1286. Incidence of Acute Hepatitis B among Adults with and without Diabetes, 2009-2010
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: In the United States, recent hepatitis B outbreaks identified among persons with diabetes have been linked to infection control lapses in health care or congregant living facilities associated with blood glucose monitoring.  To determine if adults with diabetes in the general population were at increased risk of acute hepatitis B infection, we estimated the incidence of acute hepatitis B among persons with and without diabetes reported from four Emerging Infections Program (EIP) sites – Colorado, Connecticut, New York City, and Oregon.

Methods: Persons captured by EIP acute hepatitis B surveillance who met the Council of State and Territorial Epidemiologists confirmed case definition were included.  Information about diabetes status, demographic characteristics, and hepatitis B risk factors was obtained on cases by chart review and patient interview.  State-based Behavioral Risk Factor Surveillance System (BRFSS) and New York City Community Health Survey (CHS) self-reported diabetes data were used to estimate the study population denominator for 2009.  EIP cases and BRFSS/CHS respondents with missing diabetes data were excluded; those aged <23 years also were excluded for expected high rates of hepatitis B vaccination.  Acute hepatitis B incidence was estimated for persons with and without diabetes; rate ratios and 95% confidence intervals were calculated to compare estimates.

Results: Of 330 confirmed acute hepatitis B cases aged ≥23 years, 262 (79%) had diabetes data and were included for analysis.  Median age was 44 years (range: 23-88); 62% were male, 39% white, and 19% Hispanic; 18% reported a diabetes diagnosis prior to onset of acute hepatitis B symptoms.  Of the 14 million adults in the study denominator, 1.2 million (8%) reported a diabetes diagnosis.  The estimated incidence of acute hepatitis B among adults with diabetes was 2.0 (95% CI 1.4-3.0) per 100,000, compared to 0.8 (95% CI 0.7-1.0) per 100,000 among persons without diabetes (rate ratio=2.4, P<0.001).

Conclusion: The preliminary estimate of acute hepatitis B incidence among adults with diabetes was more than twice as high as adults without diabetes.  If confirmed, hepatitis B vaccination of susceptible adults with diabetes could be a consideration for prevention of hepatitis B.

Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Meredith L Reilly, MPH1, Tasha Poissant, MPH2, Candace W Vonderwahl, BS3, Kristin Gerard, MPH4 and Trudy V Murphy, MD1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Oregon Health Authority, Portland, OR, (3)Colorado Department of Public Health and Environment, Denver, CO, (4)Connecticut Department of Public Health, Hartford, CT


M. L. Reilly, None

T. Poissant, None

C. W. Vonderwahl, None

K. Gerard, None

T. V. Murphy, None

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