Hepatitis C: Hidden HarmFriday 21st March, 2014

Dublin

Hepatitis C – A Public Health IssueJoe Barry, TCD

Hepatitis C virus (1)

• Virus first identified in 1989• Routine screening of blood started in 1991• Many people were infected through contaminated

blood/blood products prior to this• Most new cases in developed countries are in injecting drug

users• Hepatitis C can also be transmitted sexually and from an

infected mother to her baby – but these routes are less common

• Most cases are initially asymptomatic or mildly symptomatic• 55-85% of those infected develop chronic infection

Hepatitis C virus (2)

• Chronic infection can lead to chronic liver disease, cirrhosis, liver failure and liver cancer (usually over 20-30+ years)

• >170 million people chronically infected worldwide• No vaccine available• Standard treatment:

– Combination therapies using interferon and new antiviral drugs have steadily improved the rate of cure (sustained virological response) in the last decade.

– Treatment success rate of up to 80% depending on various factors.

Worldwide prevalence hepatitis C infection (source: WHO)

Strategy Main WG – membership (1)• Joe Barry, TCD (Chair)• Jean Flanagan, Hepatitis C liaison service, HSE North Dublin• Walter Cullen, UCD• Helena Irish, Hepatitis Service, SJH• Julian Pugh, Coordinator Drugs Treatment Services, HSE• Shay Keating, Hepatitis C Service, Drug Treatment Centre Board• Taru Burstall, Community Sector• Lelia Thornton, Specialist in PH Medicine, HPSC• Anna Quigley, Community Sector• Colm Bergin, Infectious Disease Consultant, SJH• John Moloney, Patrick Street Clinic, Addiction Service, HSE DML

Strategy Main WG – membership (2)

• Jack Lambert, Infectious Disease Consultant, Mater/Rotunda Hospitals

• Patricia Ramshaw, HSE West• Lesley O’Sullivan, Addiction Services, HSE DNE• Ger Power, Addiction Services, HSE DML• Maurice Farnan, Area Operations Manager, Drug Service, HSE

DML• Margaret Bourke, GP Coordinator, HSE DML• Eddie Ward, Health Promotion, HSE DML• Ruadhri McAulliffe, Uisce• Emily Reaper, UISCE• Sinead Donohoe, Registrar in PH Medicine, Dept of PH, HSE

Strategy Main WG – membership (3)

• Aiden McCormick, Consultant Hepatologist, SVUH• Des Crowley, GP Coordinator, HSE North Dublin • Susan McKiernan, Consultant Hepatologist, SJH• Naomi Glover, Hepatitis C liaison service, HSE North Dublin• Bobby Smyth, Adolescent Addiction Psychiatrist, HSE DML• Paul Kavanagh, Dept of PH, HSE East• Mary O’Shea, Dublin Aids Alliance• Louise Mullen, Dept of PH, HSE East• Jeff Connell, NVRL, UCD

Strategy Surveillance Subgroup - membership

• Lelia Thornton, Specialist in PH Medicine, HPSC (Chair)• Joe Barry, TCD• Niamh Murphy, Surveillance Scientist, HPSC• Orla Ennis, Surveillance Scientist, Dept of PH, HSE East• Julie Heslin, Specialist in PH Medicine, HSE South East• Suzie Coughlan, Senior Clinical Scientist, NVRL, UCD• Sinead Donohoe, Specialist Registrar in PH Medicine,

Dept of PH, HSE East

Strategy Education and Prevention Subgroup - membership

• Maurice Farnan, Area Operations Manager, Addiction Service HSE DML (Chair)

• Julian Pugh, Coordinator Drugs Treatment Services (Prisons), HSE

• Eddie Ward, Health Promotion, HSE DML• Bobby Smyth, Adolescent Addiction Psychiatrist, HSE

DML

Strategy Treatment Subgroup - membership• Shay Keating, Hepatitis C Service, Drug Treatment Centre

Board (Chair)• Jack Lambert, Infectious Disease Consultant, Mater/Rotunda

Hospitals• Margaret Bourke, GP Coordinator, HSE DML• Sinead Donohoe, Specialist Registrar in PH Medicine, Dept of

