Saotharlann Náisiúnta Tagartha

Viris UCDUCD National Virus Reference

Laboratory

Dr. Jeff Connell

Assistant Director

National Virus Reference Laboratory.

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Presentation

• Background

• Needle-stick investigations performed at the NVRL

• National Epidemiological Data for HIV, HBV and HCV infection

• What information is available• Limitations of the data

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• Risk of transmission is probably directly related to the concentration of the virus (viral load) in the blood of the source patient at the time of exposure

Risk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmission

Risk of transmission of a BBV to HCW from infected patient following a single open-bore needle-stick injury is;

• 20-30 % - HB eAg POSITIVE• 3% for anti-HCV positive source• 0.3% for anti-HIV positive source

Risk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmissionRisk of blood-borne virus (BBB) transmission

NVRL needle-stick investigationsNVRL needle-stick investigations

Crude data – includes

• Source investigations• Recipient investigations

0

500

1000

1500

2000

2500

3000

2003 2004 2005

NVRL Data - samples referred for needlestick investigation (n = 6904)NVRL Data - samples referred for

needlestick investigation (n = 6904)

0

2

4

6

8

10

12

Perc

enta

ge

1 2 3 4 5 6 7 8 9 10

Hospital ID

NVRL Data - Hospitals in the Dublin AreaNVRL Data - Hospitals in the Dublin Area

49 % (3388/6904) of total needle-sticks 2003-2005

HIV infectionHIV infection

HIV HIV

HIV Viral load HIV Viral load

HIV National Data – End of December 2000HIV National Data – End of December 2000

HIV National Data – End of June 2005HIV National Data – End of June 2005

HIV National Data – Q1 and Q2 2005HIV National Data – Q1 and Q2 2005

Hepatitis BHepatitis B

Hepatitis B – Electron micrographHepatitis B – Electron micrograph

Natural History of HBV infectionNatural History of HBV infection

Hepatitis B infection in IrelandHepatitis B infection in Ireland

Nationally the numbers of HBV infected individuals is not known - data sources are

• Individual studies: IVDU, prisoners - underestimate the national problem

• NVRL database

• HPSC data

• ESEN 2 – European Sero-Epidemiology Network

• Antenatal screening

• 0.29% (5/1,714) samples positive for antibodies to HBc

• age range: 34-70 years

• sex : 3 male, 2 female

• location: 3 urban, 2 rural

• Adjusted prevalence for study design, estimated Irish population prevalence of HBV = 0.51%

HBV National Data – Oral fluid studyHBV National Data – Oral fluid study

HBV NVRL DataAugust 2004 to August 2005

HBV NVRL DataAugust 2004 to August 2005

• Non- acute HBV 459• Acute HBV 44

Total 503

0

5

10

15

20

25

30

35

40

1 2 3 4 5

HBV NVRL Data – Refugee reception Centres

HBV NVRL Data – Refugee reception Centres

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4 5

HBV NVRL Data – Maternity HospitalsHBV NVRL Data – Maternity Hospitals

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4 5 6 7 8 9

HBV NVRL Data – HospitalsHBV NVRL Data – Hospitals

0

5

10

15

20

25

30

MSM ND Hepatitis/jaundice Fatigue Renal Failure

HBV NVRL DataAcute infection: n=44

HBV NVRL DataAcute infection: n=44

HBV National Data – HPSC HBV National Data – HPSC

Acute HBV

Chronic HBV

0

1

2

3

4

5

6

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group

Cru

de in

cid

en

ce rate p

er

100,000 p

op

ulatio

n

Male Female

0

10

20

30

40

50

0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group

Cru

de in

cid

en

ce rate p

er

100,000 p

op

ulatio

n

Male Female

HBV National Data – HPSC Rate of notified hepatitis B by acute and chronic status, age and sex, 2004

HBV National Data – HPSC Rate of notified hepatitis B by acute and chronic status, age and sex, 2004

020

4060

80100

120140

160180

Q1 Q2 Q3 Q4 Q1 Q2

2004 2005

Year and month

Nu

mb

er o

f n

oti

fica

tio

ns

of

hep

atit

is B Acute (8%)

Chronic (73%)

Unknown (19%)

HBV National Data – HPSC Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)

HBV National Data – HPSC Number of cases of hepatitis B notified by status, 2004 & 2005 (end July)

*Enhanced form received but no known risk factor

Risk factorNumber of

casesRelative

frequency (%)

