The Intersection of Opioids and Viral Hepatitis – A Public Health Crisis - PowerPoint Presentation

The Intersection of Opioids and Viral Hepatitis – A Public Health Crisis
The Intersection of Opioids and Viral Hepatitis – A Public Health Crisis

The Intersection of Opioids and Viral Hepatitis – A Public Health Crisis - Description

Jonathan Mermin MD MPH RADM USPHS Centers for Disease Control and Prevention National Center for HIVAIDS Viral Hepatitis STD and TB Prevention Caring Ambassadors Program US Senate Briefing ID: 738337 Download Presentation


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The Intersection of Opioids and Viral Hepatitis – A Public Health Crisis

Jonathan Mermin, MD, MPHRADM, USPHSCenters for Disease Control and PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD and TB PreventionCaring Ambassadors Program U.S. Senate BriefingMay 18, 2018

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Office of the DirectorSlide2

Hepatitis A Outbreaks in Multiple States

CDC has been assisting with multiple multi-state hepatitis A outbreaks

Primarily among homeless persons, persons who use injection and non-injection drugs, and their close contacts

More than 2,100 cases; 49 deaths

Over 1,500 hospitalizations Tested more than 1,600 specimensMajor challenge for jurisdictionsSlide3

Source: National Notifiable Diseases Surveillance System (NNDSS)

Hepatitis B

Hepatitis C

Over 22,000

Americans die of viral hepatitis each yearAcute Hepatitis C Infections Continue to SoarSlide4

Increased Transmission of Viral Hepatitis to Infants

Without preventive treatment, 40% of infants born to HBV-infected mothers will develop chronic infectionWithout treatment, a quarter will die from liver diseaseFrom 2009-2014, HCV infection among women giving birth nearly doubled

MMWR, May 12, 2017;

Why is viral hepatitis getting worse?Slide6

Geographic correlation between opioid prescriptions, drug poisoning deaths, and HCV infections

Amounts of opioids prescribed, by county, 2015

Reported New HCV Infections, 2013-14

Drug poisoning death rates, by county, 2016Slide7

Other Severe Infectious Consequences to Opioid Use

From 2002 to 2012:

Hospitalizations due to opioid use and:

Endocarditis ↑46%

Septic arthritis ↑166% Epidural abscess ↑164%Osteomyelitis ↑115% Other costly health consequences:Neonatal Abstinence Syndrome increased 300% from 1999-2013Cost >$1.5 billion per yearNecrotic skin ulcerEndocarditisSlide8

What can we do?Slide9

44 states and Puerto Rico have areas that are experiencing, or at risk for, increases or outbreaks of HCV/HIV

Just Released: Managing HIV and hepatitis C outbreaks among persons who inject drugs - A guide for state and local health departmentsSlide10

Comprehensive Community Action

MacArthur BMJ 2012. Aspinall E J et al. Int J. Epidemiology, 2014; Turner Addiction

2011; Hagan

J Sub Abuse Treatment 2000;

Sypsa JID 2017 Mobilize multi-sector community action, including healthcare, education agencies, public health, and law enforcementComprehensive community prevention programsSyringe Services Programs (SSPs) prevent overdoses; link patients to treatment; do not increase drug use or crimePeople who used SSPs 3 times more likely to stop injecting~50% reduction in incidence of HCV and HIV with a greater effect when combined with substance use treatmentSlide11

Improve Disease Prevention Strategies

Source: NVHR, Center for Health Law and Policy Innovation, Harvard University; StateofHepC.orgRespond quickly and comprehensively to Hepatitis A clustersEnsure Hepatitis B vaccines and testing are reaching the people who need them

Increase screening, diagnosis, and treatment of

Hepatitis C

and reduce barriers to treatment accessAccess to HCV treatment among Medicaid enrollees varies by stateSlide12

The opioid epidemic is increasing

infectious diseasesSituation is not inevitableActing quickly and at scale will prevent spread of infectious diseases and reduce overdose deathsSuccessful action will

reduce drug use, save lives, and save money

Think Big, Act Fast

Shom More....