1. Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment Randy Seewald, MD 1,2,3, Eli Kamara, BS 2, Ruy Tio, DO 1,2, Rashiah Elam, MD 1,2, Sara Lorenz, MD 1,2, Valentin Bonilla, Jr., RPA 1, David C Perlman, MD 1,2,3 1. Department of Medicine, Bronx, NY 2. Albert Einstein College of Medicine, Bronx, NY 3. Center for Drug Use and HIV Research, New York, NY APHA 10/31/2011 3232.0 Viral Hepatitis

2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

3. Background Injecting and non-injecting drug users are at high risk of infection with viral hepatitis. Hepatitis A and B are vaccine preventable diseases. Co-infection with HCV and either HAV and HAB may lead to worsening of liver disease, fulminant hepatitis, hepatocellular carcinoma, and/or death.

4. Aim The aim of this study was to determine the prevalence of viral hepatitis markers in a large methadone program in NYC and assess the need for vaccination.

5. Method The Beth Israel Medical Center MMTP serves approximately 6500 active patients at 18 clinics in NYC. Approximately 1500 patients are admitted and leave the MMTP annually. 8060 patients were screened between 6/2007 and 7/2009 for HAVtotAB, HBVsAg, HBVcAB), HBVsAb and HCVAb.

6. Results 8060 distinct patients were screened over 2 yrs. Not all had complete screening performed because of incomplete lab requisitions. 35% of those tested were HBV susceptible. 15% had isolated HBV core Ab+. <1% were HBV surface Ag+. 27% were HBV immune by natural disease. 23% were HBV immune by vaccination. 35% were HAV susceptible

7. Results (Cont.) Overall 50% were susceptible to either HAV, HBV or both. 56% were HCV Ab+. 17% of patients HCV Ab+ were HBV susceptible. 22% of patients HCV Ab+ were HAV susceptible. Overall 31% of patients HCVAb+ were susceptible to HAV and/or HBV.

8. Results (cont.) Of the 1029 isolated HBV core Ab+ patients who were also screened for HCV Ab, 954 (93%) were HCV Ab+. Those with HCV Ab+ were significantly more likely than those without HCV Ab+ to have isolated HBV core Ab+. (24% vs 2%, p<0.0001; OR 12.5, 95% CI: 9.8-16.0)

9. Hepatitis C

10. Hepatitis B

11. Hepatitis A

12. HCV Ab and Isolated HBV Core Ab Serology N=1029

13. Conclusions 56% of MMTP patients were HCV Ab+ indicating prior infection with HCV. This rate is lower than has previously been reported in similar populations of drug users in treatment. A notably high number of patients with isolated HBV core Ab+ are HCV Ab+ (93%). Patients with HCV Ab+ were significantly more likely than those without HCV Ab+ to have isolated HBV core Ab+, possibly indicating occult HBV coinfection.

14. Conclusions (cont.) Over one third of patients were HBV susceptible and HAV susceptible, with 50% susceptible to HAV and/or HBV. Among HCV Ab+ patients, 31% were susceptible to HAV and/or HBV highlighting the need for ongoing hepatitis screening and vaccination programs for MMTP patients.

15. Acknowledgements Supported by: Beth Israel Medical Center NY State Office of Alcohol and Substance Abuse Services. Center for Drug Use and HIV Research