Would like to now turn the presentationover to Dr. Jonathan Mermin from CDC National Center of HIV/ AIDS, ViralHepatitis, STD, and TB prevention. If we could have the next move delight? Thank you. Dr. Mermin? Great, well expressed appreciation for Corinna and Rich for organizingthe webinar and for some great slips and spots. Next slideplease. I wanted to highlight a little bitabout the epidemiology of what’s going on in the United Position with regard toopioids, viral hepatitis and HIV and talk about specific actions steps. Next slide please.First, we are dealing with a big increase in overdose deaths from what isa originating opioid epidemic.Over 500,000 beings died from overdoses over the past1 5 years and over 60,000 of those appeared last year alone. No position in theUnion is unaffected by fatal overdoses. In reality although there are some stateslike West Virginia, New Hampshire, Kentucky, Ohio, Pennsylvania, New Mexico, that have been most profoundly changed, every country has considered an increase inoverdose deaths in 2010 and often these have been profound.We also can see herethat death due to prescription opioids in purple have leveled off since 2011, tosome extent, because of a response from the nation to try to reduce the over-prescribing and shorten access into inappropriate use of prescriptionopioids. But we’ve had a dramatic increase in deaths from heroin andsynthetic opioids such as fentanyl which now make up over 50% of all the opioiddeaths. Next move satisfy. And what we can see onthis delineate when it shows up…yes, is that the rate of overdose demises is actuallycorrelated with the amount of opioids by clinicians in a state and that variesconsiderably. So some of the areas in this map…prescription rates of opioidsare over one drug per person per year.That would be in the maroon the regions and a rate that’s more than twice as frequentas in the yellowish governments. So hazardous opioid use and drug overdoses areassociated with how easy it is to get prescription opioids but alsoincreasingly they are associated with non-prescription opioid use.Next slideplease. Concomitant with this, we’ve seenincreases in viral hepatitis as well and I just wanted to highlight that over2 2,000 Americans die of either hepatitis C or hepatitis B each yearand there’s been a doubling of the quantity pregnant women with hepatitis C.This increase in viral hepatitis is mostly due to injection drug useassociated with opioids and other illicit drugs. With regard totransmission to infants, there’s been a long biography of knowledgeabout hepatitis B potentially being transmitted to babes and there isguidelines for birth dose vaccination of hepatitis B and then also for providingother involvements that can prevent transmission to babes when themother’s known to have hepatitis B illnes. Those have been highlyeffective, although not reaching everyone who needs it. But hepatitis C raisesquandaries both clinically and scientifically because there are atthe current time no medications for hepatitis C that have been approved forpregnancy or for infants or prophylaxis.So at about 5% -1 0% of babies born to fathers with hepatitis C will develop the infection.So we do have the ability to prevent these infections and in the case both totreat them and in hepatitis C action to medicine them and in hepatitis B’s client toprevent them with a inoculation but there’s much more to do. Next slide satisfy. So with regard to HIV illness in theU.S. we’ve had remarkable success in reducing HIV incidence among people whoinject treats over the past two decades and in fact you can see here usingdiagnoses of HIV as the marker, about 6,400 parties acquired their HIVpresumptively through injection drug use in 2006 and that has decreased steadilyuntil 2015 when we had the first increase in a long time and thatincrease is 4% but if we follow a 63% nosedive over the ten years prior to thatand that’s being threatened because of increasing dope injection that is beingdone by sharing needles or syringes with other people.Next move please.I also just wanted to highlight that there are often severe infectiousdisease consequences to opioid apply, particularly injection drug use. Sobetween 2002 and 2012 the hospitalization due to opioid useincreased but so did hospitalizations due to endocarditis, septic arthritiswhich is infection of your seams, epidural swellings which are abscessesin kind of the spinal column, and then bone illness and all of those areassociated with unsterile injection and then there are also other pricey healthconsequences to the opioid epidemic that are not infectious disease related likeneonatal abstinence illnes which increased 300% from 1999 to 2013 andthat alone costs over one and a half billion dollars per year to thehealthcare system.Next slide. So what can we do? And there’s really a lot withinthe overarching tactical fabric that we can do. One is we can prevent theharmful use of opioids and there’s a lot of actions whether establishingand had participated in the prescription drug monitoring programs in one state toworking to…with programs for youth that prevent use of opioids to helping people who are in chronic aching to reduce their employ of opioids sothat they don’t end up becoming addicted. The second matter is prevention of HIVand viral hepatitis. There’s a lot of ways that we can do that butparticularly for people who inject treats ensuring that there’s access tosterile insertion gear and that people know that they are atrisk of these contagious diseases causes and