Investigation of a Cluster of Acute Hepatitis C Infections in IDUs, Minnesota, 2001

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Investigation of a Cluster of Acute Hepatitis C
Infectionsin IDUs, Minnesota, 2001

• Minnesota Department of Health

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Acknowledgments
Lynne Mercedes Immunization, TB International
Health Section Minnesota Department of Health
(MDH) Tim Heymans - STD HIV Section, MDH Jessie
Saavedra - STD HIV Section, MDH Jeanette
Martimo Public Health Nursing Division St.
Louis County Public Health Department Carol
Hooker Epidemiology Environmental
Health Hennepin County Community Health
Department
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Minnesota
We are here
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Background (Tim)

• April 2001 N. MN plasma center reported HCV
  seroconversions in 3 young donors
• Additional cases searched in database
• Reported in previous 6 months
• Young adults (lt 31 yrs. of age)
• Northern MN residents

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Background (cont.)

• May 2001 N. MN local HD contacted to follow up
  results incomplete
• June 2001- DI in Greater MN asked by hepatitis
  surveillance staff to assist
• IDU suspected
• Hepatitis IDU cases usually unlocatable
• DIs in STD HIV section routinely do this

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Background (Jessie)

• June 2001 Metro local HD reported 2 acute HCV
  cases
• Male, Spanish-speaking (23 33 yrs.)
• Seen in ER with Sx
• One self reported IDU initiation w/in 6 mos.
• Both roofers, per charts
• Metro Spanish-speaking DI asked by hepatitis
  staff to assist

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Objectives

• Locate
• Interview
• Establish risk
• I.D. partners (sex, needlesharing)
• Educate on hepatitis STDs
• Refer for hepatitis A B testing, vaccine
• Local HD in N. MN made tests vaccine available
• Hepatitis A B tests, vaccine available in Metro
  area already

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Hennepin
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Methods

• Field visits (Tim)
• Element of surprise (face to face vs. phone)
• Efficient use of travel (2-day goal)
• Day 1 4 separate assignments
• Day 2 3 additional assignments return to
  Duluth
• July 2001 - () case fails Ix appointment
  cluster Ix from partner

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Methods (cont.)

• Field visits (Jessie)
• June 2001
• Address noted in chart
• Post office
• DMV gave N. MN address
• Bar, parked car
• June/July 2001
• Homeless shelter
• Roofing company, construction sites

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Results (Jessie)

• 2 assigned cases were confirmed acute
• SP of case 1 located NA w/ties to Duluth
• Confirmed IDU of case
• Admitted possible source of 1s infection
  (taught him to shoot)
• Reported case 1 moved to UT
• SP tested for STDs
• ()HCV HBV (-) started HBV vaccine
• Other STDs (-)
• SP named as NS partner of one of Tims Ix
• Case 2 homeless unlocatable IDU??

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Results (Tim)

• 5 of 8 assigned were confirmed acute
• 4 of 5 were Ix SP of 5th was cluster Ix
• Of completed Ix
• 4 acute HCV 1 partner of acute
• 2 chronic HCV
• 1 suspected acute ruled out as (-)

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Results (cont.)

• 36 additional people named (NS, SP, suspects or
  associates)
• 6 previously reported in HCV database
• 1 new () moved to Oklahoma
• 20 reside on a reservation
• Social connections between NA Latino cases
  none between whites others
• Cases on reservation led to MDH grant to tribal
  health for hepatitis education, intervention,
  prevention activities

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Conclusion

• Because of the overlap of risk factors for
  acquiring HIV, HCV, HBV, HAV STDs, hepatitis
  intervention activities can be successfully
  integrated into existing STD HIV programs.