Transcript Prevalence of Viral Hepatitis at the Beth Israel Medical

Need for vaccination for vaccine
preventable hepatitis in methadone
maintenance treatment
Randy Seewald, MD1,2,3, Eli Kamara, BS2, Ruy Tio, DO1,2, Rashiah Elam, MD1,2,
Sara Lorenz, MD1,2 , Valentin Bonilla, Jr., RPA1, David C Perlman, MD1,2,3
1. Department of Medicine, Bronx, NY
2. Albert Einstein College of Medicine, Bronx, NY
3. Center for Drug Use and HIV Research, New York, NY
APHA 10/31/2011
3232.0 Viral Hepatitis
Presenter Disclosures
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose
Background
• Injecting and non-injecting drug users are at high risk
of infection with viral hepatitis.
• Hepatitis A and B are vaccine preventable diseases.
• Co-infection with HCV and either HAV and HAB may
lead to worsening of liver disease, fulminant hepatitis,
hepatocellular carcinoma, and/or death.
Aim
The aim of this study was to determine the
prevalence of viral hepatitis markers in a
large methadone program in NYC and assess
the need for vaccination.
Method
• The Beth Israel Medical Center MMTP serves
approximately 6500 active patients at 18 clinics
in NYC.
• Approximately 1500 patients are admitted and
leave the MMTP annually.
• 8060 patients were screened between 6/2007
and 7/2009 for HAVtotAB, HBVsAg, HBVcAB),
HBVsAb and HCVAb.
Results
• 8060 distinct patients were screened over 2 yrs.
• Not all had complete screening performed
because of incomplete lab requisitions.
• 35% of those tested were HBV susceptible.
• 15% had isolated HBV core Ab+.
• <1% were HBV surface Ag+.
• 27% were HBV immune by natural disease.
• 23% were HBV immune by vaccination.
• 35% were HAV susceptible
Results (Cont.)
• Overall 50% were susceptible to either HAV, HBV or
both.
• 56% were HCV Ab+.
• 17% of patients HCV Ab+ were HBV susceptible.
• 22% of patients HCV Ab+ were HAV susceptible.
• Overall 31% of patients HCVAb+ were susceptible to
HAV and/or HBV.
Results (cont.)
• Of the 1029 isolated HBV core Ab+ patients who were
also screened for HCV Ab, 954 (93%) were HCV Ab+.
• Those with HCV Ab+ were significantly more likely
than those without HCV Ab+ to have isolated HBV
core Ab+.
• (24% vs 2%, p<0.0001; OR 12.5, 95% CI: 9.8-16.0)
Hepatitis C
Hepatitis Serology N=8060
Hepatitis C
Exposed/Infected
Non infected
Unknown
Borderline
Total
Number Percent
4503
3494
38
25
8060
56%
43%
0%
0%
100%
Hepatitis B
Hepatitis B
Number Percent
Susceptible
2520
31%
Immunized by vaccination
1648
20%
Immune by natural disease
1973
24%
Active infection
71
1%
Isolated HBV core Ab+
1099
14%
Unknown (incomplete screening)
749
9%
8060
100%
Hepatitis A
Hepatitis A
Immune
Susceptible
Unknown (incomplete screening)
Total
4630 57%
2469 31%
961 12%
8060 100%
HCV Ab and Isolated HBV Core
Ab Serology N=1029
HCV Ab negative
HCV Ab positive
Total isolated HBV core Ab+
75 7%
954 93%
1029 100%
Conclusions
• 56% of MMTP patients were HCV Ab+ indicating
prior infection with HCV. This rate is lower than has
previously been reported in similar populations of
drug users in treatment.
• A notably high number of patients with isolated HBV
core Ab+ are HCV Ab+ (93%). Patients with HCV
Ab+ were significantly more likely than those
without HCV Ab+ to have isolated HBV core Ab+,
possibly indicating occult HBV coinfection.
Conclusions (cont.)
• Over one third of patients were HBV susceptible
and HAV susceptible, with 50% susceptible to
HAV and/or HBV.
• Among HCV Ab+ patients, 31% were susceptible
to HAV and/or HBV highlighting the need for
ongoing hepatitis screening and vaccination
programs for MMTP patients.
Acknowledgements
Supported by:
• Beth Israel Medical Center
• NY State Office of Alcohol and
Substance Abuse Services.
• Center for Drug Use and HIV Research