Hepatitis C: Hidden Harm
Friday 21st March, 2014
Dublin
Hepatitis C – A Public Health Issue
Joe Barry, TCD
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
Hepatitis C virus (2)
• Chronic infection can lead to chronic liver disease, cirrhosis,
liver failure and liver cancer (usually over 20-30+ years)
• >170 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.
Worldwide prevalence hepatitis C infection
(source: WHO)
Strategy Main WG – membership (1)
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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
Strategy Main WG – membership (2)
• Jack Lambert, Infectious Disease Consultant, Mater/Rotunda
Hospitals
• Patricia Ramshaw, HSE West
• Lesley O’Sullivan, 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
Strategy Main WG – membership (3)
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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 O’Shea, Dublin Aids Alliance
Louise Mullen, Dept of PH, HSE East
Jeff Connell, NVRL, UCD
Strategy Surveillance Subgroup - membership
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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
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
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
Distribution of Strategy Recommendations
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Surveillance 8
Prevention 14
Screening/testing 6
Treatment 8
Implementation Committee – membership
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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
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
Surveillance and Screening subgroup
membership
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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
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.
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
Number or notifications hepatitis C 2004-2012, by sex
and mean age
Most likely risk factor (%) for cases of hepatitis C notified in
2012 (where data available, n=651, 63%)
Education, Prevention and Communication
subgroup
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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 O’Brien, Health Promotion Information, Social
Marketing and Advocacy, HSE
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
Challenges
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Cuts in Services
Stigma
Asymptomatic infection
Absence of IT in drug services
Opportunities
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Good structures
Health Identifier Bill
New treatment options
Awareness potential