Utilizing Electronic Lab Reporting Data to Assess HCV Burden in Arizona Clarisse Tsang, MPH VHPC/Senior Epidemiologist Office of Infectious Disease Services National Viral Hepatitis Technical Assistance Meeting October 21, 2014 azdhs.gov Health and Wellness for all Arizonans Background • Since 2007, Arizona Department of Health Services (ADHS) has not had the resources to conduct HCV surveillance. • Beginning in 2009, ADHS has been onboarding laboratories to report electronically. – Electronic Laboratory Reporting (ELR) azdhs.gov Health and Wellness for all Arizonans CSTE/ADHS HCV Case Definition Acute • Clinical description* • Lab criteria** *An acute illness with a discrete onset of any sign or symptom consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, abdominal pain, nausea, vomiting, or diarrhea), and either a) jaundice, or b) serum alanine aminotransferase (ALT) levels >400 IU/L. Chronic • Lab criteria** **HCV RIBA positive; OR Nucleic acid test (NAT) for HCV RNA positive (including qualitative, quantitative, or genotype testing); OR Antibodies to hepatitis C virus (anti-HCV) screening-test-positive with a signal to cutoff ratio predictive of a true positive as determined for the particular assay as defined by CDC. http://www.cdc.gov/hepatitis/HCV/LabTesti ng.htm). azdhs.gov Health and Wellness for all Arizonans ADHS HCV Case Classification Acute • Confirmed: Chronic • Confirmed: – – – – – Clinical description – Lab criteria – Not chronic • Clinical description Lab criteria Not acute If case is < 18 months old, laboratory confirmation must be by NAT for HCV RNA. Probable: – Not acute – Anti-HCV positive (repeat reactive) by EIA and has alanine aminotranferase (ALT or SGPT) values above the upper limit of normal, but the anti-HCV EIA result has not been verified by an additional more specific assay or the signal to cutoff ratio is unknown. azdhs.gov Health and Wellness for all Arizonans azdhs.gov Health and Wellness for all Arizonans ADHS ELR Timeline • 2009 – August: LabCorp – November: ARUP • 2012 – June: Sonora Quest – December: Carondelet azdhs.gov Health and Wellness for all Arizonans Objectives • To better understand the disease burden of HCV in Arizona • To engage VHPCs and other health departments on utilizing available hepatitis data to target prevention efforts azdhs.gov Health and Wellness for all Arizonans Methods • Obtained ELR extract of data reported from 1/1/2009-3/5/2014 • De-duplicated and analyzed data using SAS statistical software • Preliminary analysis – Age – Gender – Year – Number of tests per patient azdhs.gov Health and Wellness for all Arizonans ELR Total Records N=105,919 De-duplicated Data n=42,838 ADHS Lab Case Definition n=37,893 Antibody only n=17,254 • Enzyme Immunoassay (EIA) • Chemiluminescent Immunoassay (CIA) RNA Positive n=20,639 azdhs.gov Health and Wellness for all Arizonans Number of ELR HCV cases by age group 14000 12000 10000 8000 AB+ only PCR+ 6000 4000 2000 0 0-9 10.-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ azdhs.gov Health and Wellness for all Arizonans Number of ELR HCV cases by gender 30000 25000 20000 AB+ only 15000 PCR+ 10000 5000 0 1 Female 2 Male azdhs.gov Health and Wellness for all Arizonans LaboratoryDisplayName Frequency Percent Cumulative Frequency Cumulative Percent ARUP 2512 6.63 2512 6.63 Holy Cross Hospital 5 0.01 2517 6.64 LabCorp Birmingham 2 0.01 2519 6.65 LabCorp Burlington 1307 3.45 3826 10.10 LabCorp Dallas 2 0.01 3828 10.10 LabCorp Denver 3 0.01 3831 10.11 LabCorp Dublin 3 0.01 3834 10.12 LabCorp Houston 9 0.02 3843 10.14 LabCorp Kansas City 1 0.00 3844 10.14 LabCorp Phoenix 20150 53.18 23994 63.32 LabCorp RTP 16 0.04 24010 63.36 LabCorp Raritan 4 0.01 24014 63.37 LabCorp Salt Lake City 12 0.03 24026 63.40 LabCorp San Diego 30 0.08 24056 63.48 LabCorp Tampa 4 0.01 24060 63.49 LabCorp Willow Creek 969 2.56 25029 66.05 Monogram Biosciences Inc 55 0.15 25084 66.20 NICHOLS: Quest Nichols 811 Institute 2.14 25895 68.34 National Genetics Inst LabCorp 341 0.90 26236 69.24 Sonora Quest Laboratories 10020 26.44 36256 95.68 St. Joseph's Hospital 24 0.06 36280 95.74 St. Mary's Hospital 84 0.22 36364 95.96 4.04 37893 100.00 azdhs.gov Health and Wellness for all Arizonans ViroMed Laboratories Inc 1529 Number of ELR HCV cases by year, 1/1/2009-3/5/2014 14000 6/13/12: Sonora Quest 12000 12/12: Carondelet 10000 8000 8/9/09: LabCorp 11/09: ARUP 6000 4000 2000 0 2009 2010 2011 2012 2013 2014 azdhs.gov Health and Wellness for all Arizonans Number of ELR HCV cases by year, ARUP and LabCorp 7000 6000 5000 4000 AB+ only PCR+ 3000 2000 1000 0 2010 2011 2012 2013 azdhs.gov Health and Wellness for all Arizonans Number of tests per patient ADHS Case Definition • 95,172 total tests RNA Positives • 65,451 total tests – Mean: 2.5 tests/patient – Median: 2 tests/patient – Range: 1-36 tests/patient – Mean: 3.2 tests/patient – Median: 2 tests/patient – Range: 1-36 tests/patient azdhs.gov Health and Wellness for all Arizonans Future Analyses • Examine viral loads to assess burden • Examine time between different test results to assess: – how often patients are being tested – how long patients are positive – how often antibody positive patients are being followedup for confirmatory testing • • • • Cases by county, reporter, provider Compare current data with historic data Match with death and HDD database to assess severity Match with HIV database to look at comorbidity and other risk factors azdhs.gov Health and Wellness for all Arizonans Acknowledgments • Jonathan Gonzalez • Julia Skinner • Mohammed Khan • Shane Brady • Ken Komatsu • ADHS ELR Program – Sara Imholte – Eli Price – Shane Bagley • ADHS ITS • ELR Laboratories and providers azdhs.gov Health and Wellness for all Arizonans Questions and Discussion [email protected] 602-364-3817 azdhs.gov Health and Wellness for all Arizonans
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