Epidemiology of Hepatitis B and C in Florida 2018 Report
Explore the Department of Health's 2018 report on Hepatitis B and C in Florida, detailing case definitions, data collection methods, and surveillance practices. Learn about acute and chronic cases, reporting requirements, and special considerations for perinatal Hepatitis C cases.
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Department of Health Epidemiology of Hepatitis B and C in Florida, 2018
Epidemiology of Hepatitis B and C in Florida, 2018 Florida Department of Health Bureau of Communicable Diseases Viral Hepatitis Surveillance 2
Technical Notes Acute cases require clinical criteria (discrete symptom onset with jaundice or elevated liver enzymes) in addition to laboratory criteria. Cases with documented test conversion, where a negative lab result is followed by a positive lab result, do not require clinical criteria to be classified as an acute case. Chronic cases do not require clinical criteria for case classification. 3
Technical Notes, Continued Detailed case definitions for acute and chronic hepatitis B and C and perinatal hepatitis C can be found on the Department of Health s website: floridahealth.gov/diseases-and- conditions/disease-reporting-and-management/disease- reporting-and-surveillance/surveillance-and-investigation- guidance/index.html Data are pulled based on Morbidity and Mortality Weekly Report weeks, as outlined by the Centers for Disease Control and Prevention, and do not necessarily align with calendar years. This is referred to as report year. 4
Technical Notes, Continued Cases by year represent cases reported during that report year, regardless of event date. Someone could be reported with an acute and chronic infection in the same year or across multiple report years. Only acute cases are required to be investigated and interviewed in Florida; therefore, chronic cases may be missing demographic and risk factor information. In 2014, Florida Administrative Code (F.A.C.), Chapter 64D 3, reporting requirements for hepatitis, changed requiring the reporting of all positive and negative hepatitis results, including screening tests. Other requirements also include all serum aminotransferase levels. 5
Technical Notes, Continued Chronic cases do not include perinatal hepatitis cases and may not match data in FL CHARTS or data slides from previous years. Perinatal hepatitis C is defined as hepatitis C among children less than or equal to 36 months of age who are not known to be exposed to the virus other than perinatally (i.e., mother-to-child transmission). Data slides represent cases of all ages unless otherwise specified. Data are pulled from Merlin, Florida s reportable disease surveillance system. All data are as of 9/19/2019. 6
Number of Reported Chronic Hepatitis Cases in Florida, 2011 2018 Number of Cases Chronic hepatitis C Chronic hepatitis B 35,000 30,000 22,175 25,000 18,363 20,000 15,000 10,000 4,763 4,279 5,000 0 1 2011 2012 2013 2014 2015 2016 2017 2018 1 Change to F.A.C. 64D 3 Reporting requirements for hepatitis. Note: Chronic cases do not include perinatal hepatitis cases and may not match data in FL CHARTS or data slides from previous years. See technical notes on slide 6. Data as of 9/19/2019. 7
Rates of Chronic Hepatitis in Florida, 2011 2018 Rate per 100,000 Chronic hepatitis B Chronic hepatitis C 175.0 150.0 125.0 105.8 96.9 100.0 75.0 50.0 22.7 22.6 25.0 0.0 1 2011 2012 2013 2014 2015 2016 2017 2018 1 Change to F.A.C. 64D 3 Reporting requirements for hepatitis. Note: Chronic cases do not include perinatal hepatitis cases and may not match data in FL CHARTS or data slides from previous years. See technical notes on slide 6. Data as of 9/19/2019. 8
