Mel Krajden

Government of British Columbia, Canada, Vancouver, British Columbia, Canada

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Publications (182)785.96 Total impact

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    ABSTRACT: We described trends for sexually transmitted infections (STI) among gay/bisexual men in British Columbia, Canada, using a sentinel site surveillance approach. Using data from an electronic charting system, we included gay/bisexual men who visited high-volume STI clinics from 2000 to 2013. Diagnosis rates and incidence density were calculated for chlamydia, gonorrhea, syphilis, HIV, hepatitis C, genital herpes, and genital warts. Incidence density was estimated among repeat testers who converted from a negative to positive test result. We also conducted Poisson regression analysis to determine factors that were associated with increased incidence rates. A total of 47,170 visits were identified for gay/bisexual men during our time frame. The median age was 34 years (interquartile range, 27-43 years), and most clients were seen in Vancouver. Although trends for most STI were stable, diagnoses of gonorrhea and syphilis have risen steadily in recent years. Coinfection with HIV was associated with higher gonorrhea and syphilis rates in the Poisson regression model. In addition, visiting a Vancouver clinic and younger age were associated with increased incidence. Our clinic-based sentinel surveillance system found increasing trends for gonorrhea and syphilis among gay/bisexual men but not for other STI in British Columbia. Further investigation is required to explore the syndemic effects of syphilis, gonorrhea, and HIV. This new platform will be a valuable tool for ongoing monitoring of STI and targeting prevention efforts.
    Sex Transm Dis 03/2015; 42(3):153-159. · 2.75 Impact Factor
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    ABSTRACT: The ability to classify acute vs. chronic hepatitis C virus (HCV) infections at the time of diagnosis is desirable to improve the quality of surveillance information. The aim of this study was to differentiate acute from chronic HCV infections utilizing deep sequencing. HCV NS5B amplicons (n=94) were generated from 77 individuals (13 acute and 64 chronic HCV infections) in British Columbia, Canada with documented seroconversion timeframes. Amplicons were deep sequenced and HCV genomic diversity was measured by Shannon entropy (SE) and a single nucleotide variant (SNV) analysis. The relationship between each diversity measure and the estimated days since infection was assessed using linear mixed models and the ability of each diversity measure to differentiate acute from chronic infections was assessed using generalized estimating equations. Both SE and the SNV diversity measures were significantly different for acute vs. chronic infections (p <0.009). NS5B nucleotide diversity continued to increase for at least 3 years post-infection. Among individuals with the least uncertainty with regard to duration of infection (n=39), the area under the receiver operating characteristic curve (AUROC) was high (0.96 for SE; 0.98 for SNV). Although the AUROCs were lower (0.80 for SNV; 0.86 for SE) when data for all individuals were included, they remain sufficiently high for epidemiological purposes. Synonymous mutations were the primary discriminatory variable accounting for over 78% of the measured genetic diversity. Conclusions: NS5B sequence diversity assessed by deep sequencing can differentiate acute from chronic HCV infections and with further validation could become a powerful population level surveillance tool for incidence estimation.Approximately 184 million people worldwide have been infected with hepatitis C virus (HCV) (1), including an estimated 138,600 – 221,300 people in Canada (2). About 75% develop chronic infection and the remaining 25% clear infection spontaneously (3). Without treatment, 15% to 25% of those chronically infected will develop progressive liver disease over several decades. Fortunately, HCV can be virologically cured, which reduces all-cause and liver-related mortality (4) and newer well-tolerated direct acting antiviral treatments hold the promise of curing >95% of infections (5). This article is protected by copyright. All rights reserved.
