HCV Current Initiative: Addressing the National Epidemics of Prescription Opioid misuse and Hepatitis C through Unique Partnerships

By Dominique Saunders, Viral Hepatitis Prevention Coordinator, Kansas Department of Health and Environment and Sarah Knopf-Amelung, Project Manager, Mid-America ATTC, University of Missouri-Kansas City School of Nursing and Health Studies - See more at: https://blog.aids.gov/2015/09/hcv-current-initiative-addressing-the-national-epidemics-of-prescription-opioid-misuse-and-hepatitis-c-through-unique-partnerships.

Recently, there has been a spotlight on America’s prescription opioid misuse and overdose epidemics.  However, too often, people remain unaware of the related hepatitis C virus (HCV) epidemic. The Centers for Disease Control and Prevention (CDC) reported an estimated 150% increase in new HCV infections from 2010 to 2013 and, further, that most of the new infections were associated with injection drug use. An analysis of state and national data indicate that a large proportion of new HCV infections are occurring in young people (<30 years of age) in rural and suburban areas who use oral prescription opioid analgesics before transitioning to injecting. - See more at: https://blog.aids.gov/2015/09/hcv-current-initiative-addressing-the-national-epidemics-of-prescription-opioid-misuse-and-hepatitis-c-through-unique-partnerships.

At the same time, recent years have seen advances that have revolutionized the field of hepatitis C. Groundbreaking treatments with cure rates as high as 90-100% are now available.  Preventive screenings without cost-sharing under the Affordable Care Act make HCV screening more accessible for many people.  And the national Viral Hepatitis Action Plan increases coordination across federal programs and includes among its priorities the urgent need to reduce viral hepatitis associated with drug use behaviors. - See more at: https://blog.aids.gov/2015/09/hcv-current-initiative-addressing-the-national-epidemics-of-prescription-opioid-misuse-and-hepatitis-c-through-unique-partnerships.

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Most U.S. Hepatitis C Infections May Be Missed

TUESDAY, June 30, 2015 (HealthDay News) -- New cases of hepatitis C are drastically underreported to federal officials, researchers contend in a new study.

And they suggested that may be hampering public health efforts to cope with the chronic infection that can lead to cirrhosis or liver cancer.

The new study found that only one out of 183 Massachusetts residents diagnosed between 2001 and 2011 with acute hepatitis C infection was reported to the U.S. Centers for Disease Control and Prevention.

The rest went unreported, either because their test results didn't come back quickly enough or because the results didn't meet the strict CDC definition for hepatitis C infection, said senior study author Dr. Arthur Kim, director of the Viral Hepatitis Clinic at Massachusetts General Hospital in Boston.

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New Viral Hepatitis Numbers from the CDC, by Alan Franciscus, Editor-in-Chief

The Centers for Disease Control and Prevention (CDC) released new estimates on the acute and chronic cases of hepatitis A, B and C: 

Hepatitis A (HAV):

2013: Estimated acute cases and deaths from hepatitis A

• Acute:  3,500–range:  2,500 to 3,900
• Deaths:  80 (underlying contributing cause of death in most recent year available (2013))

Hepatitis B (HBV):

2013: Estimated acute, chronic and deaths from hepatitis B

• Acute:  19,800—range: 11,300 to 48,500
• Chronic:  700,000 to 1.4 million
• Deaths:  1,873

Hepatitis C (HCV):

2013:  Estimated acute, chronic and deaths from hepatitis C

• Acute:  29,700—range: 23,500 to 101,400
• Chronic: 2.7 to 3.9 million
• Deaths:  19,368*

NOTE: Current information indicates these represent a fraction of deaths attributable in whole or in part to chronic hepatitis C.”  

Editorial Comments:  The good news is that vaccination against hepatitis A and B and education efforts are working to keep new infections, chronic infections and deaths consistent with previous years.  Hepatitis A and B are in line with what have been previously reported and rates of new infections have leveled off.  I personally believe that hepatitis B may be under reported especially in some larger populations of immigrants who may be infected with hepatitis B.  Furthermore, we may not know the extent of chronic hepatitis B in the undocumented immigrant population. 