Chronic Hepatitis B by Age Group1 Percentage of Cases 2017 N=4,927 2018 N=4,763 30% 25% 23% 23% 25% 22% 21% 21% 20% 19% 20% 15% 11% 10% 10% 5% 2% 2% 0% <20 >=60 20 29 30 39 40 49 50 59 1 Age was missing for 14 cases in 2017 and 9 cases in 2018. Bar heights may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 9
Chronic Hepatitis B by Sex1 2017 N=4,927 2018 56% Male 57% 44% Female 42% 0% 20% 40% 60% 80% 100% 1 Sex was unknown for 12 cases in 2017 and 18 cases in 2018. Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 10
Chronic Hepatitis B by Race/Ethnicity 52% 52% Unknown 2017 N=4,927 20% 23% White 15% 13% Black 2018 N=4,763 6% 5% Hispanic 5% 4% Asian/Pacific Islander 3% 3% Other <1% <1% American Indian/Alaskan Native 0% 25% 50% 75% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 11
Chronic Hepatitis C by Age Group1 Percentage of Cases 2017 N=26,389 2018 30% 25% 25% 25% 22% 22% 22% 20% 20% 17% 16% 15% 14% 15% 10% 5% 1% 1% 0% <20 >=60 20 29 30 39 40 49 50 59 1 Age was missing for 33 cases in 2017 and 61 cases in 2018. Bar heights may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 12
Chronic Hepatitis C by Sex1 2017 N=26,389 2018 63% Male 64% 37% Female 36% 0% 20% 40% 60% 80% 100% 1 Sex was unknown for 46 cases in 2017 and 74 cases in 2018. Bar lengths may vary due to rounding. See technical notes on slide 6.Data as of 9/19/2019. 13
Chronic Hepatitis C by Race/Ethnicity 43% 47% White 2017 N=26,389 41% 39% Unknown 7% 6% Black 2018 N=22,175 5% 5% Hispanic 2% 2% Other 1% 1% Asian/Pacific Islander <1% <1% American Indian/Alaskan Native 0% 25% 50% 75% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 14
Rates1 of Chronic Hepatitis by County, 2018 Chronic hepatitis B N=4,763 Chronic hepatitis C N=22,175 Rate suppressed, <5 cases 28.0 100.0 0.0 100.0 130.0 >10.0 131.1 160.0 10.0 15.0 160.1 190.0 15.1 24.0 >190.0 >24.0 1 Per 100,000 population. See technical notes on slide 6. Data as of 9/19/2019. 15
Number of Reported Acute Hepatitis Cases in Florida, 2011 2018 Number of Cases Acute hepatitis B Acute hepatitis C 900 783 750 600 485 450 300 235 150 100 0 1 2011 2012 2013 2014 2015 2016 2017 2018 1 Change to F.A.C. 64D 3 Reporting requirements for hepatitis. See technical notes on slide 6. Data as of 9/19/2019. 17
Rates of Acute Hepatitis in Florida, 2011 2018 Rate per 100,000 Acute hepatitis B Acute hepatitis C 5.0 3.7 4.0 3.0 2.3 2.0 1.2 0.5 1.0 0.0 1 2011 2012 2013 2014 2015 2016 2017 2018 1 Change to F.A.C. 64D 3 Reporting requirements for hepatitis. See technical notes on slide 6. Data as of 9/19/2019. 18
Acute Hepatitis B by Age Group Percentage of Cases 2017 N=745 2018 35% 31% 30% 30% 24% 23% 25% 22% 21% 18% 18% 20% 15% 10% 6% 5% 5% 1% 1% 0% <20 >=60 20 29 30 39 40 49 50 59 Bar heights may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 19
Acute Hepatitis B by Sex 2017 2018 N=783 60% Male 60% 40% Female 40% 0% 20% 40% 60% 80% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 20
Acute Hepatitis B by Race/Ethnicity 64% 63% White 2017 N=745 12% 13% Black 10% 11% Unknown 2018 N=783 8% 10% Hispanic 3% 2% Other 2% 1% Asian/Pacific Islander 1% 1% American Indian/Alaskan Native 0% 25% 50% 75% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 21
Acute Hepatitis C by Age Group1 Percentage of Cases 2017 N=405 2018 35% 31% 30% 25% 25% 22% 25% 22% 20% 16% 15% 14% 14% 15% 11% 10% 3% 5% 2% 0% <20 >=60 20 29 30 39 40 49 50 59 1 Age was missing for 1 case in 2018. Bar heights may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 22
Acute Hepatitis C by Sex 2017 N=405 2018 55% Male 56% 45% Female 44% 0% 20% 40% 60% 80% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 23
Acute Hepatitis C by Race/Ethnicity 68% White 59% 2017 N=405 8% Unknown 18% 9% 10% 2018 N=485 Black 11% 10% Hispanic 2% 2% Other 1% 1% Asian/Pacific Islander 0 0 American Indian/Alaskan Native 0% 25% 50% 75% 100% Bar lengths may vary due to rounding. See technical notes on slide 6. Data as of 9/19/2019. 24
