Wisconsin Department of Health Services

Hepatitis C Virus Surveillance Examples from Wisconsin

Lauren Stockman, MPH Hepatitis C Epidemiologist NASTAD Hepatitis Technical Assistance Meeting Washington, DC October 20, 2015

Wisconsin Department of Health Services

Public Health Surveillance “Public health surveillance is the systematic, ongoing collection, management, analysis, and interpretation of data followed by the dissemination of these data to public health programs to stimulate public health action.” CDC’s Vision for Public Health Surveillance in the 21st Century, MMWR, 2012 Data Collection

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Analysis

Health Action

Hepatitis C Surveillance Data Specimens

Specimens Public Health Testing Site

Healthcare Provider Laboratory Results to providers

Results to providers Laboratory reporting of positive results

Case Reports

Case Reports

Wisconsin Electronic Disease Surveillance System • Secure, web-based • Receive case report forms • Receive laboratory data • Accessed by Viral Hepatitis Prevention Coordinator and health department staff

Weekly transmission of acute hepatitis C virus (HCV)

Issues sent back to state for resolution Data Collection

Analysis

Health Action

Wisconsin Department of Health Services

Analysis and Interpretation Prevalence Estimate: • People living with hepatitis C virus (HCV), reported infections: 36,000 • Estimated HCV infections: 74,000 • People with HCV in the southeastern region: 52%

Number of Hepatitis C Virus Infections Reported by County 2000 - 2014

Data Collection 4

Analysis

Health Action

Wisconsin Department of Health Services

Analysis Incidence Estimate : • Past or Present reported in 2014: 3,168 (rate: 55 per 100,000) • Acute reported in 2014: 49 (rate: 0.7 per 100,000)

Data Collection 5

Analysis

Health Action

Wisconsin Department of Health Services

Analysis Incidence Estimate : • Reports from people age 15–29 in 2014: 895 • Rate in this age group: 78 per 100,000 • Increase in number of reports compared to 2007: Five times

Data Collection 6

Analysis

Health Action

Wisconsin Department of Health Services

Annual Case Count

Analysis

Annual Population-based Rate

Data Collection 7

Analysis

Health Action

Wisconsin Department of Health Services

Analysis

Annual Population-based Rate

Data Collection 8

Analysis

Health Action

Wisconsin Department of Health Services

Analysis: Trends 70%

60

61% 39%

50 40 30 20

30%

Female

10

2013

2012

2011

2010

2009

2008

2007

2006

2005

Year of Positive HCV Test

Data Collection 9

Male

0 2004

• New reports in females have increased since 2003.

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2003

o 61% of reports in 2014 were from men. o 65% of known living with HCV are men.

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Percent of Reported Cases

Trends in Sex: • HCV is more common among males:

Percentage of HCV Infections, by Sex, Wisconsin, 2003-2014

Analysis

Health Action

Wisconsin Department of Health Services

Analysis: Trends Under 30 Years 30-49 Years 50 Years and Older

70 60

58%

50

Percent

Young people under age 30: • Reports increased five-fold. • Most are White, non-urban. • Attributed to recent injection drug use. • Rates similar in male and female.

Percent of HCV Infections, by Age, Wisconsin 2003 - 2014

40

43% 36% 29%

30

28%

20 10

5% 2014

2013

2012

2011

2010

2009

2008

2007

2006

2005

2004

2003

0

Year of Positive HCV Test

Data Collection 10

Analysis

Health Action

Wisconsin Department of Health Services

Analysis Baby boomers born 1945-1965: • Make up two thirds of all HCV cases reported in Wisconsin. • Have a higher rate of HCV hospitalizations. • Have a higher rate of liver transplants. • More often male than female. Photo source, CDC: http://www.cdc.gov/knowmorehepatitis/Medi a/PDFs/FactSheet-Boomers.pdf

Data Collection 11

Analysis

Health Action

Wisconsin Department of Health Services

Analysis: Disparities HCV reported cases per 100,000, by race, Wisconsin, 2014 Rate per 100,000 population

Racial disparities: • HCV disproportionally impacts minorities. • Rate of new HCV reports in Blacks is twice that of Whites. • Rate of new HCV reports in American Indians is almost three times that of Whites.