    Hepatology 02/2015; · 11.19 Impact Factor
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    ABSTRACT: Context Hepatitis C virus (HCV) infection is an important cause of progressive liver disease. It is spread through blood-to-blood contact and seldom produces symptoms at the time of infection. Three of four infections become chronic and, over decades, 15% to 30% of those infected develop cirrhosis, hepatocellular cancer, or require liver transplantation.[1] An estimated 230 000 to 450 000 (0.66% to 1.3%) of Canadians are infected with HCV.[2] In British Columbia, approximately 80 000 people have been diagnosed with HCV and many are unaware of their HCV status. Two of three HCV-infected individuals in BC are baby boomers born between 1945 and 1965, and many are now presenting with end-stage liver disease. Most new infections occur in people who inject drugs. Other HCV-affected populations include immigrants from HCV-endemic countries and Aboriginal people.[3] The Public Health Agency of Canada recommends screening these groups at least once.[4] Others, including the Canadian Liver Foundation, also recommend screening people born between 1945 and 1975.[5] Care and treatment Treatment and self-care, including reducing alcohol intake, can prevent progressive liver disease and improve quality of life. Treatment of HCV is shifting from older, poorly tolerated interferon-based therapies, which cure approximately 55% of those treated (45% for genotype 1, 60% to 70% for genotype 3, and 70% to 80% for genotype 2)[6] to new well-tolerated, short-course (8 to 12 weeks) interferon-free direct-acting antiviral drugs with cure rates approaching more than 95%.[7] The simplicity and tolerability of newer treatments opens the opportunity for HCV treatment to be delivered by primary care physicians, thus increasing treatment capacity. However, treatment can only occur if undiagnosed people get tested, and diagnosed people are engaged into care. Resources Our research identified several patient, provider, and health care system related factors associated with nonattendance for HCV care.[8] A website was designed to address some of these factors (www.hepatitiseducation.ca). The website employs a navigation hub outlining key topics along the cascade of care to support consumers and providers. These linguistically and culturally appropriate resources include basic facts about HCV, the testing process, being diagnosed, living with HCV, and treatment, and can assist providers in supporting patient information needs across the cascade of HCV care. Resources are available in English and French, have been adapted for Aboriginal and Inuit populations, and are being adapted to Punjabi and other languages. To maximize accessibility and engagement, information is presented via videos, online courses, downloadable booklets, cards, and printable materials. Summary HCV affects a large number of British Columbians and many are unaware that they are infected. Highly effective, well-tolerated, short-course curative treatments are becoming available, but for treatments to be effective people must be diagnosed and engaged into care and treatment. The illustrated and narrated education and support resources are intended to support the information needs of patients and providers related to screening, diagnosis, care, and treatment.
    BCMJ. 02/2015; 57(1):27.
  • 01/2015; 20(4).
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    ABSTRACT: Hepatitis C virus (HCV) has a naturally-occurring polymorphism Q80 K in the NS3 gene encoding the viral protease, which has been associated with reduced susceptibility to the direct-acting antiviral inhibitor Simeprevir. Q80 K is observed predominantly in genotype 1a, and seldom in other HCV genotypes; moreover, it has a markedly high prevalence in the United States. Here, we reconstruct the evolutionary history of this polymorphism to investigate why it is so highly localized in prevalence, and whether it is stably transmitted between hosts. We find the majority (96%) of HCV infections carrying Q80 K were descended from a single lineage in which a Q80 K substitution occurred around the 1940's in the United States, which implies that this polymorphism is likely highly transmissible. Furthermore, we identified two other substitutions in NS3 that may interact with Q80 K and contribute to its stability. Our results imply that the current distribution and prevalence of Q80 K are unlikely to change significantly in the short term.
    The Journal of Infectious Diseases 11/2014; · 5.78 Impact Factor
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    ABSTRACT: Introduction: Individuals living in single-room occupancy (SRO) hotels constitute a socially marginalized group with exposure to multiple factors with adverse effects on neurocognition, including substance use, viral infection, psychiatric illness, and brain injury. Consequently, marked heterogeneity in neurocognitive functioning is observed. This study aimed to identify and describe distinct neurocognitive profiles within a marginally housed sample. Method: Two hundred and forty-nine (N = 249) SRO hotel residents (mean age = 43.5 years) were recruited. A battery of tests assessed neurocognition across six domains: premorbid IQ, verbal memory, attention, inhibition, mental flexibility, and decision making. Clinical examinations collected information pertaining to substance use and psychiatric diagnoses, viral infection, psychiatric symptoms, risk behaviors, and everyday functioning. Cluster analysis was used to identify subgroups of individuals with similar neurocognitive profiles and was supplemented with a discriminant function analysis. Analyses of variance and chi-square tests were used to validate the derived clusters on key clinical and functional variables. Results: A three-cluster solution was found to be optimal. Cluster 1 (n = 59) presented as overall higher functioning, whereas Cluster 3 (n = 87) exhibited overall lower functioning with a relative strength in decision-making skills. Cluster 2 (n = 103) was characterized by neurocognitive abilities that generally bisected the performance of the other groups, but with a relative weakness in decision-making skills. Discriminant function analysis indicated the six neurocognitive variables comprised two underlying dimensions that accounted for between-group variance. Clusters meaningfully differed on demographics, substance use, viral exposure, psychiatric symptoms, neurological soft signs, and risk behavior. Conclusion: Neurocognitive functioning provides the basis for identifying meaningful subgroups of marginally housed individuals, which can be reliably differentiated on key variables. This approach facilitates an understanding of the neurocognitive dysfunction and associated vulnerabilities of marginalized persons and ultimately may elucidate intervention targets.
