Geo-epidemiology of Hepatitis C in Northeast Indiana

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1 Geo-epidemiology of Hepatitis C in Northeast Indiana Shori Gerardot, Ashley Cross, Atit Patel, Kassidy Beck MS, Scott M. Stienecker MD, and Teresa A. Beam PhD

2 Hepatitis C (HCV) ~180 million worldwide ~ million in US Often asymptomatic acute infection Becomes chronic 75-85% Progressive liver disease Blood-borne Surrogate indicator of opioid injection drug use core-concept/all

3 Hepatitis C Disease Transmission Direct contact with blood from an infected person Most common route-sharing of contaminated needles and syringes by injection drug users Less common-sexual contact with an infected partner, sharing select household objects Health care workers through needle stick Babies born to infected mothers

4 Hepatitis C Testing Recommendations Persons born from 1945 through 1965 Persons who have ever injected illegal drugs Recipients of clotting factor concentrates made before 1987 Recipients of blood transfusions or solid organ transplants before July 1992 Long-term hemodialysis patients All persons with HIV infection or abnormal liver function or disease Children born to mothers who are hepatitis C positive

5 New Infections and Injection Drug Use in US Reported cases of acute HCV infection increased more than 2.9-fold from 2010 through

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7 Indiana Drug Overdose Deaths states significant increase In 2015, 595 in Indianaoverdose involving opioids Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths United States, MMWR Morb Mortal Wkly Rep 2016;65: DOI:

8

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10 Hepatitis C in NE Indiana ISDH Chronic and Acute Case reports by county and zip code 99 chronic, 0 acute in Wabash Co. from chronic, 0 acute in Wabash Co. in 2016* *provisional, I-NEDSS

11 Incidence Rates Hepatitis C in NE Indiana Incidence/Total county population* By county and zip code Not reported here by 100,000 population Wabash Co., pop. ~32,000

12 National HCV Acute Incidence Demographics Young White Non-urban Appalachia, Midwest, New England

13 HCV case reports in NE Indiana health system by Age Group (n=787) Age

14 # HCV positive cases Year HCV case reports in NE Indiana health system (n=787)

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17 NE Indiana Health System HCV Genotype Distribution for (n=284)

18 NE Indiana Health System HCV Genotype 3 Distribution for (n=54)

19 Infectious Units/mL RNA Titers vs HCV Genotypes a 1b 2b 3a Genotypes Titers were measured in 150 patients with genotype 1a, 24 patients with genotype 1b, 19 patients with genotype 2b, and 53 patients with genotype 3a and their mean values are displayed in the graph.

20 HCV Genotype 3 Most treatment resistant Patients progress more rapidly to fibrosis and cirrhosis Higher prevalence of severe steatosis (fatty liver) Higher incidence of hepatocellular carcinoma (liver cancer)

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22 CDC - GHOST

23 Conclusion HCV case count up 3X from 2012 until 2015 in Wabash Co. Of all NE Indiana counties, Wabash Co. has the highest rate of nonfatal ED visits due to opioid overdose Of all NE Indiana counties, Wabash Co. has the highest rate of soft tissue infections due to drug abuse HCV genotype 3 incidence is higher than genotype 2 incidence in NE Indiana (limited EHR dataset) HCV case reports increasing for and age groups in NE Indiana (limited EHR dataset)

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