Transcript Establishing a Framework for better data collection and Surveillance

Establishing a framework for better data collection and
surveillance of Hepatitis in South Africa
World Hepatitis Day 2013, 29th July
N. Prabdial-Sing and J. Manamela
INTRODUCTION
•
Hepatitis B infection
•
2 Billion people infected worldwide with Hepatitis B virus
– 350 million live with chronic infection (5%)
– 600 000 persons die annually due to acute or chronic
consequences of HBV
•
Sexual contact
Blood and blood products
Vertical transmission
-Perinatally: during birth (HBsAg – 20%; HBeAg – 90%)
-Early childhood infections: inapparent infections due to close personal
contact
Occupational
•
•
•
•
•
HBV genotypes (A-H) are distributed geographically, with genotype A and
subtype A1 common in Sub- Saharan Africa.
Genotypes associated with clinical progression, HBeAgseroconversion
rates, mutational patterns, treatment responses
6

Hepatitis C infection

Worldwide, 170-180 million people are infected with HCV (~ 3%)

Intravenous drug use remains the most common risk factor (UK, US),
however, in South Africa and other African countries, transmission risks are
not known, although unhygienic injection practices and traditional
scarifications may be possible routes of HCV transmission

HCV genotypes (1-6) are distributed depending on geography and route of
infection but travel and migration are changing these patterns.

Genotypes have clinical importance as response to therapy differs and
disease progression was shown to differ.
INTRODUCTION

The Hepatitis B surface antigen prevalence rates in South Africa ranges
from 7.4 (urban) to 15% (rural) and with HIV co-infection, rates increase to
16-22%.

The seroprevalence of HCV in South Africa ranges from low (0.05-1.8%) in
blood donors and health care workers to high (13-33%) in HIV positive
individuals and patients with chronic active hepatitis, respectively

A database for NICD laboratory-confirmed cases for both hepatitis B and C
has been set up whereby demographic data, viral load and genotypes are
collated from all provinces in SA, except Western Cape, as they perform their
own testing. Plans will be developed to include the data from the Western
Cape so that the data is nationally representative.
ANALYSIS OF NICD LABORATORY-CONFIRMED HBV BY VIRAL LOAD

Samples were sent for viral load testing

The number of laboratory-confirmed cases of hepatitis B for the period
2010-2013 was 1745 of the 2734 tests requested (63%).

Sample with 200IU/ml and >200ul were tested for genotype, N=526
1
NUMBER OF POSITIVE HBV SAMPLES
800
700
Number of samples
600
500
400
300
200
100
0
2010
2011
2012
2013
Year
6
1
NUMBER OF HEPATITIS B CASES BY AGE GROUP,
2010-2013
500
450
Number of cases
400
350
300
250
200
150
100
50
0
Agegroup
7
Number of HBV positive cases by gender
60.00%
50.00%
pecentage of hepatitis B cases

40.00%
30.00%
20.00%
10.00%
0.00%
Male
Female
Sex
Unkown
1
HBV GENOTYPES
Age group
A
D
E
6≤24weeks
1%
0%
0%
2-4years
0%
0%
5%
5-9years
1%
0%
10%
10-18years
6%
4%
33%
19-25years
10%
4%
5%
26-35years
28%
36%
10%
36-45years
20%
14%
29%
46-55years
12%
4%
0%
≥56years
6%
18%
0%
Unknown
15%
21%
10%
Total
100%
100%
100%
9
ANALYSIS OF NICD LABORATORY-CONFIRMED HCV BY VIRAL LOAD
• Samples were sent for viral load testing
• Of a total of 2360 viral hepatitis C requests received
at the NICD from January 2010 - December 2012,
1002 patient specimens tested positive on viral load
(>15 international units/ml (IU/ml), 42% .
• Sample with 200 (IU/ml) and >200ul were tested for
Genotype, N=886
Number of hepatitis C laboratory confirmed
cases (2010-2012) per province
No. of positives
10000
1000
100
10
1
Provinces
Communicable Disease Surveillance Bulletin, 2013
NUMBER OF HEPATITIS C CASES BY AGE GROUP,
2010-2012
200
180
160
140
Numbers
120
100
80
60
40
20
0
≤17 Years
18-25Years
26-33 Years
34-40 Years 41-48 Years 49-55 Years 56-62 Years
Age groups infected with hepatitis C virus
63-74 Years
≥75Years
unspecified
Genotypes/
Subtypes
Major HCV genotypes (N=886)
mixed
7%
1
31%
5
36%
4
12%
3
13%
2
1%
No.
%
1
63
7.11
1a
20
2.25
1b
195
22
2
5
0.56
2a
2
0.23
2a/2c
2
0.23
2b
3
2
8
0.23
0.9
3a
104
11.7
4
79
8.91
4a
2
0.23
11
1.24
4e
7
0.79
4f
4h
3
8
0.34
0.9
5a
316
35.7
mixed
59
6.66
Total
886
100
4a/4c/4d
Communicable Disease Surveillance Bulletin, 2013