HCV however, seems be getting worse. The range of acute HCV population is much likely higher since we really don’t have an effective surveillance system in our country.  We have had large outbreaks of acute HCV in Wisconsin, Kentucky, Massachusetts, Indiana and elsewhere. I also believe the number of people with chronic hepatitis C is much higher and the deaths caused by hepatitis C is certainly higher.  The CDC has a * (see note) that captures the deaths which are most likely under reported.  Many times a death reported on a death certificate is listed as another cause when HCV or cirrhosis, liver cancer or a consequence of HCV may be listed instead.   

On a sad note, the age group that had the highest  rate of death was the 55 to 64 year old group with 51% of the total number of deaths—this is very young age for such a high death rate.


http://hcvadvocate.org/news/newsLetter/2015/advocate0615.html#4

Hepatitis C and the Baby Boomer Generation

As the Centers for Disease Control and Prevention release new guidelines regarding testing baby boomers - St. Luke' s Magic Valley is putting a new initiative in place.

"Three quarters of all patients with Hep. C in fact are baby boomers. Unfortunately more than three quarters of them are unknown to us," explained Dr. Brian Berk, Gastroenterologist, St. Luke’s Magic Valley.

Hepatitis C is a contagious liver disease that ranges in severity. It's spread primarily through contact with the blood of an infected person.

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U.S.A-Programs Focus on Hepatitis C

“Chronic hepatitis C infection is a commonly silent disease that according to the Center of Disease Control affects an estimated 3.2 million Americans”.

 “For primary care providers looking to address hepatitis, the University of Wisconsin-Superior’s Continuing Education Department holds a program 4-9:30 p.m. March 17 at Barker’s Island Inn and Convention Center in Superior”. “The Wisconsin Department of Health Services estimates 74,000 people in Wisconsin are infected; 50 percent of them baby boomers.

The Institute of Medicine reports that up to 75 percent of those infected are unaware they are infected. Yet, with appropriate care, hepatitis C can be a curable infection”.

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Quest Diagnostics and CDC Expand Public Health Collaboration to Improve Hepatitis Diagnosis and Treatment

Multi-year fee-based contract for Quest's test data and analytics expertise aims to reveal insights from national testing trends to promote guideline-based care and better outcomes for 4.4 million Americans with viral hepatitis

MADISON, N.J. and ATLANTA, Jan. 28, 2015 /PRNewswire/ -- Quest Diagnostics (NYSE: DGX), the world's leading provider of diagnostic information services, today announced that it will collaborate with the Centers for Disease Control and Prevention (CDC) to identify trends in screening, diagnosis and treatment for four strains of viral hepatitis in the United States, based on insights revealed by analysis of Quest's national testing database. Under terms of the multi-year contract, Quest Diagnostics will provide CDC researchers with analytics expertise and access to the company's national Quest Diagnostics Health Trends™ database of de-identified clinical testing hepatitis data. The agreement is the first fee-based contract for hepatitis-related research awarded by CDC to a diagnostic information services provider.

The goal of the collaboration is to generate diagnostic-based insights that will improve the ability of public health authorities to develop and monitor medical guidelines designed to reduce disease prevalence and enhance outcomes through earlier diagnosis and treatment of hepatitis.

"The innovative collaboration with Quest Diagnostics will allow us to use data analytics to better monitor the implementation of CDC's testing guidelines and progress toward reducing deaths from hepatitis," said John W. Ward, MD, director of CDC's Division of Viral Hepatitis. "Increased testing is critical to ensure that those who are infected with hepatitis receive life-saving care and treatment."

"Our partnership with CDC reflects the growing value of data analytics in health care to improve decision making, both for population health and in a clinical setting," said Rick L. Pesano, MD, PhD, vice president, research and development, and medical director, infectious diseases, for Quest Diagnostics. "Transforming data into insights to measure and predict behaviors and outcomes will be increasingly important as the nation's healthcare system moves to fill gaps in guideline-based care."

