"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
Achoo!
Microbiology lab
The clinician
Dept of Communicable
disease control
The Hepatitis surveillance system
Achoo!
Diagnose
Inform patient
Give ”rules of
conduct” lab
Microbiology
Contact tracing
Treat
The clinician
Dept of Communicable
disease control
For free
Diseases
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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)
• hepatit A-E
• hiv infektion
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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
The county council
incl. politicians
Hospital care
Primary health care
Inf control
Laboratories
Patients
Dept of Communicable
disease control
Social services
Police
Prison system
Media
Municipalities
Veterinary
NGO´s
The public
Hepatitis A
HAV acute cases
16
14
12
10
8
6
4
2
0
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
19
97
Norrbotten cases
Imported cases
Year
Average incidence 10 Y: 0,36/100.000
Hepatitis B
HBV acute and chronic cases (HBs-ag +)
3
100
2
80
Unknown
60
Norrbotten cases
40
Imported cases
20
Year
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
19
97
0
Acute cases
Average incidence 10 Y: 19/100.000
Hepatitis B
HBV acute and chronic cases (HBs-ag +)
100
80
Unknown
60
Norrbotten cases
40
Imported cases
20
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
19
98
19
19
97
0
Year
Average incidence 10 Y: 19/100.000
Hepatitis C
HCV cases (all HCV-ab +)
100
80
Unknown
60
Norrbotten cases
40
Imported cases
20
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
0
Year
Average incidence 10 Y: 29/100.000
Hepatitis C
HCV cases (all HCV-ab +)
100
80
Unknown
60
Norrbotten cases
40
Imported cases
20
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
0
Year
Average incidence 10 Y: 29/100.000
Hepatitis D and E
Hepatitis D
3
2
1
0
Imported cases
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Hepatitis E
1
All cases
0
1997
1998
1999
2000
2001
2002
2003
2004
Year
2005
2006
2007
2008
2009
2010
2011
HIV
HIV - new cases
40
35
30
25
20
15
10
5
0
Female
Male
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
HIV
40
35
30
25
20
15
10
5
0
1
1
1
Year
Unknown
1
Year
2011
2010
2009
2008
2007
2006
2005
2004
2003
Imported cases
2002
2001
2000
1999
1998
Norrbotten cases
1
2
Transm. route
iv drug abuse
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
0
• HBV
0
• HCV
1*
• HIV
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
[email protected]