    Journal of Clinical and Experimental Neuropsychology 11/2014; · 2.16 Impact Factor
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    ABSTRACT: This case series describes morbilliform and other rash presentations among schoolchildren during a March 2014 outbreak of influenza-like illness (ILI) in British Columbia, Canada. Multiplex nucleic acid testing of nasopharyngeal specimens and paired serologic investigations identified that influenza B, characterized as B/Massachusetts/02/2012-like (Yamagata-lineage), was the only viral aetiology and most likely cause of ILI and rash. An association between influenza B and rash has been described infrequently elsewhere, and not previously in North America. Influenza B should be considered in the differential diagnosis of febrile exanthem. Evaluation of the nature, incidence and contributing agent–host–environment interactions, and immunologic mechanisms to possibly explain influenza-associated rash is warranted.
    Influenza and Other Respiratory Viruses 11/2014; · 1.47 Impact Factor
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    ABSTRACT: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally.
    Canadian journal of gastroenterology & hepatology. 11/2014; 28(10):525-8.
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    ABSTRACT: Mounting evidence affirms HPV testing as an effective cervical cancer screening tool, and many organized screening programs are considering adopting it as primary testing. HPV self-collection has comparable sensitivity to clinician collected specimens and is considered a feasible option in hard-to-reach women. We explored women's intentions to HPV self-collect for cervical cancer screening from a cohort participating in a Canadian randomized controlled cervical cancer screening trial.
    BMC Public Health 10/2014; 14(1):1060. · 2.32 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) currently infects approximately 250,000 individuals in Canada and causes more years of life lost than any other infectious disease in the country. In August 2011, new therapies were approved by Health Canada that have achieved higher response rates among those treated, but are poorly tolerated. By 2014⁄2015, short-course, well-tolerated treatments with cure rates >95% will be available. However, treatment uptake is poor due to structural, financial, geographical, cultural and social barriers. As such, 'Barriers to access to HCV care in Canada' is a crucial topic that must be addressed to decrease HCV disease burden and potentially eliminate HCV in Canada. Understanding how to better care for HCV-infected individuals requires integration across multiple disciplines including researchers, clinical services and policy makers to address the major populations affected by HCV including people who inject drugs, baby boomers, immigrants and Aboriginal and⁄or First Nations people. In 2012, the National CIHR Research Training Program in Hepatitis C organized the 1st Canadian Symposium on Hepatitis C Virus (CSHCV) in Montreal, Quebec. The 2nd CSHCV was held in 2013 in Victoria, British Columbia. Both symposia were highly successful, attracting leading international faculty with excellent attendance leading to dialogue and knowledge translation among attendees of diverse backgrounds. The current article summarizes the 3rd CSHCV, held February 2014, in Toronto, Ontario.
    Canadian journal of gastroenterology & hepatology. 10/2014; 28(9):481-487.
