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Risk Behaviors Reported by Young Adults with Chronic Hepatitis C in
Florida, March – July 2012
Beth Ann Eichler MS, Catherine Lesko MPH, Janet Hamilton MPH - Florida Department of Health
Background
Acute and chronic HCV cases have the same laboratory
criteria for diagnosis and cannot be distinguished without
symptom information. In 2011, 18,407 chronic hepatitis C
cases were reported in Florida, compared to only 100 acute
hepatitis C cases.
The Florida Department of Health (FDOH) undertook to:
• Prospectively collect risk factor information for a sample
of young adults with chronic HCV infection.
• Identify cases of acute HCV infection misclassified as
chronic.
Methods
• Health department staff attempted to contact people aged
18-30 years with a chronic HCV infection reported
between March 1 and July 31, 2012 in 14 participating
counties.
• An interview tool was developed to collect specific risk
factor information.
• Changes were made to the state’s reportable disease
surveillance system to capture the data electronically.
• Data were analyzed using SAS 9.3 (Gary, NC).
• Final proportions were calculated using a denominator that
excluded ‘Missing’ responses.
Table 1: Demographics of the young adult population
(18-30 years), chronic hepatitis C cases reported
between March 1 and July 31 2012 in participating
counties, and cases interviewed, Florida,
March 1 – July 31, 2012
Florida
population
N
%
Eligible
Cases
N
%
Ethnicity
Hispanic
NonHispanic
Unknown
Eligible (n=897)
Interviewed
Cases
N
Investigated (n=804)
Case Contacted (n=373)
5,293,669 51.4
5,013,186 48.6
8,063,510 78.2
1,731,856 16.8
511,489 5.0
3,064,230 29.7
7,242,625 70.3
496 55.3
397 44.3
4 0.4
176
141
55.5
44.5
540 60.2
82 9.1
47 5.2
251
37
13
79.1
11.7
4.1
228 25.4
16
5.0
60
• Of the 897 eligible cases identified,
90% (n=804) were investigated, and
46% (n=373) of those were able to be
contacted. Interviews were completed
for 85% (n=317) of those contacted
(Figure 1).
%
Sex
Female
Male
Unknown
Race
White
Black
Other
Unknown
/Refused
Figure 1: Cases meeting eligibility criteria for chronic
hepatitis C in young adults (18-30 years) enhanced
surveillance protocol, Florida, March 1 – July 31, 2012
6.7
33
10.4
530 59.1
268
84.5
307 34.4
16
5.0
Figure 2: Rates of newly reported chronic hepatitis C
(confirmed, probable and suspect case classification),
by sex and age group, Florida 2003-2012
Case Not Contacted (n=431)
Interview Completed (n=286)
Invalid Phone Number (n=130)
Partial Interview (n=31)
No Response, 3 Attempts (n=181)
Declined Interview (n=42)
No contact information (n =2)
Unable to Participate (n=14)
Located but Contact Not Possible (n=118)
Incarcerated (n=59)
In a drug treatment program (n=57)
Deceased (n=2)
Figure 3: Most common risk factors reported by people
with chronic hepatitis C aged 18-30 years eligible for
inclusion in enhanced surveillance project, Florida,
March 1 – July 31, 2012
• More than 80% of those interviewed
reported using street drugs (n=248)
and 71% reported abusing prescription
drugs. The most commonly reported
drugs used were marijuana/hash
(88%), oxycontin/oxycodone (75%)
and powder cocaine (71%).
• More than 3/4 of illicit drug users
reported injection drug use (IDU).
Oxycodone/oxycontin (including
roxycodone) was the most commonly
injected drug. Of those reporting recent
IDU (within 6 months), 97% reported
sharing needles.
• Twenty-eight percent of all people
interviewed reported symptoms of
acute hepatitis or elevated liver
enzymes at the time of HCV testing.
These cases likely represent acute
infections. Extrapolating to all chronic
hepatitis C cases in young adults
equates to 447 acute cases incorrectly
reported as chronic in Florida per year.
Cases per 100,000 population
The rate of chronic hepatitis C cases among Floridians aged
18 to 30 years has been increasing since 2005. The majority
of chronic hepatitis C virus (HCV) infections reported in
Florida still occur among persons 45 to 64 years old (the
“baby boomer” generation) but the rates of newly reported
chronic infections in that population leveled off in 2008 while
those in young adults have continued to increase. This trend is
of concern because while older adults were likely infected
years or decades ago, HCV infections in younger adults can
be more recent, possibly acute infections, resulting from
current risk behaviors.
Results
Conclusions
Acute hepatitis C is underreported in Florida. Many chronic hepatitis C cases reported in young adults are in fact acute
infections. Despite being reportable by Florida law, symptom information and liver function tests for viral hepatitis cases are often
not reported to FDOH, highlighting deficiencies in acute hepatitis C reporting by health care providers.
Prescription drug abuse in Florida seems to be contributing to hepatitis C infections in a unique way compared with other states
(Hepatitis C Virus infection among adolescents and young adults – Massachusetts, 2002-2009. MMWR, 2011; 60(17):537-541.). Prescription opioids were the most commonly
named drugs by current injection drug users.