Men who have sex with men 20 20.4Possible sexual exposure 12 12.2Born in endemic country/Asylum seeker 4 4.1Infection acquired abroad 3 3.1Vertical transmission 2 2Tatooing/body piercing/acupuncture 2 2Surgery 2 2Intravenous drug user 2 2Household contact 2 2Dental work 2 2Percutaneous/mucocutaneous blood/body fluid exposure 1 1No risk data available 32 32.7No known risk factor* 14 14.3Total 98 100

Acute HBV National Data – HPSC Risk factors for acute cases of hepatitis B, 2004 & 2005 (end Aug)

Acute HBV National Data – HPSC Risk factors for acute cases of hepatitis B, 2004 & 2005 (end Aug)

Region of BirthNumber of

cases%

Western Europe 40 87Sub-Saharan Africa 2 4.3East Asia & Pacific 2 4.3Eastern Europe 1 2.2Central Europe 1 2.2Total 46 100

Acute HBV National Data – HPSC Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)

Acute HBV National Data – HPSC Region of birth (where known) for acute cases of hepatitis B, 2004 & 2005 (end Aug)

Risk factor or proxy for risk factor for all casesNumber of

casesRelative

frequency (%)Born in endemic country/Asylum seeker 219 22.7Household contact 6 0.6Vertical transmission 5 0.5Resident intellectual disability institition 3 0.3Intravenous drug user 3 0.3Dental work 3 0.3Men who have sex with men 2 0.2Infection acquired abroad 2 0.2Possible sexual exposure 2 0.2Surgery 1 0.1Renal Dialysis 1 0.1No risk data available 713 73.8No known risk factor* 6 0.6Total 966 100

Chronic HBV National Data – HPSC Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

Chronic HBV National Data – HPSC Risk factors for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

Region of BirthNumber of

cases%

Sub-Saharan Africa 55 57.9East Asia & Pacific 12 12.6Eastern Europe 14 14.7Western Europe 6 6.3South & South-East Asia 4 4.2Central Europe 3 3.2North Africa & Middle East 1 1.1Total 95 100

Chronic HBV National Data – HPSC Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

Chronic HBV National Data – HPSC Region of birth (where known) for chronic cases of hepatitis B, 2004 & 2005 (end Aug)

HBV National Data – HPSC Recent dataRate of notified hepatitis B in Quarter 4 2005

HBV National Data – HPSC Recent dataRate of notified hepatitis B in Quarter 4 2005

ACUTE

CHRONIC

Hepatitis CHepatitis C

Hepatitis CHepatitis C

Persistent High viral load – reaches a stable baseline

Natural History of HCV infectionNatural History of HCV infection

Hepatitis C infection in IrelandHepatitis C infection in Ireland

Numbers of HCV infected individuals not known

• NVRL – HPSC database • National HCV database (blood and blood products)

• Individual studies: IVDU, prisoners - underestimate the national problem

• NVRL data

Problems in the detection of HCV infected individuals

Problems in the detection of HCV infected individuals

• Unknown modes of transmission outside the classic “risk factors”

• Asymptomatic acute and chronic infection

• Atypical anti-HCV response

• Delayed immune response - long window period before anti-HCV develops

HCV Genotypic investigations in Ireland 1994 –2005 – NVRL DATA

HCV Genotypic investigations in Ireland 1994 –2005 – NVRL DATA

0

200

400

600

800

1000

1200

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

HCV Genotypes in Ireland 1994 –2005 – NVRL DATA (n – 8812)

HCV Genotypes in Ireland 1994 –2005 – NVRL DATA (n – 8812)

0

10

20

30

40

50

60

70

80

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

1 2 3 4

HCV National Data – HPSC HCV National Data – HPSC

HCV National Data – HPSC Number of notifications of HCV Q1, 2004 to Q4 2005

HCV National Data – HPSC Number of notifications of HCV Q1, 2004 to Q4 2005

• Needle-stick injuries are a substantial problem

• Changing demographics in Ireland – increased level of HIV and HBV

• National data is improving

National Epidemiology Profile - National Epidemiology Profile - ConclusionsConclusions

National Epidemiology Profile - National Epidemiology Profile - ConclusionsConclusions

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Acknowledgments:

Dr. Lelia Thornton, HPSCLindsay Jones. IT, NVRLStaff at the NVRL

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Thanks for your attentionAny questions ?