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    ABSTRACT: Objectives We compared a 3rd generation (gen) and two 4th gen HIV enzyme immunoassays (EIAs) to pooled nucleic acid testing (PNAT) for the identification of pre- and early seroconversion acute HIV infection (AHI). Study design 9550 specimens from males >18 years from clinics attended by men who have sex with men were tested by Siemens ADVIA Centaur® HIV 1/O/2 (3rd gen) and HIV Combo (4th gen), as well as by Abbott ARCHITECT® HIV Ag/Ab Combo (4th gen). Third gen non-reactive specimens were also tested by Roche COBAS® Ampliprep/COBAS® TaqMan HIV-1 Test v.2 in pools of 24 samples. Sensitivity and specificity of the three EIAs for AHI detection were compared. Results 7348 persons contributed 9435 specimens and had no evidence of HIV infection, 79 (94 specimens) had established HIV infection, 6 (9 specimens) had pre-seroconversion AHI and 9 (12 specimens) had early seroconversion AHI. Pre-seroconversion AHI cases were not detected by 3rd gen EIA, whereas 2/6 (33.3%) were detected by Siemens 4th gen, 4/6 (66.7%) by Abbott 4th gen and 6/6 (100%) by PNAT. All three EIAs and PNAT detected all individuals with early seroconversion AHI. Overall sensitivity/specificity for the EIAs relative to WB or NAT resolved infection status was 93.6%/99.9% for Siemens 3rd gen, 95.7%/99.7% for Siemens 4th gen and 97.9%/99.2% for Abbott 4th gen. Conclusions While both 4th gen EIAs demonstrated improved sensitivity for AHI compared to 3rd gen EIA, PNAT identified more AHI cases than either 4th gen assay. PNAT is likely to remain a useful strategy to identify AHI in high-risk populations.
    Journal of Clinical Virology 09/2014; · 3.47 Impact Factor
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    ABSTRACT: Background & Aims People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality, and establish an international surveillance system for evaluating the population level impact of HCV treatments. Methods Population level HCV diagnosis databases from Scotland (1997-2010), Australia (New South Wales [NSW]) (1997-2006), and Canada (British Columbia [BC]) (1997-2003) were linked to corresponding death registries using record linkage. For each region, age-adjusted cause-specific mortality rates were calculated, and trends in annual age-adjusted liver-related mortality were plotted. Results Of 105,138 individuals diagnosed with HCV (21,810 in Scotland, 58,484 in NSW, and 24,844 in BC), there were 7,275 deaths (2,572 in Scotland, 2,655 in NSW, and 2,048 in BC). Liver-related deaths accounted for 26% of deaths in Scotland, 21% in NSW, and 22% in BC. Temporal trends in age-adjusted liver related mortality were stable in Scotland (males p=0.4; females p=0.2) and NSW (males p=0.9; females p=0.9), while there was an increase in BC (males p=0.002; females p=0.04). Conclusions The risk of liver-related mortality after a diagnosis of HCV has remained stable or increased over time across three regions with well-established diagnosis databases, highlighting that HCV treatment programmes to-date have had minimal impact on population level HCV-related liver disease. With more effective therapies on the horizon, and greater uptake of treatment anticipated, the potential of future therapeutic strategies to reduce HCV-related mortality is considerable.
    Journal of Hepatology 09/2014; · 10.40 Impact Factor
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    ABSTRACT: Objectives: (1) To describe obstetrical and neonatal outcomes among a cohort of hepatitis C virus (HCV) infected women, comparing HCV RNA positive to HCV RNA negative women; (2) to characterize virologic and hepatic parameters associated with HCV infection during pregnancy; and (3) to describe the rate of HCV vertical transmission. Methods: We prospectively enrolled 145 HCV-positive pregnant women across British Columbia between 2000 and 2003. Participating women were monitored during pregnancy and their infants were followed to assess them for HCV infection. Maternal HCV RNA was assessed close to delivery. Results: Seventy percent of women reported injection drug use as their primary risk factor for HCV acquisition. Observed rates of intrauterine fetal death, preterm delivery, small for gestational age, and low birth weight infants were 3.4%, 17.9%, 11.3%, and 12.5%, respectively, without a significant association with maternal HCV RNA status. The rate of cholestasis was 5.6% in the HCV RNA-positive group (6/108) and 2.8% in the HCV RNA-negative group (1/37) (P = 0.496). Serum alanine aminotransferase levels decreased significantly through pregnancy, and were significantly higher in HCV RNA-positive women than in HCV RNA-negative women after controlling for cholestasis, co-infections, and alcohol consumption. Among the HCV RNA-positive women, the median FIB-4 score was 0.67 (IQR 0.56 to 0.76) in the first trimester, 0.74 (IQR 0.52 to 1.18) in the second trimester, and 0.89 (IQR 0.52 to 1.09) in the third trimester (P = 0.02). The median HCV viral load at delivery was 424 561 IU/mL. The vertical transmission rate was 4.7% in HCV RNA-positive women, with no cases in HCV RNA-negative women. Conclusion: Because of the high rates of poor obstetrical outcomes found in this prospective cohort, population-level screening for HCV in pregnancy should be considered.
