cases
Reports received often incomplete, inaccurate and/or illegible

11. Screen Screen high risk residents through:
CDPH STD/HIV specialty clinics
Pilot HCV testing at one clinic by January, 2002
Contract with State Lab for expanded hepatitis C testing services
Provide written materials relating to HCV testing, education, and follow-up resources
Community organizations
Provide limited mobile testing
Provide support for HCV activities (training, resources)

12. Screening Barriers Limited Home Access test kits received from IDPH
CDPH clinic implementation protocol burdensome
Lack of resources or support from STD/HIV program
Agency testing & follow-up varies widely
Substance abuse agencies reluctant to use names on HCV reports/do testing on clients

13. Immunize
Increase rates of high-risk immunization against hepatitis A and B
CDPH STD/HIV specialty clinics
Discuss importance of vaccination for HAV & HBV
Create protocols for vaccination
Provide written materials and referral resources relating to HAV and HBV vaccination
Community organizations
Provide vaccine for agencies with administration capacity
Support hepatitis A and B immunization services
Provide written materials relating to HAV and HBV vaccination

14. Immunization Barriers
No history of high risk adult A or B vaccination in CDPH clinics
Supply of HAV/HBV adult vaccine not guaranteed
Community agencies have very limited vaccine administration resources
Most hepatitis immunization resources focused on children

15. High Risk Adolescent & Adult Outreach
Education, screening and immunization resources offered to community agencies focusing on high risk outreach
High risk adolescent immunization continued at Cook County Juvenile Temporary Detention Center

16. Outreach Barriers Limited staff
High-risk individuals often difficult to identify
High-risk adolescents require parental approval in juvenile justice system

17. Education Assess resources in Chicago for HCV:
Education, Testing, Counseling & Treatment
Increase outreach & education regarding HCV for:
Health care providers & outreach workers
Community organizations
Individuals
Provide training for agencies to improve HCV services
Trainings currently being conducted on:
Hepatitis A, B & C: The facts on hepatitis
Hepatitis Integration into Prevention Activities

18. Education Barriers
Only one staff member, therefore training efforts focused on staff working with high risk adults

19. Treatment
Identify & improve coordination of services for HCV infected residents
Work with primary clinics to recognize hepatitis C and preventive measures
Develop network of medical services:
Recommended annual complete physical assessments for HCV positive residents
Recommended ongoing primary care
Coordinate with treatment facilities to serve as resources

20. Treatment Barriers
Very few resources exist

21. Support
Support community organizations working on hepatitis C virus programs by offering:
Training regarding HCV
Educational materials
Technical assistance
Collaboration

22. Where We Plan to Go…

23. Future Plans Surveillance: Screening:
Analyze 2001 data, identify target areas for resources
Begin to understand epidemiology of HCV in Chicago
Work with labs to improve hepatitis reporting
Continue to do/refine case investigation of acute cases
Complete 2002 data entry
Screening:
Implement screening of high risk patients in all STD clinics
Increase outreach to very high risk populations with mobile testing, e.g., corrections, drug abusers

24. Future Plans, con’t Immunization
Immunization Program adding new staff for adult immunization activities
CDPH neighborhood health center & STD/HIV clinic trainings planned for 1~2/03 regarding adult immunization with HAV, HBV and Twinrix to start asap
Plan for high-risk population outreach and vaccination in corrections and substance abuse

25. Future Plans, con’t Assessment & Training
Chicago Area agency meeting planned for April 2003
Agency survey/needs assessment to be completed at April meeting
Trainings will continue to be offered to agencies working with high risk adults

26. Future Plans, con’t
Coordination of health care for HCV infected residents
April 2003 meeting will stress regular medical care for HCV infected individuals
Treatment resources made available to agencies doing screening, requesting staff training or upon request

27. Thank you!