Hepatitis C: Hidden Harm Friday 21st March, 2014 Dublin

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Hepatitis C Hidden HarmFriday 21st March,
2014Dublin

• Hepatitis C A Public Health Issue
• Joe Barry, TCD

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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

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Hepatitis C virus (2)

• Chronic infection can lead to chronic liver
  disease, cirrhosis, liver failure and liver
  cancer (usually over 20-30 years)
• gt170 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.

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Worldwide prevalence hepatitis C infection
(source WHO)
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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

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Strategy Main WG membership (2)

• Jack Lambert, Infectious Disease Consultant,
  Mater/Rotunda Hospitals
• Patricia Ramshaw, HSE West
• Lesley OSullivan, 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

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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 OShea, Dublin Aids Alliance
• Louise Mullen, Dept of PH, HSE East
• Jeff Connell, NVRL, UCD

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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

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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

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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

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Distribution of Strategy Recommendations

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

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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

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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

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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

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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.

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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

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Number or notifications hepatitis C 2004-2012, by
sex and mean age
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Most likely risk factor () for cases of
hepatitis C notified in 2012 (where data
available, n651, 63)
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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 OBrien, Health Promotion Information,
  Social Marketing and Advocacy, HSE

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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

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Challenges

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

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Opportunities

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