    09/2014; 36(9):785-794.
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    ABSTRACT: In light of accumulated scientific evidence of the secondary preventive benefits of antiretroviral therapy, a growing number of jurisdictions worldwide have formally started to implement HIV Treatment as Prevention (TasP) programs. To date, no gold standard for TasP program monitoring has been described. Here, we describe the design and methods applied to TasP program process monitoring in British Columbia (BC), Canada.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 07/2014; · 4.39 Impact Factor
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    ABSTRACT: Failure to understand the risk of false negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false negative result for various days post-exposure.
    International Journal of STD & AIDS 07/2014; · 1.04 Impact Factor
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    ABSTRACT: Background. No immunogenicity data has been reported after a single dose of the quadrivalent HPV vaccine (qHPV-Gardasil®) and no data are available on co-administration of this vaccine with the HAV/HBV vaccine (Twinrix-Junior®). Two pre-licensure studies reported similar anti-HPV but lower anti-HBs titers when co-administering HPV and HBV vaccines. Objectives. To assess the immunogenicity of the qHPV and HAV/HBV vaccine when co-administered (Group-Co-adm) or given one month apart (Group-Sep) and to measure the persistence of HPV antibodies three years post-second dose of qHPV vaccine in both study groups. Methods. 416 9-10 year-old girls were enrolled. Vaccination schedule was 0-6 months. Anti-HAV and anti-HBs were measured in all subjects 6 months post-first dose and 1 month post-second dose. Anti-HPV were measured 6 months post-first dose in Group-Co-adm and in all subjects 1 and 36 months post-second dose. Results. Six months post-first dose: 100% of subjects had detectable anti-HAV and 56% and 73% had detectable anti-HBs in Group-Co-Adm and Group-Sep, respectively. In Group-Co-adm 94, 100, 99 and 96% had detectable antibodies to HPV 6, 11, 16 and 18, respectively. One month post-second dose of qHPV and HAV/HBV vaccine, in both study groups 99.5-100% of subjects had an anti-HAV titer ≥ 20IU/L, 97.5-97.6% an anti-HBs level ≥ 10IU/L, and 100% had an anti-HPV titer ≥ 3LU. Thirty-six months post-second dose of qHPV all but four subjects (99%) had antibodies to HPV18 and 100% had antibodies to HPV6, 11 and 16. The great majority (97-100%) had an anti-HPV titer ≥ 3 LU. Post-second dose administration of qHPV and HAV/HBV, no meaningful difference was observed in the immune response in the two study groups to any component of vaccines. Conclusions. The results indicate that qHPV and HAV/HBV can be given during the same vaccination session. Two doses of of qHPV and HAV/HBV vaccines induce a strong immune response. Three years post-second dose of qHPV, the great majority of subjects had antibodies to HPV types included in the vaccine. A two-dose schedule for pre-adolescents might be a reasonable alternative to the currently approved three-dose schedules.
    Human Vaccines and Therapeutics 07/2014; 10(8). · 3.64 Impact Factor
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    ABSTRACT: Little is known about factors associated with HCV transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n=313), G1b: 6% (n=41), G2a: 3% (n=20), G2b: 7% (n=46), G3a: 33% (n=213), G4a: <1% (n=4), G6a: 1% (n=8), G6e: <1% (n=1) and unclassifiable: 1% (n=9). The mean age was 36 years, 162 (25%) were female and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n=156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (vs. age ≥40, adjusted odds ratio [AOR] = 1.64; 95% CI 1.03, 2.63), HIV infection (AOR = 1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR = 3.05; 95% CI 1.40, 6.66) and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36). Conclusion: In this sample of PWID, one-third demonstrated phylogenetic clustering. Factors independently associated with phylogenetic clustering included younger age, recent HCV seroconversion, prevalent HIV infection, and recent syringe borrowing. Strategies to enhance the delivery of prevention and/or treatment strategies to those with HIV and recent HCV seroconversion should be explored, given an increased likelihood of HCV transmission in these sub-populations.3 (Hepatology 2014;)
    Hepatology 07/2014; 60(5). · 11.19 Impact Factor
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    ABSTRACT: To understand A(H1N1)pdm09 epidemic resurgence during the 2013-14 influenza season, we compared age-related cross-sectional estimates of sero-protection pre-pandemic (2009) and post-pandemic (2010 and 2013) to subsequent surveillance-based laboratory-confirmed A(H1N1)pdm09 incidence in British Columbia, Canada. Pre-pandemic sero-protection was negligible except among the very old ³80 years (80%). Conversely, post-pandemic sero-protection followed a U-shaped distribution: ∼35-45% among working-age adults but ³70% in the very old and young children, excluding children <5years in 2013 for whom sero-protection again fell below 20%. Incidence was 5-fold higher in 2013-14 than 2010-11, highest in preschool-aged children and working-age adults, following a mirror-image of sero-protection by age.
