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 • Consulting Fees: Abbvie, Gilead, Merck, Intercept, Lupin Hemant Shah MD MScCH HPTE Jordan J Feld MD MPH Francis Family Liver Clinic Toronto Centre for Liver Disease Dr. Feld @hepatoMD Sandra Rotman Centre for Global • Research : Abbott, Abbvie, Gilead, Janssen, Merck Health • Consulting : Abbvie, Gilead, Merck Guess the Impact of the Infectious Disease Learning Objectives #1 HCV • Appreciate the Burden of HBV and HCV globally and in Canada #2 S. PNEUMO #3 HPV #4 HBV • Identify where data may be lacking #6 HIV • Appreciate the active work going on in Hepatitis policy #8 INFLUENZA 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 Worldwide Prevalence of HBV Viral Hepatitis Deaths Globally (WHO) 1
9/17/2018 Acute Hepatitis B in Canada Chronic Hepatitis B in Canada -Chronic HBV surveillance data only -Acute HBV collected since 2009 reportable since -Dataset excludes 1969 Ontario https://www.canada.ca/en/public-health/services/publications/diseases- https://www.canada.ca/en/public-health/services/publications/diseases- conditions/report-hepatitis-b-c-canada-2013.html#f1fn1 conditions/report-hepatitis-b-c-canada-2013.html#f1fn1 Hepatitis B Modeling Prevalence – Canadian CNDSS Data Limitations vs Non-Canadian Born • Data has severe limitations • Inconsistent reporting • Duplication removal • Etiology Identification • Likely significant underreporting CNDSS: Canadian Notifiable Disease Surveillance System Leber et al. Can J Gastroenterol 2011 (Supp). Global Prevalence of Hepatitis C Hepatitis B – Predicting Prevalence to 2020 Infection **Likely an underestimate as immigration patterns have changed in Canada Leber et al. Can J Gastroenterol 2011 (Supp). Thomas Nature 2012 2
9/17/2018 PHAC Results – Prevalence by Risk Group Hepatitis C in Canada • Widely quoted as: Exposure Category Total Pop in HCV number (rate) • 0.8% of the population Canada • 79% of those infected know they have it IDU 84,361 52,512 (62.2%) • Based on mathematical modeling by PHAC Ex-IDU 183,839 87,452 (47.6%) Hemophilia 2,162 861 (39.8%) “Modeling the Incidence and Prevalence of Hepatitis C Infection and its Transfused 3,325,746 25,905 (0.78%) Sequelae in Canada, 2007” Other 27,624,347 75,790 (0.27%) TOTAL 31,220,455 242,521 (0.78%) http://www.phac-aspc.gc.ca/sti-its-surv-epi/model/pdf/model07-eng.pdf Epidemiology of HCV in Canada Rate of Diagnosed Patients Under diagnosis TOTAL = 192,225 (79% of cases) 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 PHAC Results – Prevalence by Risk Group Exposure Category Total Pop in HCV number (rate) • Individuals aged 3-79 living in private households (i.e. EXCLUDED Canada aboriginals on reserve, institutionalized, homeless) IDU 84,361 52,512 (62.2%) • HCV: 0.5% prevalence Ex-IDU 183,839 87,452 (47.6%) • HCV: 69.5% did not know of diagnosis Hemophilia 2,162 861 (39.8%) Transfused 3,325,746 25,905 (0.78%) • CHMS: Health Reports 2013; 24 11: 3-13 Other 27,624,347 75,790 (0.27%) TOTAL 31,220,455 242,521 (0.78%) PHAC - Public Health Agency of Canada 3
9/17/2018 Birth Cohorts and Hepatitis C PHAC Results – Prevalence by Risk Group Prevalence Exposure Category Total Pop in HCV number (rate) Canada 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 Trubnikov, CCDR 2014 Advanced Liver Disease Increasing Proportion of HCV with Advanced Disease Increasing 2013 (8.7%) 2035 (23%) Estimated Peak Increase Disease State Peak Year Cases (2013 to 2035) Decompensated cirrhosis 3,380 2031 80% HCC 2,220 2035 205% Myers et al. Can J Gastro Hep. 2013 Myers et al. Liver-related deaths 1,880 2034 160% CJGH 2014 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 4
Recommend
More recommend
