1. Progress in Facilitating National HCV Prevention
Miriam J. Alter, Ph.D.
Division of Viral Hepatitis
Centers for Disease Control and Prevention

2. Accomplishments During the Past 10 Years
Virtually eliminated PT-HCV infection
Documented >80% decline in incidence of all new infections
Characterized the epidemiology of HCV in the United States
Characterized burden of infection and morbidity in the general population
WE HAVE A PLAN

3. HCV Prevention and Control
Prevent new infections
Prevent and control disease progression
Evaluate effectiveness of activities
Surveillance and Research
MMWR 1998;47 (No. RR-19)

4. Progress in HCV Prevention and Control
Prevent new infections
Injection drug users
Prevent and control disease progression
Evaluate effectiveness of activities
Surveillance and Research
MMWR 1998;47 (No. RR-19)

5. Injecting Drug Use and HCV in 2003 Results of Surveillance and Research
Harm reduction messages more HCV-specific
All drug paraphernalia, not just needles/syringes
Cumulative infection rates have slowed
30% prevalence after 2-3 years (vs. 80% in 1989)
Incidence remains high
15% annual rate
Account for 60% of all new infections

6. Injecting Drug Use and HCV in 2003 Results of Research and Demos
IDUs will accept vaccination
Coverage high when offered “on site”
HCV-infected IDUs will follow-up with medical referrals
Recent, recovering, or occasional IDUs with chronic hepatitis C can be treated successfully
Permissive consensus statement on treatment

7. Progress in HCV Prevention and Control
Prevent new infections
Prevent and control disease progression
Identify, counsel and test persons at risk
Evaluate effectiveness of activities
Surveillance and Research
MMWR 1998;47 (No. RR-19)

8. HCV Testing Routinely Recommended Based on increased risk for infection
Ever injected illegal drugs
Received clotting factors made before 1987
Received blood/organs before July 1992
Ever on chronic hemodialysis
Evidence of liver disease
MMWR 1998;47 (No. RR-19)

9. HCV Testing Routinely Recommended Based on increased risk for infection
Ever injected illegal drugs
In high-risk settings identifies 60-70% of HCV positives
Received clotting factors made before 1987
Received blood/organs before July 1992
Ever on chronic hemodialysis
Evidence of liver disease

10. Case Control Studies of Acute Hepatitis C United States, 1979-1985
Cases Controls
Exposure (prior 6 months) n=148 n=200
Ear piercing 2.7% %
Tattooing 0.7% %
Acupuncture %
Incarceration 4.1% 1.0%
Military service 1.3% %
Potential exposure known to have occurred before onset of disease
Source: JID 1982;145:886-93; JAMA 1989;262:

11. Cross-sectional Studies of HCV
Volunteer Patient Groups College Juvenile
Exposure Donors GI Spinal VA STD Students Detainees
+ + NA NA
+ + NA
NA = not applicable
Transfusion
IDU
Nasal drug use
Tattooing
+ - ND ND
ND = not done
Sources: Conry-Cantilena; Murphy; Balasekaran; Haley; Briggs; Gunn; Hwang; Bair

12. Cross-sectional or Prevalence Study
Exposure and disease outcomes collected simultaneously
Identify possible associations requiring further study
Temporal sequence of exposure relative to disease unknown
Cannot establish association or causal relationship
Results not replicated consistently cannot be interpreted as associated with infection

13. Prevalence of Transfusion or Tattooing and HCV

14. Average Percent Anti-HCV Positive
HCV Prevalence in Selected Groups of Adults by Known or Potential Risk for HCV, United States
General
population
Males
Females
STD clients
Snorted cocaine
Tattooed
Body pierced
Average Percent Anti-HCV Positive

15. Average Percent Anti-HCV Positive
HCV Prevalence in Selected Groups of Adults by Known or Potential Risk for HCV, United States
General
population
Males
Females
STD clients
Snorted cocaine
Tattooed
Body pierced
Average Percent Anti-HCV Positive

16. Progress in HCV Prevention and Control
Prevent new infections
Prevent and control disease progression
Evaluate effectiveness of activities
Surveillance and Research
MMWR 1998;47 (No. RR-19)

17. Evaluation of Screening Criteria
Screened HCV Pos.
Setting and Criteria No. (%) No. (%)
STD clients 3356 (100) 165 (5)
IDU (self-report), transfusion < % 64%
IDU (self report, staff assessment),
transfusion < % 70%
Plus other (hx STD, age) 63% 97%
Incoming prison inmates 1148 (100) 152 (13)
IDU 11% 61%
IDU, hx liver disease 13% 70%
Plus other (ALT, anti-HBc) 27% 91%
Source: R Gunn, San Diego; D Burnett, Wisconsin

18. Progress in HCV Prevention and Control
Prevent new infections
Prevent and control disease progression
Evaluate effectiveness of activities
Surveillance and Research
Additional guidelines for implementation
MMWR 1998;47 (No. RR-19)

19. Guidelines for Viral Hepatitis Surveillance and Case Management
Distributed and available on-line in early 2002
Includes both acute disease and chronic infections
Monitor trends in incidence of and risk factors for infection disease
Assess burden of disease
Identify infected persons requiring counseling and medical follow-up
Identify contacts of infected persons requiring counseling and/or post exposure prophylaxis
Identify and control outbreaks
Demonstration projects to evaluate systems

20. States reporting registries, 2002
HBV and HCV
HBV only
HCV only
Registry unspecified
Pending
No registry

21. Prevention of Viral Hepatitis in Corrections, MMWR Jan. 24, 2003
Immunization for hepatitis A and hepatitis B
Counseling and testing for HCV
Medical evaluation and management of chronic hepatitis
Substance abuse treatment and prevention
Release planning for continuity of care and services

22. Laboratory Guidelines for Anti-HCV Testing
Publication in MMWR on February 7, 2003
Establish standardized approach for lab testing and reporting to ensure that a positive report uniformly represents serologic evidence of HCV infection.
Expand recommendations to include an option for supplemental testing based on screening test s/co ratios
Limits cost while improving accuracy of reported results
<5% of high risk persons require additional test
Educate regarding performance and interpretation

23. Progress in HCV Prevention and Control
Prevent new infections
Prevent and control disease progression
Evaluate effectiveness of activities
Surveillance and Research
MMWR 1998;47 (No. RR-19)