Epid Epidemiolo logy of of Hepatit itis is B and and C in n - - PDF document

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Epid Epidemiolo logy of of Hepatit itis is B and and C in n - - PDF document

Jun 18, 2023 490 likes •547 views

9/17/2018 Conflict of Interest Disclosure Epid Epidemiolo logy of of Hepatit itis is B and and C in n Dr. Morven Cunningham Can anada None Pr Presented ed by by: : Dr Dr. Mor orven en Cun Cunnin ningham Dr. Shah

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9/17/2018 1 Epid Epidemiolo logy of

  • f Hepatit

itis is B and and C in n Can anada

Pr Presented ed by by: : Dr

  • Dr. Mor
  • rven

en Cun Cunnin ningham

Hemant Shah MD MScCH HPTE Francis Family Liver Clinic @hepatoMD Jordan J Feld MD MPH Toronto Centre for Liver Disease Sandra Rotman Centre for Global Health

Conflict of Interest Disclosure

  • Dr. Morven Cunningham
  • None
  • Dr. Shah
  • Consulting Fees: Abbvie, Gilead, Merck, Intercept, Lupin
  • Dr. Feld
  • Research: Abbott, Abbvie, Gilead, Janssen, Merck
  • Consulting: Abbvie, Gilead, Merck

Learning Objectives

  • Appreciate the Burden of HBV and HCV globally and in Canada
  • Identify where data may be lacking
  • Appreciate the active work going on in Hepatitis policy

Guess the Impact of the Infectious Disease

INFLUENZA HIV HBV HPV

  • S. PNEUMO

HCV

Kwong JC et al. (2012) The Impact of Infection on Population Health: Results of the Ontario Burden of Infectious Diseases Study. PLoS ONE 7(9): e44103. doi:10.1371/journal.pone.0044103

#8 #6 #2 #1 #3 #4

Viral Hepatitis Deaths Globally (WHO) Worldwide Prevalence of HBV

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9/17/2018 2

Acute Hepatitis B in Canada

https://www.canada.ca/en/public-health/services/publications/diseases- conditions/report-hepatitis-b-c-canada-2013.html#f1fn1

  • Acute HBV

reportable since 1969

Chronic Hepatitis B in Canada

  • Chronic HBV

surveillance data only collected since 2009

  • Dataset excludes

Ontario

https://www.canada.ca/en/public-health/services/publications/diseases- conditions/report-hepatitis-b-c-canada-2013.html#f1fn1

CNDSS Data Limitations

  • Data has severe limitations
  • Inconsistent reporting
  • Duplication removal
  • Etiology Identification
  • Likely significant underreporting

CNDSS: Canadian Notifiable Disease Surveillance System

Hepatitis B Modeling Prevalence – Canadian vs Non-Canadian Born

Leber et al. Can J Gastroenterol 2011 (Supp).

Hepatitis B – Predicting Prevalence to 2020

**Likely an underestimate as immigration patterns have changed in Canada

Leber et al. Can J Gastroenterol 2011 (Supp).

Global Prevalence of Hepatitis C Infection

Thomas Nature 2012

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9/17/2018 3

Hepatitis C in Canada

  • Widely quoted as:
  • 0.8% of the population
  • 79% of those infected know they have it
  • Based on mathematical modeling by PHAC

“Modeling the Incidence and Prevalence of Hepatitis C Infection and its Sequelae in Canada, 2007”

http://www.phac-aspc.gc.ca/sti-its-surv-epi/model/pdf/model07-eng.pdf

PHAC Results – Prevalence by Risk Group

Exposure Category Total Pop in Canada HCV number (rate) IDU 84,361 52,512 (62.2%) Ex-IDU 183,839 87,452 (47.6%) Hemophilia 2,162 861 (39.8%) Transfused 3,325,746 25,905 (0.78%) Other 27,624,347 75,790 (0.27%) TOTAL 31,220,455 242,521 (0.78%)

Rate of Diagnosed Patients

TOTAL = 192,225 (79% of cases)

Epidemiology of HCV in Canada Under diagnosis

  • HCV is often asymptomatic; therefore, an estimated 21% of infected

Canadians are unaware of their infection (PHAC, 2007)

  • If true, Canada is among the top countries in the world at diagnosing

HCV despite not having a national screening program (Shah, 2013)

  • So likely not true, undiagnosed rate likely closer to 70% in

Canada

  • ~63% of Americans are unaware they are infected with HCV (Shah,

2013)

  • Individuals without insurance and limited access to care are still

largely undiagnosed

Canadian Health Measures Survey 2011

  • Individuals aged 3-79 living in private households (i.e. EXCLUDED

aboriginals on reserve, institutionalized, homeless)

  • HCV: 0.5% prevalence
  • HCV: 69.5% did not know of diagnosis
  • CHMS: Health Reports 2013; 24 11: 3-13

PHAC Results – Prevalence by Risk Group

Exposure Category Total Pop in Canada HCV number (rate) IDU 84,361 52,512 (62.2%) Ex-IDU 183,839 87,452 (47.6%) Hemophilia 2,162 861 (39.8%) Transfused 3,325,746 25,905 (0.78%) Other 27,624,347 75,790 (0.27%) TOTAL 31,220,455 242,521 (0.78%)

PHAC - Public Health Agency of Canada

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9/17/2018 4

PHAC Results – Prevalence by Risk Group

Exposure Category Total Pop in Canada HCV number (rate) IDU 84,361 52,512 (62.2%) Ex-IDU 183,839 87,452 (47.6%) Hemophilia 2,162 861 (39.8%) Transfused 3,325,746 25,905 (0.78%) Other 27,624,347 138,121 (0.5%) TOTAL 31,220,455 304,852 (0.97%)

Additional 62,331 Cases

Birth Cohorts and Hepatitis C Prevalence

Trubnikov, CCDR 2014

Advanced Liver Disease Increasing

Disease State Estimated Peak Cases Peak Year Increase (2013 to 2035) Decompensated cirrhosis 3,380 2031 80% HCC 2,220 2035 205% Liver-related deaths 1,880 2034 160% Myers et al. CJGH 2014

Proportion of HCV with Advanced Disease Increasing

2013 (8.7%) 2035 (23%) Myers et al. Can J Gastro Hep. 2013

Incidence vs. Morbidity Summary

  • Hepatitis B and C are prevalent infections
  • They have a high morbidity and mortality burden
  • Surveillance data in Canada can be improved