261271 Hepatitis C cluster in young injection drug users in a rural Midwestern county: Investigation and public health response

Monday, October 29, 2012

Amy Wergin, RN , Manitowoc County Health Department, Manitowoc, WI
Carrie Redo, RN , Manitowoc County Health Department, Manitowoc, WI
Marisa Stanley, MPH , AIDS/HIV and Hepatitis C Program, WI Division of Public Health, Madison, WI
Katarina Grande, MPH , Department of Population Health Sciences, University of Wisconsin-Madison Population Health Institute, Madison, WI
Sheila Guilfoyle , AIDS/HIV and Hepatitis C Program, WI Division of Public Health, Madison, WI
Mari Gasiorowicz, MA , AIDS/HIV Program, WI Division of Public Health, Madison, WI
Background: Investigation of, and response to, a large cluster of hepatitis C cases in 2010 and 2011 in a rural Wisconsin county present circumstances, challenges, and lessons that apply nationally. Shifting demographics: HCV case reports in Wisconsin increased by 8% from 2006 to 2010 with a concomitant increase from 2000 to 2010 in the percentage of cases under age 30 (from 5% to 18%) and in females (from 31% to 39%). The geographic center of HCV moved northwest during the period, away from Milwaukee, the state's largest city. HCV Cluster: The county averaged 18 HCV cases in 2004-09, (19% < age 30), 36 cases in 2010, and 65 preliminary cases in 2011 (35% < age 30). As of the end of 2011, the LHD had compiled a list of 180 individuals—82 HCV cases, 55 HCV-negative partners, and 43 not yet tested for HCV. The large number of cases was driven by individuals seeking testing at the LHD and in jail after hearing about an increase in cases of both HCV and HIV in their injection drug using (IDU) networks. Excellent working relationships among the LHD, the police department drug unit, and the AIDS services organization that distributes clean syringes have facilitated a community norm in which IDUs seek HCV and HIV testing and name partners. Social network software: Investigators used UCINET to visualize the cluster and to identify and prioritize follow-up with HCV-negative and untested individuals at greatest risk, namely those with the largest number of connections to HCV cases.

Learning Areas:
Communication and informatics
Protection of the public in relation to communicable diseases including prevention or control
Public health or related nursing

Learning Objectives:
This session will describe: 1) The shifting demographics of new HCV cases in a rural county in the midwest; 2) The local health department’s approach and successes in working with injection drug users to identify new cases of hepatitis C and HIV and to elicit partners; and 3) The use of social networks software, both to visualize the cluster and to help prioritize testing of high-risk negatives.

Keywords: Hepatitis C, Outbreaks

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as Public Health Nurse Manager for Manitowoc County Health Department and managed the Hepatitis C cluster investigation for the county.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.