Immunisation status of children presenting to the emergency department: Linkage of a longitudinal birth cohort with national immunisation data

Abstract Background In support of the recent United States Preventive Services Task Force’s (USPSTF) revised recommendations for non-targeted HCV screening, we have noted a shift away from active infections within the birth cohort (patients born between 1945-1965), as these individuals have often undergone successful treatment, and a shift towards younger adults who are RNA positive, especially people who use intravenous drugs (PWID). Methods Located in Northeastern New York State, Albany Medical Center conducts routine emergency department (ED) HCV screening, with active linkage to care. We performed a retrospective study of our HCV linkage to care data from April 2019 to June 2020. Patients were offered screening if they belonged to the birth cohort, were PWID, or at staff discretion. We estimated the effect of birth cohort, intravenous drug use and other potential risk factors on RNA positivity via Chi-square tests and Modified Poisson Regression. Results There were 242 people that were HCV antibody positive. The mean age was 50.9 years-old, with 118 (46.8%) in the birth cohort and 103 (42.56%) PWID. As compared to the birth cohort, a significantly greater proportion of non-birth cohort patients were PWID (62% vs 21.2%, p< 0.01) and homeless (17.7% vs 9.3%, p=0.05). Birth cohort patients were 0.55 times (95%CI: 0.39 to 0.79) less likely to be RNA positive. PWID were 2.22 times (95% CI: 1.58 to 3.13) and homeless people were 2.05 times (95% CI: 1.50 to 2.80) more likely to be RNA positive. After multivariable adjustment, birth cohort was not a significant risk factor for RNA positivity but PWID (RR: 1.84; 95% CI: 1.26 to 2.68) and homelessness (RR: 1.69; 95% CI: 1.20 to 2.39) were significantly associated with RNA positivity. Conclusion These data suggest that the RNA positivity rate is higher among the non-birth cohort age group but is explained by the higher prevalence of drug use and homeless. The findings support USPSTF’s new guidelines for testing all adults and shed light on the demographics of populations at risk for active infection vs. populations who are antibody positive and RNA negative. Further research might explore (a) whether these findings are applicable to other clinical settings and geographic locations and (b) the feasibility of targeting patients with active infection in settings such as the ED. Disclosures Talia A. Segal, BS, GILEAD FOCUS Foundation (Grant/Research Support) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Adam Rowden, DO, GILEAD FOCUS Foundation (Grant/Research Support) Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)

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LO44: Birth cohort hepatitis C screening in an academic emergency department in Canada: preliminary results

CJEM ◽

10.1017/cem.2020.99 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S23-S23

Author(s):

S. Friedman ◽

C. Capraru ◽

K. Bates ◽

D. Porplycia ◽

T. Mazzulli ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C ◽

Birth Cohort ◽

Screening Program ◽

Hcv Rna ◽

Screening Programs ◽

Hcv Prevalence ◽

Canadian Association ◽

The Us ◽

Hcv Screening

Introduction: Epidemiologic and modeling studies suggest that between 45 and 70% of individuals with chronic hepatitis C virus (HCV) infection in Canada remain undiagnosed. The Canadian Association for the Study of the Liver (CASL) recommends one-time screening of baby boomers (1945-1975). Screening programs in the US have shown a very high prevalence of previously undiagnosed HCV among patients seen in the emergency department (ED). We sought to assess the feasibility of implementing a targeted birth-cohort HCV screening program in a Canadian ED setting. Methods: Patients born from 1945 to 1975 presenting to the ED of a downtown Toronto hospital were offered HCV testing. Patients with life-threatening conditions, unable to provide verbal consent in English or intoxication were excluded. Blood samples were collected by finger prick on Dried Blood Spot (DBS) collection cards and tested for anti-HCV antibody with reflex to HCV RNA. Patients with positive HCV RNA were referred to a liver specialist. Results: During a 27-month period (July 2017 - Sept 2019), 8363 patients in the birth cohort presented to the ED during daytime hours. 80% (6714) met eligibility criteria, and 48.4% (3247) were offered testing. Screening was performed by non-medical staff (mean 8/day, median spots on DBS 4). 345 (10.6%) had been previously tested, and 639 (19.7%) declined. 2136 (65.8%) patients underwent testing: median age 58.4 years (40-82), 1117 male (52.3%). Of these, 45 patients (2.1%; 95% CI 1.5%-2.7%) were anti-HCV positive: 32 (76.2%) were HCV RNA positive, 10 (23.8%) negative and 3 not done due to inadequate DBS sample. 26 patients (81.3%) were linked to care and 3 (9.4%) lost to follow-up. HCV prevalence in the ED was significantly higher than the general Canadian population (2.1% vs 0.7%; p < 0.0001) but much lower than reported rates in American EDs (2.1% vs 10.3%; p < 0.0001). Conclusion: Acceptance of HCV screening in the ED birth cohort was high and easily performed using DBS to ensure the majority of positive samples were tested for HCV RNA. Challenges included implementation that limited number of people tested, and linkage to care for HCV positive patients. HCV prevalence among this ED birth cohort was higher than the general population but lower than seen in the ED in the US. This may in part be due to exclusion of individuals with more severe medical issues, refusal by higher risk subgroups, or population and healthcare system differences between countries.

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Results of a Hepatitis C Virus Screening Program of the 1945–1965 Birth Cohort in a Large Emergency Department in New Jersey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy065 ◽

2018 ◽

Vol 5 (4) ◽

Cited By ~ 8

Author(s):

Julia Kang Cornett ◽

Vimal Bodiwala ◽

Victor Razuk ◽

Devangi Shukla ◽

Navaneeth Narayanan

Keyword(s):

Emergency Department ◽

New Jersey ◽

Hepatitis C Virus ◽

Viral Load ◽

Hepatitis C ◽

Birth Cohort ◽

Insurance Status ◽

Black Race ◽

Hcv Antibody ◽

Hcv Screening

Abstract Background Persons born between 1945 and 1965 account for an estimated 81% of those infected with hepatitis C virus (HCV) in the United States. However, up to 60% remain undiagnosed. Prior studies have reported HCV screening results from large urban emergency departments. Methods This is a retrospective cohort study of patients in the 1945–1965 birth cohort tested for HCV in a large emergency department (ED) in New Jersey from June 1, 2016, through December 31, 2016. The purpose was to report HCV antibody and viral load results of this testing program located in a small urban/suburban area and to analyze specific characteristics associated with positive results, such as race/ethnicity and insurance status. Descriptive statistics were performed, and, using a multivariate logistic regression model, adjusted odds ratios and 95% confidence intervals were calculated. Results A total of 3046 patients were screened: 55.8% were white, and 17.9% were black; 52.1% had private insurance, 33.4% Medicare, 3.9% Medicaid. One hundred ninety-two were antibody positive (6.3%). Of 167 with HCV viral load testing results, 43% had a positive viral load. On multivariate analysis, black race and Medicaid were independently associated with a positive HCV viral load. Conclusions HCV antibody seropositivity was above 6% and twice as high as the Centers for Disease Control and Prevention estimated prevalence in this birth cohort. These results indicate that EDs outside of large urban cities are also important sites for routine HCV screening. Other findings of interest include 43% with chronic HCV infection and the persistent association between black race and positive HCV viral load even when adjusted for insurance status.

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