Quest Diagnostics is a leader in hepatitis diagnostic information services with services that include genotyping, risk stratifying and viral load testing to aid diagnosis, treatment and monitoring. Medical and bioinformatics experts from Quest Diagnostics and CDC's Division of Viral Hepatitis will analyze de-identified test results from the Quest Diagnostics Health Trends™ national database for hepatitis A, B, C and E viral infection in American adults age 18 years and over. Analysis will include results of screening and confirmatory diagnostic tests as well as treatment-guiding genotyping and viral load tests by gender, age group, geography and type of physician. The teams will jointly develop study designs and protocols based on Quest's proprietary data-mining techniques to identify patterns in prevalence and clinical management of patients.

The new agreement supplants a non-fee-based agreement formed by CDC and Quest Diagnostics in July 2013.  Under that prior agreement, the organizations jointly analyzed de-identified hepatitis C testing data in the Quest Diagnostics Health Trends database for individuals born between 1945 and 1965. In 2012, CDC issued recommendations for one-time lab screening for hepatitis C for these "Baby Boomers," who are five times more likely than other adults to be infected with hepatitis C. Untreated, chronic hepatitis can cause liver cancer and death.

A primary objective of the expanded agreement is to identify and monitor trends in hepatitis B and C viral infection in pregnant women and to characterize these patients by demographics and type of physician. About 40% of untreated newborns infected with hepatitis B in utero will develop chronic hepatitis, and one in four of these will die from liver disease. CDC guidelines call for pregnant women to be screened with a lab test for hepatitis B, but only recommend hepatitis C screening when other risks are present. In recent years, CDC's Division of Viral Hepatitis has partnered with Quest Diagnostics and others to add pregnancy status to hepatitis B lab test orders to improve surveillance of infected mothers.

"The right screening and medical interventions can prevent the tragedy of lifelong hepatitis-related liver disease in children born to infected mothers," said Dr. Pesano. "We're proud to work with CDC to assess trends in hepatitis B screening in pregnant women in order to identify gaps in screening and treatment, because it will yield insights that will help health professionals take actions to save people's lives."

Quest Diagnostics maintains the largest private clinical database of diagnostic testing information in the United States, Quest Diagnostics Health Trends, based on more than 20 billion de-identified test results. The company's scientists, in collaboration with top health institutions, analyze and publish studies based on this data in peer reviewed publications and as a public service in order to identify trends in disease and wellness.

In a 2010 report, the Institute of Medicine underscored a lack of awareness among the public and medical providers about the health dangers of hepatitis. The IOM also called upon public and private organizations to partner to increase data collection on infection, treatment and outcomes of hepatitis B and C, and to educate at-risk populations, healthcare providers and the general public about hepatitis to promote vaccination and prevention strategies and encourage screening and testing.

About Quest Diagnostics Quest Diagnostics is the world's leading provider of diagnostic information services needed to make better healthcare decisions. The company offers the broadest access to diagnostic information services through its network of laboratories and patient service centers, and provides interpretive consultation through its extensive medical and scientific staff.  Quest Diagnostics is a pioneer in developing innovative diagnostic tests and advanced healthcare information technology solutions that help improve patient care.  Additional information is available at QuestDiagnostics.com.  Follow us at Facebook.com/QuestDiagnostics and Twitter.com/QuestDX.

Quest, Quest Diagnostics, the associated logo, and all associated Quest Diagnostics marks are the registered trademarks of Quest Diagnostics. All third party marks — ®' and ™' — are the property of their respective owners.

Quest Diagnostics Contacts:Wendy Bost, Quest Diagnostics (Media): 973-520-2800
Dan Haemmerle, Quest Diagnostics (Investors): 973-520-2900

CDC Contact: CDC Media Line: 404-639-8895

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SOURCE Quest Diagnostics: http://newsroom.questdiagnostics.com/2015-01-28-Quest-Diagnostics-and-CDC-Expand-Public-Health-Collaboration-to-Improve-Hepatitis-Diagnosis-and-Treatment