1. Saotharlann Náisiúnta Tagartha Viris UCD UCD National Virus Reference Laboratory Dr. Jeff Connell Assistant Director National Virus Reference Laboratory. National Epidemiology Profile

2. 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

3. 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

4. Risk of transmission of a BBV to HCW from infected patient following a single open-bore needle-stick injury is; 20-30 % - HB eAg POSITIVE 3% for anti-HCV positive source 0.3% for anti-HIV positive source Risk of blood-borne virus (BBB) transmission

5. NVRL needle-stick investigations Crude data – includes Source investigations Recipient investigations

6. NVRL Data - samples referred for needlestick investigation (n = 6904)

7. NVRL Data - Hospitals in the Dublin Area 49 % (3388/6904) of total needle-sticks 2003-2005

8. HIV infection

9. HIV

10. HIV Viral load

11. HIV National Data – End of December 2000

12. HIV National Data – End of June 2005

13. HIV National Data – Q1 and Q2 2005

14. Hepatitis B

15. Hepatitis B – Electron micrograph

16. Natural History of HBV infection

17. 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

18. 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

19. HBV NVRL Data August 2004 to August 2005 Non- acute HBV459 Acute HBV44 Total503

20. HBV NVRL Data – Refugee reception Centres

21. HBV NVRL Data – Maternity Hospitals

22. HBV NVRL Data – Hospitals

23. HBV NVRL Data Acute infection: n=44

24. HBV National Data – HPSC

25. Acute HBV Chronic HBV HBV National Data – HPSC Rate of notified hepatitis B by acute and chronic status, age and sex, 2004

26. HBV National Data – HPSC Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)

27. * 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)

28. Acute HBV National Data – HPSC Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)

29. Chronic HBV National Data – HPSC Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

30. Chronic HBV National Data – HPSC Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

31. HBV National Data – HPSC Recent data Rate of notified hepatitis B in Quarter 4 2005 ACUTE CHRONIC

32. Hepatitis C

34. Persistent High viral load – reaches a stable baseline Natural History of HCV infection

36. 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

37. 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

38. HCV Genotypic investigations in Ireland 1994 –2005 – NVRL DATA

39. HCV Genotypes in Ireland 1994 –2005 – NVRL DATA (n – 8812)

40. HCV National Data – HPSC

41. Number of notifications of HCV Q1, 2004 to Q4 2005

42. 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

43. National Epidemiology Profile Acknowledgments: Dr. Lelia Thornton, HPSC Lindsay Jones. IT, NVRL Staff at the NVRL

44. National Epidemiology Profile Thanks for your attention Any questions ?