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"Burden and prevention of viral hepatitis in the Arctic region"
Hepatitis surveillance system and epidemiology in Northern
Sweden ANDERS NYSTEDT
Norrbotten County Council, Sweden
Norrbotten County
Lapland
Norrbotten region
Norrbotten County Council demography 31 dec 2011
• 98.250 square km (25 % of Swe´s total land area)
• Population 248.545 • In Norrbotten 192.525 • In Lapland 56.020
Norrbotten County Council demography 31 dec 2011
• Life expectancy 80,5 Y (F 82,7 Y, M 78,2 Y)
• Mean age 43,2 (41,1 Sw)
• 9,2 % are born abroad
The Hepatitis surveillance system
Dept of Communicable disease control
Microbiology lab
Achoo!
The clinician
The Hepatitis surveillance system
Dept of Communicable disease control
Microbiology lab
Achoo!
The clinician
Diagnose
Inform patient
Give ”rules of conduct”
Contact tracing
Treat
For free
Diseases • campylobacterinfektion • difteri • fågelinfluensa (H5N1) • EHEC (infektion med enterohemorragisk E.coli) • giardiainfektion • gonorré • hepatit A-E • hivinfektion • infektion med HTLV I eller II • klamydiainfektion • kolera • MRSA (infektion med meticillinresistenta gula
stafylokocker) • mjältbrand • paratyfoidfeber • pest • infektion med pneumokocker med nedsatt
känslighet för penicillin G • polio • rabies • salmonellainfektion • shigellainfektion • syfilis • tuberkulos • tyfoidfeber • virala hemorragiska febrar exkl. denguefeber och
sorkfeber (nefropathia epidemica) • smittkoppor • sars (svår akut respiratorisk sjukdom)
• atypisk mykobakterieinfektion • botulism (S) • brucellos (S) • cryptosporidiuminfektion (S) • denguefeber • echinokockinfektion (S) • entamöba histolyticainfektion (S) • enterobacteriacae-infektion som producerar ESBL
(Extended Spectrum Betalactamase) (ingen klinisk anmälan, anmäls endast från laboratorierna)
• gula febern • GAS (beta-hemolyserande grupp-A-streptokocker),
invasiv infektion • haemophilus influenzae, invasiv infektion • harpest (tularemi) • Influensa A(H1N1) 2009 • kikhosta (S) • legionellainfektion (S) • leptospirainfektion • listeriainfektion (S) • malaria • meningokockinfektion, invasiv • mässling (S) • pneumokockinfektion, invasiv • papegojsjuka (S) • påssjuka (S) • röda hund (S) • sorkfeber (nephropathia epidemica) • stelkramp • trikinos (S) • Q-feber • vancomycinresistenta enterokocker (VRE) (S) • vibrioinfektion exkl. kolera (S) • viral meningoencefalit • yersiniainfektion (S)
• hepatit A-E • hiv infektion
Primary health care
Laboratories
Patients
Social services
Prison system
Police
The public
Media Veterinary
Inf control
Hospital care
Municipalities
The county council incl. politicians
NGO´s
Dept of Communicable disease control
HAV acute cases
02468
10121416
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
Norrbotten casesImported cases
Hepatitis A
Average incidence 10 Y: 0,36/100.000
Hepatitis B
HBV acute and chronic cases (HBs-ag +)
020406080
100
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
UnknownNorrbotten casesImported cases
Average incidence 10 Y: 19/100.000
2 3
Acute cases
Hepatitis B
HBV acute and chronic cases (HBs-ag +)
020406080
100
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
UnknownNorrbotten casesImported cases
Average incidence 10 Y: 19/100.000
Hepatitis C
HCV cases (all HCV-ab +)
0
20
40
60
80
100
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
UnknownNorrbotten casesImported cases
Average incidence 10 Y: 29/100.000
Hepatitis C
HCV cases (all HCV-ab +)
0
20
40
60
80
100
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
UnknownNorrbotten casesImported cases
Average incidence 10 Y: 29/100.000
Hepatitis D
0123
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Imported cases
Hepatitis E
0
1
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
All cases
Hepatitis D and E
HIV - new cases
05
10152025303540
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
FemaleMale
HIV
05
10152025303540
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
UnknownNorrbotten casesImported cases 2 1
1
1
Transm. route iv drug abuse
HIV
1
1
Sápmi demography
• About 2 million people • Sámi people in Sápmi
about 91.000 • Sámi people in Sweden
about 36.000 • Sámi people in
Norrbotten about 18.000 Figures from Prof Per Sjölander at the Southern Lapland Research Department in Vilhelmina
Sápmi demography…
Who is sámi? • One who, or one who’s
parents or grandparents have spoken Sámi language at home
• One who’s parents were registered to the Sámi Parliament entitled to vote
• One who consider himself to be a Sámi.
Viral hepatitis and blood bourne infections among Sámi population in northern Sweden 2002-2011 - cases
• HAV
• HBV
• HCV
• HIV
0
1*
0
0
…as far as I know…
The health condition in the Sami population of Sweden
“Early contacts with the western society brought infectious diseases such as smallpox and tuberculosis, while western influence during the last five decades have had more profound effects on the lifestyle causing an increase of lifestyle related western diseases such as cancer, diabetes, stroke, obesity and hypertension.”
“Compared to other native populations, the prevalence of infectious diseases appears to be low among the Sami.” “Even though the knowledge is quite incomplete, the Sami does not seem to suffer from infectious diseases more than Swedes in general”.
Hassler
