1. A Cluster of Hepatitis C among Rural, Young Adults – Illinois, 2012 Julia Howland, MPH CPH CDC/CSTE Applied Epidemiology Fellow Illinois Department of Public Health

2. Background: hepatitis C Approximately 4.1 million Americans and 300 million people worldwide are infected with the hepatitis C virus (HCV) Leading cause of chronic liver disease and liver transplantation and causes 10,000-20,000 deaths per year in the US Male sex, black race, age 45-65, history of IDU, and receipt of a blood or soft tissue donation before 1992 are risk factors. Illicit, and specifically injection, drug use is the most common risk factor.

3. Hepatitis in young adults Increased cases described in New York, Massachusetts and Wisconsin: –Young adults –White –Rural, suburban communities –Equal male and female –Injection opiate use (Onofrey, Church, Kludt et al, 2011)

4. Background: the outbreak February 2012: a communicable disease nurse at a local health department (LHD) in a small, rural county in southern Illinois (county A) contacted the Illinois Department of Public Health (IDPH) to report four cases of acute HCV occurring within three months

5. Methods: case identification Cases were defined as laboratory confirmed cases of HCV ages 15-34 (young adult) from January 2010 – present with a home address in County A Cases were identified through provider reporting to the state reportable disease surveillance system and contact tracing The LHD conducted initial interviews with the reported cases to determine risk factors and symptoms

6. Methods: data collection Medical and public health records were abstracted for co-morbidities, risk behaviors, and HCV diagnosis We interviewed cases for risk behaviors, symptoms, and contacts Contacts were offered HCV testing and interviewed

7. Results: case characteristics Thirteen cases were identified. Five met the case definition for acute infection Ten (76.9%) were identified through surveillance, three (23.1%) were contacts Four cases (30.8%) were interviewed The mean age of cases was 25.2 (range 15-34) All cases were white, non-Hispanic. Six cases were female. Seven (53.8%) cases were symptomatic at the time of HCV diagnosis.

8. Results: co-morbidities Eleven (84.6%) cases had a history of illicit drug use, ten (76.9%) of injection drug use Six used methamphetamine and prescription opiates and five used heroin Six of seven cases had mental health diagnosis No cases had a history of HBV or HIV Of the four cases interviewed, all reported sharing drug preparation equipment and drug snorting equipment. Three shared needles.

9. Case connections Three interviewed cases identified contacts Six of 13 cases connected to one another –Five through drug use –One through sexual contact

10. HCV in rural Illinois In 2005, the state young adult rate was 8.4/ 100,000 young adults. By 2011, the rate was 28.0 –50% female –84.4% white 2011 rate of HCV among young adults (age 15-34) in County A was 82.24/ 100,000 young adults

11. Conclusions Hepatitis C is an emerging problem among young, rural adults Enhanced surveillance may be warranted among young adults Infection prevention efforts should focus on: –Safe injection practices –Provider awareness of HCV infection among young adults

12. Acknowledgments Dr. Yoran Grant Dr. Craig Conover The Illinois Department of Public Health The CDC/CSTE Applied Epidemiology Fellowship Program

13. Author contact Julia Howland Illinois Department of Public Health Division of Infectious Diseases 312-793-0098 Julia.Howland@Illinois.gov