PH, HSE• Helena Irish, Hepatitis Service, SJH• Susan McKiernan, Consultant Hepatologist, SJH• John Moloney, Patrick Street Clinic, Addiction Service, HSE

DML• Colm Bergin, Infectious Disease Consultant, SJH• Des Crowley, GP Coordinator, HSE North Dublin

Distribution of Strategy Recommendations

• Surveillance 8• Prevention 14• Screening/testing 6• Treatment 8

Implementation Committee – membership • Joe Barry, TCD (Chair)• Lelia Thornton, Specialist in PH Medicine, HPSC • Michele Tait, National Hepatitis C Coordinator, HSE • Ruadhri McAulliffe, Uisce (Union for improved services,

communication and education)• Margaret Bourke, GP Coordinator, HSE DML • Suzanne Norris, SJH, Chair of Irish Hepatitis C Outcomes Research

Network (ICORN) • Diane Nurse, Lead National Planning Specialist-HSE National Social

Inclusion Office • Ruth Armstrong, Project Manager - Health Promotion &

Improvement - HSE • Vivienne Fay, Area Operations Manager, Addiction Service, HSE

DML

ToR – Implementation Committee

• Oversee and monitor implementation of recommendations of the HSE National Hepatitis C Strategy.

• Facilitate communication and provision of information throughout the health services and wider community in respect of progress made on implementation of recommendations, identification of emerging issues, and other matters

• Update recommendations in light of new evidence• Develop and encourage synergies across the Hepatitis

C sector

Surveillance and Screening subgroup membership

• Lelia Thornton, HPSC (Chair)• Elizabeth Keane, Director of PH, HSE South• Jeff Connell, National Virus Reference Lab• Shay Keating, National Drug Treatment Centre• Niamh Murphy, Surveillance Scientist, HPSC• Fionnuala Cooney, HSE East• Orla Ennis, HSE East• Joanne Moran, NVRL and HSPC• Chantal Migone, SpR in Public Health• Eve Robinson, SpR in Public Health

Surveillance priorities for 2014

• Development of national hepatitis C screening guidelines– The national hepatitis C screening guidelines will be developed according

to the approach recommended by the National Clinical Effectiveness Committee (NCEC). A formal “Notice of intent to develop clinical guidelines” has been submitted to NCEC. It has been accepted and published on NCEC website. A provisional project plan and timeline has been developed. The guidelines will cover what population groups should be offered testing, in what settings, at what frequency, by what type of test.

• Population Prevalence project – determining current prevalence and assessing need for and options for a seroprevalence study– Work is currently focused on exploring ways to establish prevalence of

hepatitis C in IDUs, based on screening carried out in drug treatment clinics and exploring the different options for a seroprevalence survey.

Epidemiology of hepatitis C in Ireland

• Hepatitis C became notifiable in 2004• 2004-2012: 11,568 cases notified, mean annual number: 1,285• Crude notification rate in 2012: 24.4/100,000• Likely to include some cases diagnosed before 2004 and not previously notified, and some duplicates (as full names not always provided)• 65% of cases notified 2004-2012 were male• The median age at notification 2004-2012 was 34 years• Risk factor data collected since early 2007 – data available for 55% of cases notified between 2007 and 2012• 77% were injecting drug users

Number or notifications hepatitis C 2004-2012, by sex and mean age

Most likely risk factor (%) for cases of hepatitis C notified in 2012 (where data available, n=651, 63%)

Education, Prevention and Communication subgroup

• Ruth Armstrong, Project Manager Alcohol, HSE• Gail Hawthorne, Hepatitis C Liaison Nurse CNS, HSE• Kenneth Hartnett, Service User Representative Forum (SURF)• Nicola Perry, Manager, Community Response Ltd• Susan Donlon, Coordinator Prevention Education and

Training, Dublin Aids Alliance• Sarah O’Brien, Health Promotion Information, Social

Marketing and Advocacy, HSE

Education, prevention and communication priorities for 2014

• To provide clear, consistent and updated advice on the transmission risks of hepatitis C through the development of an education and awareness week in July 2014

• To collate and review existing informational and educational material to identify gaps in information and advice on hepatitis C

Challenges

• Cuts in Services• Stigma• Asymptomatic infection• Absence of IT in drug services

Opportunities

• Good structures• Health Identifier Bill• New treatment options• Awareness potential