Ahmed, K Nadeem, MD

Eid, Sherrine, MPH

Friel, Timothy J, MD

Hoffman-Terry, Margaret, MD, FACP

Pacella, Kimberly A

Rhodes III, Luther V, MD, FACP

Yozviak, Joseph L, DO, FACP

English

Rhodes III, Luther, MD

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineDefining an Emerging Epidemic: HCVSeroprevalence in a Large, Tertiary-Care HealthNetwork in PennsylvaniaMargaret Hoffman-Terry MD, FACPLehigh Valley Health Network, Margaret.Terry@lvhn.orgJoseph L. Yozviak DO, FACPLehigh Valley Health Network, joseph.yozviak@lvhn.orgK Nadeem Ahmed MDLehigh Valley Health NetworkSherrine Eid MPHLehigh Valley Health Network, Sherrine.Eid@lvhn.orgTimothy J. Friel MDLehigh Valley Health Network, Timothy.Friel@lvhn.orgSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Diseases Commons, Infectious Disease Commons, and the Medical SciencesCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHoffman, M., Yozviak, J., Ahmed, K., Eid, S., Friel, T., Pacella, K., & Rhodes III, L. (2009, May 13-16). Defining an emerging epidemic:HCV seroprevalence in a large, tertiary-care health network in pennsylvania. Poster presented at: The 32nd Annual Meeting of the Societyof General Internal Medicine, Miami Beach, FL.AuthorsMargaret Hoffman-Terry MD, FACP; Joseph L. Yozviak DO, FACP; K Nadeem Ahmed MD; Sherrine EidMPH; Timothy J. Friel MD; Kimberly A. Pacella; and Luther V. Rhodes III MD, FACPThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/medicine/152Background:In the United States, 1.6% of the population is infected with the hepatitis C virus (HCV), representing approximately 4-5 million people. Since most of these individuals remain unaware of their infection, they can serve as an ongoing source of transmission to others. HCV-infection places them at risk of developing progressive fibrosis leading to cirrhosis and possibly hepatocellular carcinoma. Additionally, undiagnosed individuals cannot benefit from potentially curative peginterferon/ribavirin therapy. The Lehigh Valley is the third most populated metropolitan region in Pennsylvania, consisting of Lehigh, Northampton, and Carbon counties in eastern PA. The local prevalence has been previously estimated at 0.78%, far less than NHANES data would predict. Our objective is to establish a prevalence of HCV in the community served by the 986 bed tertiary-care system of Lehigh Valley Health Network (LVHN), the largest health network in Pennsylvania. CONCLUSIONS:HCV seroprevalence in LVHN far exceeds previous local estimates and is nearly twice the national prevalence.  Whereas illicit drug use is commonly considered to be more prevalent in urban areas, HCV-positive subjects in this study were scattered widely among the urban, suburban, and rural areas served by LVHN.  Thus, a significant number of HCV-positive individuals may be missed if local testing efforts targeted urban centers alone.  Broad testing for HCV, particularly among individuals born between 1954 and 1973, would result in the diagnosis of a significant number of HCV-infected individuals and allow referral for potentially curative peginterferon alfa and ribavirin combination therapy.Results: •  Twenty-eight samples (2.8%) tested positive for HCV. •  The highest HCV prevalence was seen among those aged 45-54 years old (8.2%), representing 60.7% of all HCV-positive tests. The next highest prevalence was among those aged 35-44 years old: 3.6% [x2 p<0.001].   •  Men were more than twice as likely as women to be HCV-positive (OR 2.2; CI [1.03,4.81]).  •  HCV seroprevalence was evenly distributed among inpatient and outpatient settings (x2 p>0.05) and among urban, suburban, and rural areas. •  Three subjects (10.7% of HCV-positive subjects), all inpatients who lived in an urban area, were co-infected with HIV. HIV prevalence results have been previously presented elsewhere.Table 1: Planned Sample Distribution based on LVHN Discharge Data(Dec. 2005 - Nov. 2006)Methods:Figure 1a: Sample Population Distributed by AgeHCV Seroprevalence in a Large, Tertiary-care Health Network in PennsylvaniaML Hoffman-Terry1, JL Yozviak1, KN Ahmed1, S Eid1, TJ Friel1, K Pacella2, and LV Rhodes III11Lehigh Valley Health Network, Allentown, Pennsylvania, USA2Health Network Laboratoaries, Allentown, Pennsylvania, USADefining anEmerging Epidemic: •  Based on a 99% confidence interval with a 5% margin for error, an adequate sample size was determined to be 1000 subjects. •  1000 consecutive leftover blood samples were studied: 399 inpatients and 601 outpatients (including Emergency Department).  •  Samples were stratified by age and sex based on hospital admission statistics. Baseline demographics including age, sex, zip code of residence, and site of care (inpatient vs. outpatient) were collected. •  De-identified samples were analyzed for HCV via Abbott’s Microparticle Enzyme ImmunoAssay (RIBA performed on those not meeting the CDC’s recommended signal to cut-off ratio of 9.9 for true antibody positivity) and for human immunodeficiency virus (HIV) via ELISA with confirmatory Western blot. •  Univariate and multivariate analyses were conducted in SPSS 15.0 statistical software, utilizing T-test, Pearson’s Chi-sqaure and correlation analyses, and reporting Poisson’s 95% confidence intervals where appropriate.Figure 1b: HCV-positive Results Distributed by AgeFigure 2: Prevalence of HCV Distributed by Age231(22 % )85(9 % ) 125(13 % )183(18 % )208(21 % )168(17 % )18-24 25-34 35-44 45-54 55-64 65-80 18-24 25-34 35-44 45-54 55-64 65-8017(60% )2(7% )1(4% )1(4% )1(4% )6(21% )1.6 %2.8 %1.2 %0.8 %3.6 %8.2 %1.1 %0.4 %00.010.020.030.040.050.060.070.080.09PrevalenceU .S .A . O vera ll 18-24 25-34 35-44 45-54 55-64 65-80A gePrevalenceInpatient Age Group Male FemaleGroup I       18-24 9 18Group II      25-34 13 32Group III     35-44 23 34Group IV     45-54 37 40Group V      55-64 39 39Group VI     65-80 58 57TOTAL 180 220OutpatientGroup I       18-24 25 35Group II      25-34 32 48Group III     35-44 42 69Group IV     45-54 48 83Group V      55-64 40 65Group VI     65-80 45 68TOTAL 232 368

Defining an Emerging Epidemic: HCV Seroprevalence in a Large, Tertiary-Care Health Network in Pennsylvania

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Defining an Emerging Epidemic: HCV Seroprevalence in a Large, Tertiary-Care Health Network in Pennsylvania

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