    The Journal of infectious diseases. 06/2014;
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    ABSTRACT: People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection. Trends in HCV incidence and associated risk factors among PWID recruited between 1996 and 2012 in Vancouver, Canada were evaluated.
    PLoS ONE 06/2014; 9(6):e97726. · 3.53 Impact Factor
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    ABSTRACT: Objective: Test uptake and case detection trends for rubella, syphilis, HIV, and hepatitis C (HCV) were compared among the 2007 to 2011 cohort of women undergoing prenatal testing in British Columbia. Analysis involved linkage of provincially centralized laboratory and surveillance data to assess prenatal test uptake and rates of newly diagnosed versus prevalent infections. Methods: We included prenatal specimens submitted from BC women aged 16 to 45 years in 2007 to 2011. Laboratory records were linked to provincial surveillance systems to identify confirmed maternal syphilis and HIV cases. Previous positive status was determined for HIV and HCV if a prior confirmed case was identified from laboratory records. We determined rates of HIV and HCV newly identified at prenatal screening (new diagnoses per 100 000 per year). Prevalence for HIV and HCV was the sum of all new and prior diagnoses (prevalence per 100 000 per year). Results: Of 233 203 women, 96.9% were screened for rubella, 93.3% for syphilis, 93.8% for HIV, and 21.5% for HCV. From 2007 to 2011, the overall rates of new diagnoses were 15.4, 5.1, and 82.8 cases per 100 000 per year for syphilis, HIV, and HCV, respectively. The overall prevalence was 45.9 and 551.5 cases per 100 000 per year for HIV and HCV, respectively (0.05% and 0.6%). From 2007 to 2011, new diagnoses of HCV decreased 40% from 106.0 to 62.1 cases per 100 000 per year. HCV prevalence did not change and increased with maternal age. Conclusion: This study links surveillance and laboratory data to provide a provincial picture of prenatal screening test uptake and case detection, with the advantage of distinguishing new from prior diagnoses. This information can help guide prenatal communicable disease screening policy.
    06/2014; 36(6):482-490.

Publication Stats

5k Citations
785.96 Total Impact Points

Institutions

  • 2010–2014
    • Government of British Columbia, Canada
      Vancouver, British Columbia, Canada
    • BC Cancer Agency
      Vancouver, British Columbia, Canada
  • 2002–2014
    • University of British Columbia - Vancouver
      • • Department of Pathology and Laboratory Medicine
      • • Faculty of Medicine
      • • Centre for Disease Control
      • • Department of Anesthesiology, Pharmacology and Therapeutics
      Vancouver, British Columbia, Canada
  • 2001–2014
    • BC Centre for Disease Control
      Vancouver, British Columbia, Canada
  • 2012
    • Provincial Health Services Authority, British Columbia , Canada
      Vancouver, British Columbia, Canada
  • 2009
    • University of New South Wales
      Kensington, New South Wales, Australia
  • 1998–2009
    • University of Toronto
      • • Institute of Health Policy, Management and Evaluation
      • • Department of Laboratory Medicine and Pathobiology
      Toronto, Ontario, Canada
  • 2005
    • Vancouver General Hospital
      Vancouver, British Columbia, Canada
  • 1999
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 1993–1999
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1996
    • St. Michael's Hospital
      Toronto, Ontario, Canada