Saotharlann Náisiúnta Tagartha Viris UCD UCD National Virus Reference Laboratory Dr. Jeff Connell Assistant Director National Virus Reference Laboratory. National Epidemiology Profile
Presentation Background Needle-stick investigations performed at the NVRL National Epidemiological Data for HIV, HBV and HCV infection What information is available Limitations of the data National Epidemiology Profile
Risk of transmission is probably directly related to the concentration of the virus (viral load) in the blood of the source patient at the time of exposure Risk of blood-borne virus (BBB) transmission
Risk of transmission of a BBV to HCW from infected patient following a single open-bore needle-stick injury is; % - HB eAg POSITIVE 3% for anti-HCV positive source 0.3% for anti-HIV positive source Risk of blood-borne virus (BBB) transmission
NVRL needle-stick investigations Crude data – includes Source investigations Recipient investigations
NVRL Data - samples referred for needlestick investigation (n = 6904)
NVRL Data - Hospitals in the Dublin Area 49 % (3388/6904) of total needle-sticks
HIV infection
HIV
HIV Viral load
HIV National Data – End of December 2000
HIV National Data – End of June 2005
HIV National Data – Q1 and Q2 2005
Hepatitis B
Hepatitis B – Electron micrograph
Natural History of HBV infection
Hepatitis B infection in Ireland Nationally the numbers of HBV infected individuals is not known - data sources are Individual studies: IVDU, prisoners - underestimate the national problem NVRL database HPSC data ESEN 2 – European Sero-Epidemiology Network Antenatal screening
0.29% (5/1,714) samples positive for antibodies to HBc age range:34-70 years sex:3 male, 2 female location:3 urban, 2 rural Adjusted prevalence for study design, estimated Irish population prevalence of HBV = 0.51% HBV National Data – Oral fluid study
HBV NVRL Data August 2004 to August 2005 Non- acute HBV459 Acute HBV44 Total503
HBV NVRL Data – Refugee reception Centres
HBV NVRL Data – Maternity Hospitals
HBV NVRL Data – Hospitals
HBV NVRL Data Acute infection: n=44
HBV National Data – HPSC
Acute HBV Chronic HBV HBV National Data – HPSC Rate of notified hepatitis B by acute and chronic status, age and sex, 2004
HBV National Data – HPSC Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)
* Enhanced form received but no known risk factor Acute HBV National Data – HPSC Risk factors for acute cases of hepatitis B, 2004 & 2005 (end Aug)
Acute HBV National Data – HPSC Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)
Chronic HBV National Data – HPSC Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)
Chronic HBV National Data – HPSC Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)
HBV National Data – HPSC Recent data Rate of notified hepatitis B in Quarter ACUTE CHRONIC
Hepatitis C
Persistent High viral load – reaches a stable baseline Natural History of HCV infection
Hepatitis C infection in Ireland Numbers of HCV infected individuals not known NVRL – HPSC database National HCV database (blood and blood products) Individual studies: IVDU, prisoners - underestimate the national problem NVRL data
Problems in the detection of HCV infected individuals Unknown modes of transmission outside the classic “risk factors” Asymptomatic acute and chronic infection Atypical anti-HCV response Delayed immune response - long window period before anti- HCV develops
HCV Genotypic investigations in Ireland 1994 –2005 – NVRL DATA
HCV Genotypes in Ireland 1994 –2005 – NVRL DATA (n – 8812)
HCV National Data – HPSC
Number of notifications of HCV Q1, 2004 to Q4 2005
Needle-stick injuries are a substantial problem Changing demographics in Ireland – increased level of HIV and HBV National data is improving National Epidemiology Profile - Conclusions
National Epidemiology Profile Acknowledgments: Dr. Lelia Thornton, HPSC Lindsay Jones. IT, NVRL Staff at the NVRL
National Epidemiology Profile Thanks for your attention Any questions ?