Rates1 of Acute Hepatitis by County, 2018 Acute hepatitis B N=783 Acute hepatitis C N=485 Rate suppressed, <5 cases Rate suppressed, <5 cases 0.0 0.0 0.1 3.0 0.1 3.0 3.1 5.0 3.1 5.0 >5.0 >5.0 1 Per 100,000 population. See technical notes on slide 6. Data as of 9/19/2019. 25
Drug use was the most commonly reported risk factor for acute hepatitis cases in 2018. Acute Hepatitis B Acute Hepatitis C Non-Injection Drug Use Recent Hospitialization Injection Drug Use Incarcerated > 24hrs Incarcerated > 6mos Recent Tattoo Exposure to Someone's Blood Recent Dental Work Recent Hemodialysis 0% 5% 10% 15% 20% 25% Range of missing/unknown risk factors is 37 52% for acute hepatitis B and 66 76% for acute hepatitis C. See technical notes on slide 6. Data as of 9/19/2019. 26
Perinatal Hepatitis C in Florida, 2016 2018 Number of Cases 50 45 40 34 30 20 22 10 0 1 2 2016 2017 2018 1 Perinatal hepatitis C became reportable in Florida in 2016. 2 Perinatal hepatitis C case definition was updated to include a suspect case classification and age was increased from 2 years to 3 years. In 2018, there were 5 suspect cases reported. See technical notes on slide 6. Data as of 9/19/2019. 27
Perinatal Hepatitis C by Age and Sex 2017 N=22 N=45 2018 Percentage of Cases 50% 45% 41% 40% 59% 40% Male 31% 29% 30% 53% 20% 14% 41% 10% Female 47% 0% <12 months 12 23 months 24 35 months 0% 20% 40% 60% In 2018, there were 5 suspect perinatal hepatitis C cases reported. See technical notes on slide 6. Data as of 9/19/2019. 28
Perinatal Hepatitis C by Race/Ethnicity White Unknown Black Hispanic Other Asian/Pacific Islander American Indian/Alaskan Native 64% 44% 2017 N=22 27% 42% 5% 2018 N=45 0 5% 2% 0 11% 0 0 0 0 0% 25% 50% 75% 100% In 2018, there were 5 suspect perinatal hepatitis C cases reported. See technical notes on slide 6. Data as of 9/19/2019. 29
The number of women of childbearing age with acute or chronic hepatitis C increased by 57% from 2011 to 2018. Women 15 44 years old with any hepatitis C infection Children <3 years old with any hepatitis C infection 66 4,512 45 2,872 2011 2018 2011 2018 Note: These charts represent persons with any reported hepatitis C infection and may not match data in FL CHARTS or data slides from previous years. FL CHARTS data represent counts of cases and not counts of persons. See technical notes on slide 6. Data as of 9/19/2019. 30
Hepatitis Surveillance Resources Florida CHARTS: flhealthcharts.com Case Definitions: cdc.gov/nndss/conditions/search/hepatitis/ Serology Training: cdc.gov/hepatitis/resources/professionals/training/serology/traini ng.htm 31
Hepatitis Prevention Resources Treatment Map: floridahealth.gov/diseases-and- conditions/hepatitis/Hepatitis_Treatment_Map_8_20_19.xlsx Hepatitis Resource Guide: floridahealth.gov/diseases-and- conditions/hepatitis/_documents/docs-for-hepatitis-resource- page/_documents/hepatitis-resource-guide-general- resources.pdf 32
Hepatitis Prevention Resources Hepatitis Fact Sheets English: floridahealth.gov/diseases-and- conditions/hepatitis/_documents/docs-for-hepatitis-resource-page/hep- abc-chart-english.pdf Spanish: floridahealth.gov/diseases-and- conditions/hepatitis/_documents/educational-materials/_documents/hep- abc-chart-spanish.pdf Creole: floridahealth.gov/diseases-and- conditions/hepatitis/_documents/docs-for-hepatitis-resource- page/_documents/abc-chart-creole.pdf For more prevention resources, visit flahepatitis.org 33
Viral Hepatitis Surveillance Data Contacts Kati Touchstone Viral Hepatitis Epidemiologist Kati.Touchstone@flhealth.gov 850-901-6982 Shana Geary Supplementary Surveillance Program Mgr. Shana.Geary@flhealth.gov 850-901-6615 Emma Spencer HIV/Hepatitis Surv. Program Mgr. Emma.Spencer@flhealth.gov 850-245-4432 Tom Bendle Hepatitis Program Manager Thomas.Bendle@flhealth.gov 850-245-4426 Hepatitis data are also available on Florida CHARTS floridacharts.com/charts/CommunicableDiseases/default.aspx 34
