Curbing the hepatitis C virus epidemic in Pakistan: the impact of scaling up treatment and prevention for achieving elimination

Background: The World Health Organization (WHO) has developed a global health strategy to eliminate viral hepatitis. We project the treatment and prevention requirements to achieve the WHO HCV elimination target of reducing HCV incidence by 80% and HCV-related mortality by 65% by 2030 in Pakistan, which has the second largest HCV burden worldwide. Methods: We developed an HCV transmission model for Pakistan, and calibrated it to epidemiological data from a national survey (2007), surveys among people who inject drugs (PWID), and blood donor data. Current treatment coverage data came from expert opinion and published reports. The model projected the HCV burden, including incidence, prevalence and deaths through 2030, and estimated the impact of varying prevention and direct-acting antiviral (DAA) treatment interventions necessary for achieving the WHO HCV elimination targets. Results: With no further treatment (currently ?150 000 treated annually) during 2016�30, chronic HCV prevalence will increase from 3.9% to 5.1%, estimated annual incident infections will increase from 700 000 to 1 100 000, and 1 400 000 HCV-associated deaths will occur. To reach the WHO HCV elimination targets by 2030, 880 000 annual DAA treatments are required if prevention is not scaled up and no treatment prioritization occurs. By targeting treatment toward persons with cirrhosis (80% treated annually) and PWIDs (double the treatment rate of non-PWIDs), the required annual treatment number decreases to 750 000. If prevention activities also halve transmission risk, this treatment number reduces to 525 000 annually. Conclusions: Substantial HCV prevention and treatment interventions are required to reach the WHO HCV elimination targets in Pakistan, without which Pakistan�s HCV burden will increase markedly

Household Responses to School Closure Resulting from Outbreak of Influenza B, North Carolina

Parents accepted school closure during an outbreak, but children’s presence in other public settings has implications for pandemic planning

Global burden of hepatitis C: considerations for healthcare providers

An estimated 2%-3% of the world's population is living with hepatitis C virus (HCV) infection, and each year, >350 000 die of HCV-related conditions, including cirrhosis and liver cancer. The epidemiology and burden of HCV infection varies throughout the world, with country-specific prevalence ranging from <1% to >10%. In contrast to the United States and other developed countries, HCV transmission in developing countries frequently results from exposure to infected blood in healthcare and community settings. Hepatitis C prevention, care, and treatment programs must recognize country-specific epidemiology, which varies by setting and level of economic development. Awareness of the global epidemiology of HCV infection is important for US healthcare providers treating foreign-born patients from countries where HCV infection is endemic and for counseling patients who travel to these countries. Countries with a high burden of HCV infection also would benefit from establishing comprehensive prevention, care, and treatment programs. Globally, an estimated 130-170 million persons (2%-3% of the world's population) are living with hepatitis C virus (HCV) infection Available data indicate that infection with HCV varies considerably by country and region. However, the true burden of disease is not well known in many countries, because capacity is limited for collecting epidemiologic data. In contrast, the mode of transmission is fairly well defined and most often involves exposure to contaminated needles or syringes, although the means by which this exposure occurs differs by country. Whereas HCV transmission in developing countries frequently results from exposure to infected blood and blood products in healthcare and community settings, HCV infections in most developed countries are associated with injection drug use (ie, personal behavior typically of an illicit nature). The global picture directly impacts the United States; tens of millions of foreign-born persons reside in the United States, many of whom are from countries where HCV infection is endemic (eg, countries with an HCV prevalence ≥2%), and >1 million new immigrants enter the United States annually. Therefore, US healthcare providers who treat immigrants and foreign-born persons must recognize that decisions to screen these patients based on established risk factors for HCV infection in the United State

Literacy in the open-access

Background. The Hispanic population in the United States is growing, and disparities in the receipt of healthcare services as a result of limited English proficiency have been demonstrated. We set out to determine if Spanish language preference was a barrier to receiving influenza vaccinations among Hispanic persons 65 years and older in the USA. Methods. Differences in the receipt of vaccinations by language preference were tested with both Chi-square analyses and adjusted logistic regression analyses. Results. Findings suggest that elderly Hispanic persons, 65 years of age and older, who prefer to communicate in Spanish instead of English, are significantly less likely to have received influenza vaccinations when compared to their Hispanic counterparts who prefer to communicate in English. Conclusions. Influenza infections can more often be fatal in older persons and may disparately affect minority populations such as Hispanic persons. Therefore, understanding barriers to the receipt of effective preventive health measures is necessary

Hepatitis A surveillance using commercial laboratory data

ObjectiveTo evaluate the use of commercial laboratory data for monitoring trends in HAV infections over time and identifying geographic and demographic characteristics of HAV case clusters for the purpose of targeting interventions.IntroductionHepatitis A virus (HAV) infections have persisted in the United States despite the availability of an effective vaccine. Recent outbreaks of HAV infections among unvaccinated adults attributed to consumption of HAV-contaminated food, or person-to-person contact in certain populations (e.g., men who have sex with men) or settings (e.g., homeless shelters) have emphasized the importance of targeted vaccination of at-risk adults.MethodsWe used commercial laboratory data from Quest Diagnostics (Quest) and Laboratory Corporation of America (LabCorp) to identify unique individuals within each database who tested positive for HAV IgM antibody (indicative of acute HAV infection) from January 2011 through June 2017. Though de-depulication across the two laboratories was not possible, comparison of case characteristics indicated limited possible overlap of cases (<0.5%) and thus data from the two laboratories were combined. Demographic characteristics associated with the first positive test were used to classify cases by age, gender, state of residence, insurance type, and provider specialty. Persons co-infected with hepatitis B and/or hepatitis C were identified based on positive test results for hepatitis B surface antigen and hepatitis C RNA, respectively.ResultsA total of 6,702,256 HAV IgM test results from Quest and 7,043,555 HAV IgM test results from LabCorp were processed. Of those, 24,697 (0.4%) and 13,785 (0.2%) tests, respectively, had a ‘Reactive’, or positive result, indicating acute HAV infection. From these test results, we identified 15,415 unique individuals from Quest and 10,622 unique individuals from LabCorp with an acute HAV infection between January 2011 and June 2017. Among the 26,037 acute cases, the majority were female (14,056; 54.0%), were aged 50 or older (13,940; 53.5%), resided in large central or fringe metropolitan areas (17,842; 68.5%), and had tests ordered by family or internal medicine providers (12,358; 47.5%; Table). We identified 330 cases (1.3%) among incarcerated persons. Although data could not be de-duplicated across labs, we estimated a minimum of 630 persons (2.4%) were co-infected with hepatitis B and 852 persons (3.3%) were co-infected with hepatitis C. From 2011 to 2015, there were 7,370 cases of acute HAV reported to CDC, whereas Quest and LabCorp test results indicated 19,822 cases over the same time period. Trends in cases by month revealed seasonal increases in cases in late summer and early fall months (Figure 1). Mapping of acutely-infected individuals demonstrated a range of cases from 0 to 1,119 cases by county over the study period (Figure 2).ConclusionsHAV IgM test results over a 6-year period from two commercial laboratories serving the United States suggest continuing hepatitis A transmission. Most cases occur among older adults, and appear to cluster geographically in metropolitan areas. Commercial laboratory data is a useful tool for supplementing case-based surveillance and informing prevention efforts.