Hepatitis C Surveillance

1
Hepatitis C Surveillance New Mexico Department
of Health Public Health Division, Region 5 April
9, 2008
2
Facts Figures

• NM leads the nation in death rate due to Chronic
  Liver Disease (CLD)
• In NM there are approximately 150 new cases of
  HIV and 3,500 new cases of HCV reported annually
• More than 8,000 lab reports received for HCV in a
  year on average only handful (2006, 4) are acute

3
10 Essential Public Health Services

• ES 1 Monitor the health status of individuals in
  the community to identify community health
  problems.
• ES 7 Link individuals who have a need for
  community and personal health services to
  appropriate community and private providers.

4
Reasons for HCV Surveillance

• To monitor morbidity/mortality and risk factor
  trends by population and place
• To plan/evaluate resource utilization for
  prevention and control
• To link persons with HCV to health and social
  services since more than 50 of persons with HCV
  are unaware of chronic infection status

5
Past Challenges of HCV Surveillance

• Too many cases, no dedicated FTE
• No treatment available locally for low income or
  uninsured persons
• Lack of leadership for HCV as public health
  priority

6
Present Opportunities for HCV Surveillance

• 2006 NM Electronic Disease Surveillance System
  in R5 100 or so new HCV cases monthly
• Project ECHO since June 2003 legislative
  appropriation of 1.6M starting July 2005 thru
  DOH to UNMHSC
• Secretary of Health Dr. Alfredo Vigils support

7
NMEDSS Data Characteristics

• 55 of case reports lack county/city
  identification for person tested
• 55 of case reports are in suspect category
• Many repeat positive tests not with field follow
  up before in different case registries

8
Official Notifiable Condition

• Hepatitis C Virus (HCV) is a reportable disease
  in New Mexico reporting is required by New
  Mexico Administrative Code 7.4.3.13.
  Authorization for reporting hepatitis C
  information to health department is granted under
  the HIPAA Privacy Rule. All case reports are
  handled with the highest level of
  confidentiality.

9
Private Provider Responsibilities

• Provider and Laboratory are both required to
  report each positive test.
• Current information must be provided every time a
  patient tests positive for a reportable condition
  even if a repeat positive.
• Both are required to provide accurate locating
  information for person tested.

10
DOH Office Roles

• Cases may be reported to State/Central Office or
  Region Office.
• Region Office Disease Surveillance Unit for HCV
  is comprised of Saul Hernandez and Cindy Lyell
  under supervision of Patty Frank.
• If report is received at Local Office, PHN should
  advise R5 Disease Surveillance Unit of case
  status.

11
CSTE/CDC Case Definition Chronic HCV

• Clinical criteria
• Most hepatitis C virus infected persons are
  asymptomatic. However, many have chronic liver
  disease, which can range from mild to severe
  including cirrhosis and liver cancer.
• Laboratory criteria
• Anti-HCV positive by EIA, verified by an
  additional more specific assay (e.g., RIBA or PCR
  or RNA), or
• HCV RIBA positive, or
• HCV RNA positive, or
• Report of HCV genotype, or
• Anti-HCV positive by EIA, with a signal to
  cut-off ratio predictive of a true positive as
  determined for the particular assay as determined
  and posted by CDC.

12
CSTE/CDC Case Definition Chronic HCV

• ConfirmedA case that meets the clinical case
  definition and is laboratory confirmed.
• Probable A case that is anti-HCV positive by EIA
  and has ALT/SGPT levels above the upper limit of
  normal but the anti-HCV EIA result has not been
  verified by an additional more specific assay or
  the signal to cut-off ratio is unknown.
• Suspect (New Mexico) A case that is anti-HCV
  positive by EIA and has no other supporting test
  results.

13
R5 Field Follow Up Operations

• In Doña Ana County, Saul Hernandez, HE Beatriz
  Vela, RN back-up
• Rest of Counties, Cindy Lyell, RN
• Disease Prevention Specialists may assist in
  Deming (Mike Lucero) and in Alamogordo (Angelica
  Garcia) if requested
• Public Health Nurses may assist outside of Doña
  Ana County in cooperation with Cindy Lyell

14
Case Interview

• Field follow for case interview is done to offer
  person education, support, and referral as
  necessary. Another purpose of interview is
  gather data for case status designation to
  determine if a case is confirmed or probable for
  epidemiologic purposes. Somewhat different from
  HIV or STDs in that little done for partner
  elicitation or notification.

15
PHR5 Performance Measures for HCV Surveillance

• / of cases entered in NMEDSS within 30 days
  of receipt
• / of cases with phone or in-person interview
• / of cases with successful referral to Public
  Health or Project ECHO
• / of cases moved from suspect status to
  confirmed or probable case status
• / with identified risk factor added

16
Future for HCV Surveillance?

• OraQuick for HCV pending FDA approval
• In April NMCD to implement universal testing in
  state prisons upon entry
• Sentinel surveillance in the Doña Ana County
  Detention Center PHO
• Expanded HCV CTR and Hepatitis A/B vaccinations
  (Twinrix) in the DACDC PHO
• Surveillance field follow up component for case
  management in Project ECHO Web-based EHR

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Internet Intranet for More Information

• http//www.healthynm.org/ (Under Quick Links,
  click on Hepatitis C Virus Initiative)
• Or
• http//www.doh/phd3/index.htm

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Toll Free Hotline for Help

• 888-DOH-HepC
• 888-364-4372