Hepatitis Prevention Program UPDATE. Hepatitis Prevention Program Staff
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1 Hepatitis Prevention Program UPDATE Hepatitis Prevention Program Staff PCPG Meeting - Tampa November 9, 2010
2 Hepatitis A Total Reported Cases Source: Merlin Database, Florida Department of Health
3 Acute Hepatitis B Total Reported Cases Source: Merlin Database, Florida Department of Health
4 Acute Hepatitis C Total Reported Cases Source: Merlin Database, Florida Department of Health
5 Chronic Hepatitis C Thru Sept 124,688 23,062 20,888 15,815 NOTES: on track to approx. 21,000 -BOE suggested ceasing reporting requirement -Only half the states report chronic hep C -Fla has reported 184,453 cases since % of estimated 297,000 cases SOURCE: Merlin Database, Florida DOH
6 HIV/HCV Co-infected Cases by County Living through 2008, Florida, N=7,365 ALACHUA CO. 94 GULF CO. 2 ORANGE CO. 527 BAKER CO. 4 HAMILTON CO. 2 OSCEOLA CO. 111 BAY CO. 41 HARDEE CO. 7 PALM BEACH CO. 409 BRADFORD CO. 6 HENDRY CO. 10 PASCO CO. 91 BREVARD CO. 159 HERNANDO CO. 21 PINELLAS CO. 374 BROWARD CO HIGHLANDS CO. 17 POLK CO. 181 CALHOUN CO. 3 HILLSBOROUGH CO. 459 PUTNAM CO. 26 CHARLOTTE CO. 17 INDIAN RIVER CO. 29 SANTA ROSA CO. 13 CITRUS CO. 20 JACKSON CO. 9 SARASOTA CO. 79 CLAY CO. 16 JEFFERSON CO. 1 SEMINOLE CO. 84 COLLIER CO. 56 LAKE CO. 45 ST JOHNS CO. 26 COLUMBIA CO. 13 LEE CO. 153 ST LUCIE CO. 105 DADE CO LEON CO. 35 SUMTER CO. 7 DE SOTO CO. 8 LEVY CO. 6 SUWANNEE CO. 4 DIXIE CO. 3 MANATEE CO. 78 TAYLOR CO. 1 DUVAL CO. 480 MARION CO. 92 UNION CO. 2 ESCAMBIA CO. 143 MARTIN CO. 22 VOLUSIA CO. 123 FLAGLER CO. 10 MONROE CO. 68 WAKULLA CO. 1 GADSDEN CO. 10 NASSAU CO. 5 WALTON CO. 4 GILCHRIST CO. 1 OKALOOSA CO. 33 WASHINGTON CO. 1 GLADES CO. 2 OKEECHOBEE CO. 6 County totals exclude Department of Corrections cases (N=584).
7 HIV/HCV Co-infection 5-10% of HCV are HIV infected 30-40% of HIV are HCV infected 50-90% of HIV infected IDUs also have HCV Rx for hepatitis C while co-infected with HIV may take 6 months longer for sustained viral response (SVR) SOURCES:
8 Testing # Hepatitis Panels Done by State Lab* 2005: 13, : 14, : 24, : 34, : 35, % Increase in Testing from 2005 thru 2009 *Based on HMS Data
9 Positivity Rate*, Hepatitis Testing State Lab - Jan-Dec 2008 Hepatitis A Antibody: 25.9%** Hepatitis B Surface Antibody: 42.4%*** Hepatitis B Surface Antigen: 1.2%**** Hepatitis C Antibody: 6.8%***** * Raw data from LabWare (Fla State Laboratory) ** + A Antibody means immunity due to previous infection or vaccination *** + Hep B Surface Antibody usually denotes vaccine protection **** + Hep B Surface Antigen usually means acute or chronic infection ***** Most Hep C Antibody + (over 99%) are chronic
10 Positivity Rate*, Hepatitis Testing State Lab - Jan-Dec 2009 Hepatitis A Antibody: 28.7%** Hepatitis B Surface Antibody: 45.4%*** Hepatitis B Surface Antigen: 1.1%**** Hepatitis C Antibody: 6.5%***** * Raw data from LabWare (Fla State Laboratory) ** + A Antibody means immunity due to previous infection or vaccination *** + Hep B Surface Antibody usually denotes vaccine protection **** + Hep B Surface Antigen usually means acute or chronic infection ***** Most Hep C Antibody + (over 99%) are chronic
11 Florida State University
12 TOTAL A, B & A/B Vaccines* # Vaccines # Diff Last Yr % Diff Last Yr , , % , % , % , % *Based on HMS Data
13 Total A, B & A/B Vaccines HMS vs Florida SHOTS Databases HMS Fla SHOTS (CHD) Fla SHOTS (All Sites) ,221 29,189 29, ,525 42,702 45, ,726 46,067 50, ,621 40,092 46,372 All Sites includes MOA partners (Alert Health Inc, Armor Health Care, CFDFL, etc) NOTE: Information on vaccine activity entered into Fla SHOTS (State Health Online Tracking System) is not always entered into HMS
14 14,284 5,572 14,180 10,634 25,732 23,891 12,761 22,756 12,982 45,588 50,832 46,372 Adult Hepatitis Vaccine Delivery Florida Hepatitis Prevention Program 60,000 50,000 40,000 A 30,000 B 20,000 10,000 Comb Total All sites-florida SHOTS
15 317 Vaccine Initiative Partnership between hepatitis & immunization programs (CDC and DOH) Hep B & A/B combo vaccine only No infrastructure Advance Elimination of Hepatitis B in US Venue-based vaccine delivery (STD, jails, substance abuse Rx facilities) Florida: $786k (2008), $1.1 million (2009) & $1.1 million (2010)
