epidemiology of hepatitis c boston, 2014 · •between 2004 and 2014, there were 1,111 cases of...
TRANSCRIPT
Craig Regis, MPH Infectious Disease Bureau
Boston Public Health Commission
Epidemiology of Hepatitis C Boston, 2014
Picture from http://hepcsupport.org/ 2014
• Case definitions • Local data
– Demographics – Rates by neighborhood
• Hepatitis C in youth
Overview
• The following case reports were included in the data
Confirmed • Tests were positive HCV by viral load testing or a
significant antibody level followed by a confirmatory test or a single antibody test at a cutoff defined as positive by the manufacturer
Suspect/Probable • Tests were positive for antibody, but additional
laboratory information unknown
Case Definitions
• In Boston, there were 924 cases* of hepatitis C reported to BPHC in 2014 – This translates into an incidence rate of 150 cases per
100,000 people
Boston: Hepatitis C Overview
*Data for Boston residents only
Boston 2014: Reported Cases by Year
0
200
400
600
800
1000
1200
1400
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
• The majority of cases in 2014 occurred in men (67%)
Boston 2014: Gender
5
295
622
0 100 200 300 400 500 600 700
Transgender
Female
Male
N=924
• White residents represented the greatest proportion of cases in 2014, followed by Black and Latino residents
Boston 2014: Race
N=924
Asian 3%
Black 18%
Latino 12%
Other 1%
Unknown 26%
White 40%
• 84% of cases in 2014 occurred in people between the ages of 20 and 59
Boston 2014: Age
N=924
0%
5%
10%
15%
20%
25%
30%
< 20 20-29 30-39 40-49 50-59 60-69 70+ Age Group (Years)
• Genotype 1 was the most common in Boston in 2013
Boston 2014: Genotype
74%
5%
17%
2% 2%
Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 6
N=197
• ONLY 25% of all hepatitis C cases were diagnosed at a congregate setting, including homeless shelters, drug treatment facilities, and correctional facilities
Boston 2014: Diagnoses at Congregate Settings
N=924
2%
8%
15%
<1%
75%
Correctional Facility
Drug Treatment Program
Homeless Shelter
Long Term Care Facility
Neighborhood
Boston 2011-2014: Risk Factors
*Note: These risks are not mutually exclusive ^Based on data as of 3/25/2015
Risk* 2011 2012 2013 2014^
Injection Drug Use (IDU) 54% 55% 50% 43%
Household Contact 4% 5% 3% 3%
Sexual Partner 4% 3% 4% 3%
Transfusion prior to 1992
4% 3% 3% 2%
Hemodialysis 1% <1% 1% <1%
• 43% of 2014 hepatitis C cases reported injection drug use (IDU) as a risk factor – Unknown IDU risk for 44% of cases
Hepatitis C in Boston Youth 15-25 2004 – 2014
• Between 2004 and 2014, there were 1,111 cases of hepatitis C reported in Boston residents between the ages of 15 and 25. – This represents nearly 10% of all hepatitis C cases during
this time period in Boston. – About 9% of all hepatitis C cases in 2014 were between
the ages of 15 and 25.
Boston: Focus on Youth
Boston 15-25 Year Olds: Cases by Year
86
73
98
136
107
68
134
96
113 121
84
0
20
40
60
80
100
120
140
160
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Case
s
Year
Boston 15-25 Year Olds: Gender, 2014
34
49
0 10 20 30 40 50 60
Female
Male
# Cases
• The majority of the most recent diagnoses in this age range are men (58%) – Typically more even in this age group
N=84* *One case categorized as “other”
• The majority of the most recent hepatitis C cases in this age group were in White residents
Boston 15-25 Year Olds: Race, 2014
Unknown 24%
White 60%
Other 2% Latino
7%
Black 5%
Asian 2%
N=84
• 79% of the 1,111 hepatitis C cases in this age group were between ages 21-25
Boston 15-25 Year Olds: Age at Diagnosis, 2004-2014
0
50
100
150
200
250
15-16 17 18 19 20 21 22 23 24 25
Case
s
Age (years)
• Genotype 1 was the most common in this age group in from 2004-2014
Boston 15-25 Year Olds: Genotype, 2004-2014
60%
10%
29%
1% 0%
Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 6
N=221
• ONLY 38% of all cases in this age group were diagnosed at congregate settings, including drug treatment programs, homeless shelters, and correctional facilities
Boston 15-25 Year Olds: Diagnoses at Congregate Settings, 2014
2%
20%
15% 62%
Correctional Facility
Drug Treatment Program
Homeless Shelter
Neighborhood
N=84
Boston 15-25 Year Olds: Risk Factors
*Note: These risks are not mutually exclusive ^Based on data as of 3/25/2015
2004-2010 2011 2012 2013 2014^
Route Injection 61% 69% 68% 65% 67%
Intranasal 15% 10% 18% 18% 14%
Drug Class
Opiates 48% 65% 55% 59% 45%
Cocaine 25% 29% 27% 25% 19%
Benzodiazepines 8% 14% 10% 10% 2%
• Consistently high rates of hepatitis C in Boston • High rates in young adults and baby boomers • Some neighborhoods disproportionately affected by
the epidemic • Driven by injection drug use
Conclusions
