Piloting HCV GHOST in Michigan - NASTAD · Impact of GHOST ¨Epidemiological, demographic, risk and...
Transcript of Piloting HCV GHOST in Michigan - NASTAD · Impact of GHOST ¨Epidemiological, demographic, risk and...
PilotingHCVGHOSTinMichigan
November29,2017 JoeCoyle,MPH
www.michigan.gov/hepatitis
Outline
¨ MDHHSHCVSurveillance
¨ BasicsofHCVGHOST
¨ ExampleofGHOSTinAction
¨ ImplicationsforPublicHealthSurveillance
MDHHSHCVSurveillance
HCVReportinginMDSS,2016
NewHCVCasesbyYearofBirth,2016
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1925 1932 1939 1946 1953 1960 1967 1974 1981 1988 1995 2002 2009 2016
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NewHCVDiagnosesamong18-29YearOlds
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Epidemiologyof2016YoungAdultHCVCasesAge(n=2060)
Median 25Mean 24.96Range 18- 29
Sex(n=2057) Rateper100,000Female 967(47.0%) 124.92Male 1090(53.0%) 138.09
Race(n=1524) Rateper100,000White 1351(88.6%) 110.60Black 139(9.1%) 54.04AmericanIndian 22(1.4%) 178.43Asian 12(0.8%) 24.38
HispanicEthnicity(n=1163) Rateper100,000HispanicorLatino 40(3.4%) 45.77NotHispanicorLatino 1123(96.6%) 71.83
HistoryofIVDU(n=978)Yes 823(84.2%)No 155(15.8%)
Howdoyouidentifyanoutbreak?Wheretofocusresources?
ChronicHCVCaseAcuteHCVCase
HCVinYoungAdults(2010-2015)
ChallengeswithTraditionalHCVSurveillanceAlone
¨ Largevolumeofcases¤Whichcasesmightreallyberelatedtoeachother?
¨ Largenumberofundiagnosedcasesduetoasymptomaticinfection¤ “Missinglinks”
¨ Timefromexposuretodiagnosis(acutevs.chronic)¤ E.g.anewcasein2016couldbeanepilinkofacasereportedin2012
¨ Geo-spatial-temporalrelationshipsbetweencases???
HCVGHOSTBasics
GlobalHealthOutbreakSurveillanceTechnology
GlobalHealthOutbreakSurveillanceTechnology
HCVGHOSTinpracticeHCVGHOSTinpractice
HCVMSMCluster
EpidemiologicInfo
CaseEpiInfoMedianAge:31AgeRange:21– 48yearsSex:Male(29)Race:AfricanAmerican(28),Hispanic(1)HCVGenotype:1a(16/16)Residence:Detroit(19),Wayne(5),
Oakland(3),Macomb(2)
CaseRiskFactorsIVDU:No(28)“Uppers”:No(28)HIV:Positive(29)SexualHistory:MSMorBi(29)PreviousSTDs:
Syphilis(21)LGV(6)GC(19)CT(16)
Other(HepatitisA,Giardia,Shigella,Cryptosporidium)
¨ 5acutecases,24chroniccasesperCDC/CSTEHCVcasedefinitions
“EpiCurve”
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Q12014
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Q42014
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Q22015
Q32015
Q42015
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Q22016
Q32016
Q42016
Coun
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Quarter-Year
DateofFirstPositiveHCVLab
Case(n=29)SuspectCase(n=10)
Howlargeisthecluster?
Arethecasespartofthesametransmissionnetwork?
HCVGHOSTTransmissionCluster
ImpactofGHOST
¨ Epidemiological,demographic,riskandpartner/contacttracingstillcruciallyimportanttocommunicablediseaseinvestigation¤ Butsometimesthisisn’tenoughfordeterminingpatientrelatedness
¨ Moleculardatacanhelppiecetogetherdisjointedorunrecognizedtransmissionnetworks¤ Forthisclusterinparticular,anonymoussexusinggeosocialnetworkingappswascommon(i.e.partnerswerenotoftenknown)
ImplicationsforPublicHealthSurveillance
ATheoreticalPublicHealthResponse
¨ Contacttracing¨ Education¨ Co-locationofservices:
¤ Referraltosubstanceabusetreatment¤ Patientcounseling¤ Cleanneedles¤ Overdoseprevention¤ HCV/HIVtesting¤ HepatitisA/Bvaccinations
¨ HCVTreatment?¨ InformingotherCD/Preventionareas(STD,HIV,etc.)
ATheoreticalPublicHealthResponse
ApplicationofGHOSTinMichigansofar
¨ PilotingHCVGHOSTtechnologyin-houseonconveniencesampleofHCVRNA+specimensreceivedbytheMDHHSBOL¤ 115specimenshavecurrentlyundergoneGHOSTanalysis¤ 1largeclusteramongtheHIV-infectedMSMpopulation¤ Handful2-3personclustersamongsuspectedPWIDs
¨ Inprocessofdevelopingprotocolsforinvestigation/follow-up¤ Howtorespondtoacluster?¤Whoresponds?
Thanks!
¨ CouncilofStateandTerritorialEpidemiologists:¤ ProjectstoAssessEmergingSurveillanceIssuesinSubstanceAbuseandMentalHealth
¨ AssociationofPublicHealthLaboratories:¤ PilotofGlobalHepatitisOutbreakandSurveillanceTechnology(GHOST)forMolecularSurveillanceofHCVInfection
¨ CDCDivisionofViralHepatitisLaboratory
¨ MDHHSBureauofLaboratories
¨ NationalAllianceofStateandTerritorialAIDSDirectors
THANKS!
JoeCoyle,MPHMichiganDepartmentofHealthandHumanServicesE-mail:[email protected]:517-335-8165Website:www.mi.gov/hepatitis