16 Adult Hepatitis Vaccine End of CDC-sponsored adult hepatitis vaccine 2010 ($250k?) HPP working with Bureau of Imm to access Florida 317 vaccine in 2011 HPP working with Bureau of Epi to access hepatitis funds to purchase vaccine ($100k - $150k) $106k line item in HPP budget Total of $456k - $506k Plus, using up 317 supply from 2010
17 Public Health Reports Article submitted describing Florida s HPP experience with the availability of 317 adult hepatitis vaccine Initial increase in hep A vaccine Opportunity to collaborate with CBOs, jails, etc. Unintended + consequence of increased amount of hepatitis panel testing
18 Destin
19 I.O.M. Hepatitis Report Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C Pre publication copy released January 2010 Final copy in May Generated lots of press Researched, met with key stakeholders Florida s HPP was an invited reviewer/editor Florida s HPP cited (from 2007 PHR article) Florida s Hepatitis Comprehensive Plan used as resource
20 I.O.M. Report Contents Hepatitis Surveillance (consistent, national) Knowledge & Awareness (for health care providers, those at risk & general population) Immunization (Infants, adolescents & adults hepatitis B elimination & develop hep C vaccine) Hepatitis Services (community health cntrs, SEPs, Medicare, Medicaid, corrections) 22 Recommendations
21 CDC Hepatitis Plan Division of Viral Hepatitis Strategic Plan Will be finalized later this year 4 Strategic Imperatives 13 Goals Recognizes recommendations from IOM report
22 4 Strategic Imperatives from CDC Strategic Plan Protect vulnerable populations from viral hepatitis (32% of resources) Prevent disease & death from chronic hepatitis B & C (32%) Collect and disseminate data to guide disease prevention (32%) Act globally to disseminate effective interventions and detect emerging threats (4% of resources)
23 Federal Legislation HR 3974: Viral Hepatitis & Liver Cancer Control & Prevention Act of 2009 (B & C) Reps. Mike Honda (D-CA) and Charles Dent (R-PA) et al (Bipartisan support) Sen. John Kerry introduced bill in Senate Outlines: Prevention, Medical Mgmt, Education & Training, Surveillance, Vaccine, More Support for AVHPCs $90 million (2011) to $150 million (2015) 2010 CDC funding: $19.3 million 2011 funding: Prob. $ 21.1 million
24 Funding In Florida Total State Funding: $2,864,818 for Current state funding: -$2,140,400 for 15 funded CHDs -$481,749 for vaccine, laboratory, test kits, supplies -$242,669 for 5 HQ FTEs Current federal funding: -$86,044 Coop Agreement with CDC -$1,097,889 in 317 Vaccine Gone after Nov. 1, 2010
25 Downtown Tampa
26 Viral Hepatitis Council (VHC) Next meeting: 2011 Updating Plan for Group will analyze: Gaps in Services Barriers to Service Provision Unmet Needs (with or without additional funding) Current goals, objectives & action steps
27 Program Goals & Objectives Raise awareness of viral hepatitis Develop & distribute educational info Coordinate & collaborate with disease control programs re intervention & prevention (spirit of PCSI) Track the burden of disease through case surveillance and reporting Conduct research & evaluation Reduce hepatitis morbidity & mortality
28 Analysis & Evaluation Review objectives 2x/year for IPR and APR to CDC Performance measures Reported A-B-C Cases (from Merlin to MSR) Chronic hepatitis C # Vaccines given (inc. 2 nd A dose & 2 nd & 3 rd B doses) # Tests performed (and positives) Budget (how and where money is spent) Clients with a risk
29 10 th ANNIVERSARY FLORIDA HEPATITIS PREVENTION PROGRAM
30 Program Highlights Legislature 1 st funded program in FY Jan 2000: 1 st six BIG funded CHDs Sep 2000: 1 st full-time Program Admin Mar 2001: All 67 CHD offer hep A & B vaccine and testing Mar 2004: 1 st VHC meeting (Tampa)
31 More Highlights Jul 2004: 1 st issue of Hepatitis Health Oct 2004: 1 st comprehensive plan ( ) Feb 2006: 20-year surveillance report Nov 2007: AVHPC Coop Agreement with CDC Nov 2007: 1 st CDC 317 vaccine funding May 19, 2008: 1 st observance of WHD Jan 2010: 594 chronic C cases reported in ,019 reported in 2009 (62% of the nearly 300,000 estimated in Fla)
32 World Hepatitis Day, 2010 Tallahassee, May 19 Partnering with the Talla Fire Dept for EMS Awareness Week Other partners: DOH, state, private Press release Press conference Displays Vaccine Mayoral proclamation Next: July 28, 2011
33 Thanks for Listening St. Petersburg Beach
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