HomeMy WebLinkAbout04.12.21 PH Report
From:Pickett, Andy
To:Alpert, Bruce;Bennett, Robin;Clerk of the Board;Connelly, Bill;Cook, Holly;Cook, Robin;Kimmelshue, Tod;
Lucero, Debra;Paulsen, Shaina;Pickett, Andy;Ring, Brian;Ritter, Tami;Rodas, Amalia;Sweeney, Kathleen;
Teeter, Doug
Subject:PH Report
Date:Monday, April 12, 2021 12:50:18 PM
Attachments:Butte County HCV and HIV trends summary.docx
Board Members,
Director Danette York was requested to provide data on HIV, HCV, and Endocarditis. I am sending
the report for all of you to have.
Andy
Máximo A. Pickett
Chief Administrative Officer
Butte County Administration
25 County Center Drive, Suite 200, Oroville, CA 95965
T:
HCV, HIV, and endocarditis trends summary
Butte County, 2015 – 2020 (preliminary data)
Chronic Hepatitis C virus (HCV)
Injection drug use is the single greatest risk factor for Hepatitis C infection. A CDC surveillance report stated
that, for those persons with known risk factors, 72% of persons with HCV injected drugs. Newly diagnosed cases
of Hepatitis C infection are reportable to local health officers in California. However, these data do not provide a
measure of new infections (incidence) of HCV because:
-People with newly acquired HCV infection are typically either asymptomatic or have symptoms that are
mild and non-specific. Because infected persons are unlikely to seek medical care or, if they do, to be
tested for HCV, the initial infection often goes undetected and therefor, unreported.
-Approximately 70 to 85% of persons acutely infected with HCV will become chronically infected.
Chronic HCV can be “silent” for years to decades. Persons with chronic HCV often remain undiagnosed
until the patient is tested as part of diagnostic or screening procedure.
o Although recommendations exist for routine screening testing for HCV infection, many at-risk
persons remain untested for a complex set of healthcare and socio-behavioral related factors.
-Reporting may be incomplete and/or delayed.
-Persons infected with HCV may be infected for years following the initial report of a case. It remains
unknown how many of the persons reported with HCV are currently living.
-CA Dept of Public Health periodically de-duplicates HCV data at the state level. As part of that process,
CDPH assigns the case to the county of residence at the time of first report.
Injection drug use is the major means of transmission of HCV. Because the time from infection to diagnosis can
be years to decades, HCV is not a timely indicator of injection drug use in a community. However, surveillance
data remains critically important in monitoring trends in HCV cases and assessing community impact, including
local risk factors, and informing medical providers and partner agencies on testing and treatment needs.
*These data are local Butte County data and may differ from CDPH data. 2020 data may not yet be complete. Additionally,
the apparent decline in newly reported cases during 2020 may reflect decreased testing due to pandemic control efforts.
**Cases are displayed by year of first report. Patients may be reported years to decades after initial infection.
Acute Hepatitis C virus infection
Initial infection with HCV often results in no or very mild symptoms. Reported cases of acute HCV represent only
a small fraction of total new infections. Most new infections go undetected and unreported. Although reported
cases of acute HCV cannot be used as a measure of the incidence of HCV infection in a local health jurisdiction,
reporting of acute HCV remains critically important to identify possible transmission events, including outbreaks.
*These data are local Butte County data and may differ from CDPH data. 2020 data may be incomplete.
HIV
Surveillance of HIV/AIDs is unique among reportable diseases. Like other reportable diseases, cases are
reported to the local health jurisdiction by medical providers and diagnostic laboratories. However, unlike other
reportable diseases, reporting of HIV/AIDs includes multiple data sources and tracks medication and case
management measures over the lifetime of a patient. These systems provide additional data on the public
health impact of HIV.
From 2015 – 2020, between 7 and 14 Butte residents were newly reported with HIV each year.
*These data are local Butte County data and may differ from CDPH data. 2020 data may be incomplete.
The graph below shows CDPH data on the number of Butte County residents living with HIV each year and the
rate of persons living with HIV per 100,000 persons. Between 2015 and 2019, the rate of HIV in Butte County
increased increase from 103.9 per 100,000 persons to 121.1 per 100,000 persons.
Endocarditis
Endocarditis can have a variety of causes, one of which is systemic infection resulting from injection drug use.
Beginning in 2016, the percent of endocarditis cases with a diagnosis of opioid abuse began a multi-year
increase that coincides with an increase in the total number of endocarditis cases.
From 2015 – 2018, the 3 yr. average number of endocarditis cases was 30 cases annually, of which 3% were
opioid dependent. In comparison, by 2020 the same hospital had 87 patients with endocarditis, of which 16%
were opioid dependent.
Annual Number of Patients with Endocarditis and
Percent with Opioid Dependence, 2013-2020
10020
18
Patient Volume
8016
Opioid Dependence
14
6012
10
408
6
20
4
2
Number of endocarditis patients
Percent with Opioid Dependence
00
20132014201520162017201820192020
Year
Concomitantly, a decrease in the average age of endocarditis patients is evident, dropping from a 3-year average
of 64 yrs. of age to an average age of 38 years in 2020, further supporting injection drug use and opioid use as a
significant contributory cause of endocarditis cases at one Butte county hospital.
Note: Endocarditis is not a reportable condition. These data were voluntarily shared with BCPH by Enloe
Hospital. Patients included in the trend data for endocarditis are patients seen at Enloe Hospital and are not
restricted to Butte residents only.
For additional information:
Hepatitis C virus infection
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680496/#CR58
https://www.cdc.gov/hepatitis/statistics/2018surveillance/HepC.htm
HIV outbreaks in person who inject drugs
https://pubmed.ncbi.nlm.nih.gov/32504576/
Endocarditis in persons who inject drugs
https://pubmed.ncbi.nlm.nih.gov/32877563/
https://pubmed.ncbi.nlm.nih.gov/31770395/