World Hepatitis Day 2013, 29th July

Establishing a framework for better data collection and surveillance of Hepatitis in South Africa

N. Prabdial-Sing and J. Manamela

6

INTRODUCTION

• Hepatitis B infection• 2 Billion people infected worldwide with Hepatitis B virus

– 350 million live with chronic infection (5%)– 600 000 persons die annually due to acute or chronic

consequences of HBV

• Sexual contact• Blood and blood products• Vertical transmission

-Perinatally: during birth (HBsAg – 20%; HBeAg – 90%)-Early childhood infections: inapparent infections due to

close personal contact• Occupational

• HBV genotypes (A-H) are distributed geographically, with genotype A and subtype A1 common in Sub- Saharan Africa.

• Genotypes associated with clinical progression, HBeAgseroconversion rates, mutational patterns, treatment responses

Hepatitis C infection

Worldwide, 170-180 million people are infected with HCV (~ 3%)

Intravenous drug use remains the most common risk factor (UK, US), however, in South Africa and other African countries, transmission risks are not known, although unhygienic injection practices and traditional scarifications may be possible routes of HCV transmission

HCV genotypes (1-6) are distributed depending on geography and route of infection but travel and migration are changing these patterns.

Genotypes have clinical importance as response to therapy differs and disease progression was shown to differ.

The Hepatitis B surface antigen prevalence rates in South Africa ranges from 7.4 (urban) to 15% (rural) and with HIV co-infection, rates increase to 16-22%.

The seroprevalence of HCV in South Africa ranges from low (0.05-1.8%) in blood donors and health care workers to high (13-33%) in HIV positive individuals and patients with chronic active hepatitis, respectively

A database for NICD laboratory-confirmed cases for both hepatitis B and C has been set up whereby demographic data, viral load and genotypes are collated from all provinces in SA, except Western Cape, as they perform their own testing. Plans will be developed to include the data from the Western Cape so that the data is nationally representative.

INTRODUCTION

Samples were sent for viral load testing

The number of laboratory-confirmed cases of hepatitis B for the period 2010-2013 was 1745 of the 2734 tests requested (63%).

Sample with 200IU/ml and >200ul were tested for genotype, N=526

ANALYSIS OF NICD LABORATORY-CONFIRMED HBV BY VIRAL LOAD

1

6

NUMBER OF POSITIVE HBV SAMPLES

2010 2011 2012 20130

100

200

300

400

500

600

700

800

Year

Num

ber

of s

ampl

es

1

7

NUMBER OF HEPATITIS B CASES BY AGE GROUP, 2010-2013

<6wee

ks

6≤24

weeks

2-4ye

ars

5-9ye

ars

10-18

years

19-25

years

26-35

years

36-45

years

46-55

years

≥56ye

ars

Unkno

wn0

50100150200250300350400450500

Agegroup

Num

ber

of c

ases

Number of HBV positive cases by gender

Male Female Unkown0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Sex

pece

ntag

e of

hep

atiti

s B

case

s

1

9

HBV GENOTYPESAge group A D E

6≤24weeks 1% 0% 0%

2-4years 0% 0% 5%

5-9years 1% 0% 10%

10-18years 6% 4% 33%

19-25years 10% 4% 5%

26-35years 28% 36% 10%

36-45years 20% 14% 29%

46-55years 12% 4% 0%

≥56years 6% 18% 0%

Unknown 15% 21% 10%

Total 100% 100% 100%

ANALYSIS OF NICD LABORATORY-CONFIRMED HCV BY VIRAL LOAD

• Samples were sent for viral load testing • Of a total of 2360 viral hepatitis C requests

received at the NICD from January 2010 - December 2012, 1002 patient specimens tested positive on viral load (>15 international units/ml (IU/ml), 42% .

• Sample with 200 (IU/ml) and >200ul were tested for Genotype, N=886

FREE ST

ATE

GAUTEN

G

KWAZU

LU-NATA

L

LIMPO

PO

MPUMALAN

GA

NORTH W

EST

WESTER

N CAPE

unspe

cified

Grand T

otal

1

10

100

1000

10000

Number of hepatitis C laboratory confirmed cases (2010-2012) per

province

Provinces

No.

of p

ositi

ves

Communicable Disease Surveillance Bulletin, 2013

NUMBER OF HEPATITIS C CASES BY AGE GROUP, 2010-2012

≤17 Years 18-25Years 26-33 Years

34-40 Years

41-48 Years

49-55 Years

56-62 Years

63-74 Years

≥75Years unspecified0

20

40

60

80

100

120

140

160

180

200

Age groups infected with hepatitis C virus

Num

bers

131%

21%3

13%

412%

536%

mixed7%

Major HCV genotypes (N=886)

Genotypes/ Subtypes No. %

1 63 7.11

1a 20 2.25

1b 195 22

2 5 0.56

2a 2 0.23

2a/2c 2 0.23

2b 2 0.233 8 0.9

3a 104 11.7

4 79 8.91

4a 2 0.23

4a/4c/4d 11 1.24

4e 7 0.79

4f 3 0.344h 8 0.9

5a 316 35.7

mixed 59 6.66

Total 886 100

Communicable Disease Surveillance Bulletin, 2013