180 160 140 120 100 80 60 40 20 0

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44 White (NonHispanic)

Black (NonHispanic)

American Indian

Asian

Race

Data Collection 12

130

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Analysis

Health Action

Wisconsin Department of Health Services

Analysis: Context and Comparisons Reports of Selected Diseases, Wisconsin, 2012 Number of Cases

3,000

2,608

2,500 2,000 1,500 1,000 500 0

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71

Hepatitis A

TB

266

241

Syphilis

HIV

393 Hepatitis Hepatitis B C

Data Collection 13

Analysis

Health Action

Wisconsin Department of Health Services

Analysis: Summary If HCV surveillance data is available, VHPC, epidemiologist, data analyst, student might: • Count number confirmed and probable reported • Use age 15–29 as proxy for recent transmission • Look at a 5-year trend • Find percent of reports by sex and age group • Use county or zipcode to look within key geographic areas

Data Collection 14

Analysis

Health Action

Wisconsin Department of Health Services

More Data Options If HCV surveillance data is not available or to supplement surveillance data, use: • Hospitalizations, emergency department visits • Medicaid claims • Mortality data • State or private laboratory data • Opioid or heroin treatment admission data • Research by academic partners

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Data Collection

Analysis

Health Action

Wisconsin Department of Health Services

Hospitalization Data Hospitalizations for HCV or HIV, Wisconsin, 2010-2012 Hepatitis C

100

HIV

Age-djusted Rate of HCV Hospitalization, Wisconsin, 2003-2012

3,966

3,891

1,223

Rate of HCV Hospitalization per 100,000 population

90

3,865

1,213

1,249

71 per 100,000

80 70 60 50 40

58 per 100,000

50 per 100,000

30 20 10 0

2010

2011

2012

2003

2006

2009

2012

Year of Discharge Data Collection 16

Analysis

Health Action

Wisconsin Department of Health Services

Vital Records Data Deaths Associated with Hepatitis C, Hepatitis B and HIV: Wisconsin, 2000-2011 180 Hepatitis C

Number

160 140

HIV

120

Hepatitis B

100 80 60 40 20 0 2000

2001

2002

2003

2004

2005 2006 2007 Year of Death

2008

Data Collection 17

2009

2010

Analysis

2011

Health Action

Wisconsin Department of Health Services

Vital Records Data Age Distribution of Deaths, Wisconsin, 2009-2011

• 80 percent of HCV deaths occurred in persons aged 45-64 years. • The median age of death related to HCV was 57 years. • On average, those who had a death related to HCV died 22 years younger than those who died of other causes. Data Collection

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Analysis

Health Action

Wisconsin Department of Health Services

Injection Drug Use Data

Source: Journal Sentinel July 7, 2015

Data Collection 19

Analysis

Health Action

Wisconsin Department of Health Services

Heroin Deaths

* Madison

* Madison

* Milwaukee

2012

2008 (n=67) Data Collection 20

* Milwaukee

(n=187)

Analysis

Health Action

Wisconsin Department of Health Services

Hepatitis C in Young People

* Madison

2014

2008 (n=210) Data Collection 21

* Milwaukee

* Madison

* Milwaukee

(n=721)

Analysis

Health Action

Wisconsin Department of Health Services

Syndromic Surveillance BioSense Platform • Supported by CDC to enhance national health surveillance • Used by state and local health departments • Contains emergency department, hospitalization and ambulatory visits • Includes free-text of chief complaint and triage notes • Allows users to find increases in injection drug use within the state

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Data Collection

Analysis

Health Action

Wisconsin Department of Health Services

Syndromic Surveillance Visits August 1, 2014 – August 1, 2015

Example results • Emergency department visits with a chief complaint of: • injection drug use • heroin • Real time, up-to-date • Mapped by facility or patient residence

Data Collection 23

Analysis

Health Action

Wisconsin Department of Health Services

Concurrent HIV/HCV Surveillance • • • •

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Hepatitis C Program collaborates with HIV Surveillance Team Look for recent HCV infection among people living with HIV Match individuals across surveillance systems Rapidly link to care, treatment and prevention services

Data Collection

Analysis

Health Action

Wisconsin Department of Health Services

Concurrent HIV/HCV Surveillance Example: Report monitoring recent HIV/HCV coinfections

Data Collection 25

Analysis

Health Action

Wisconsin Department of Health Services

Disseminate and Use Data • Create annual reports • Integrate within state HIV programs and publications • Create fact sheets and infographics

Data Collection 26

Analysis

Health Action

Wisconsin Department of Health Services

Disseminate and Use Data • • • •

Monitor counties at risk for HCV transmission Help prioritize resources and HCV tests Help focus education and training Conduct individual case investigation and guide follow-up

Data Collection 27

Analysis

Health Action

Wisconsin Department of Health Services

Thank You! Contact for Questions: Lauren Stockman, MPH Hepatitis C Epidemiologist [email protected] Sheila Guilfoyle Viral Hepatitis Prevention Coordinator [email protected]

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