that they can preventit through certain measures can be very helpful.Third is medicine of substance give disorder. There’s various highlyeffective drugs that help people not use or introduce narcotics includingmethadone buprenorphine and probuphine ution which is a long-actingbuprenorphine derivative.It is an implant that lasts for six months.All of those increase the occasion that beings will will not use drugs andas Richard mentioned they can be synergistic with other preventionprograms so if one participates in syringe service programs you are threeand half ages as likely to actually stop using medicines as well. The otherissues…those essence expend planneds are truly screen people for HIV andhepatitis and ensure that people are treated appropriately if they have thoseinfections and we can also vaccinate beings for at least hepatitis B andother inoculation pertained illness that occur among people who use drugs.Next move please.So CDC’s response..this move was initially deduced to talkabout some of the five mainstays the hell is focuses for CDC to prevent opioidoverdoses and opioid related distress. They also can concerning the infectiousdisease consequences of opioid use and actually one understands theimportance of building the mood, local, and tribal capability both to respondquickly if there are outbreaks of infection but too to work in all thedifferent areas that help us prevent or consider these, either opioid exploit or the infectious diseases associated with it. We also can support providers, healthsystems, and payers through either our guidelines for prescribing opioids forchronic ache or health systems can implement coordinated care plans thatclosely monitor and integrate care for patients on chronic opioid rehabilitation andthen pharmacy benefit program overseers can stimulate implementation of guidelinesthrough improvements of coverage.With regard to public safety, it’s criticalfor a variety of involvements that there’s a strong engagement with publichealth clinical care and law enforcement and this is important not just for whatlaw enforcement is doing for preventing access to illicit drugs and DEA’s high-pitched intensitydrug trafficking orbits but likewise to use surveillance to see where there’s thegreatest need for interventions and instruct the public safety communityabout opioid help condition being a chronic disease and the importance ofpreventing infection with HIV and hepatitis and other illness frominjection. We can entitle consumers to induce safe alternatives through a treatmentawareness campaign which abuses real-life evidences that we’re using right nowfor people who’ve really kind of suffered through this and have the ability of a first-hand experience to share that can really movepeople to make changes in their lives.And then we too deport surveillanceand research to make sure we’re doing a better activity. This is an unprecedentedpublic health threat both from the overdose feature and the increasinghepatitis and HIV the circumstances and it is essential to do research to be able to make surethat we’re doing a good job and we have programs and then to develop newtechnologies that will help us do a better errand including and ensuring that we have adequate surveillance plans. Next slip please.I just wanted to highlight this that one thing, one issue is where could this begoing on? Where could we be having HIV and hepatitis C and B being transmittedamong people who inject dopes? We “ve thought about” deporting a numerical modelthat would help us learn where there might be provinces that are at particular risk.At the same time Congress also requested state departments to submitinformation to CDC if they thought that they were at risk for or currentlyexperiencing these outbreaks enabled to to use federal funds for syringeservice programs and when we did that we kind of have developed this map.It is acurrent map that shows that 3-4 states and Puerto Rico have areas thatare either at risk for or currently experiencing these increases ininfections or outbreaks. There are probably places in everysingle state where this is a concern and it involves its community andthe regional health departments and the state state agencies to look at theinformation available to then be able to react quickly and to respondeffectively and comprehensively to utter the differences that we need inpreventing new infections. We also…I have a note here that we’re…we soon willbe problem a guide on overseeing HIV and hepatitis C eruptions among people whoinject drugs so that country and regional health bureaux can respond mosteffectively when they see that the need is there. Next slide please.And then lastly it’s important to leveraging existing services, communityhealth centers and HIV and STD programs and clinical assistances exist in allthe states and those planneds can screen and refer beings to substance usetreatment and they too can research and treat for viral hepatitis and HIV.Andthen viral hepatitis the programmes which we support in 46 nations can do enhancedsurveillance in the states that at least have some resources either federally orfrom the states to actually look for where we’re construe acute hepatitis Cand sometimes hepatitis B disputes. They can actually say this is where we need torespond most effectively because it’s an indicator ofthe need for community action. Next slip please.So we think we need…the opioid epidemic is increasing infectiousdiseases. The situation is not inevitable but we really need to think big-hearted and actfast and comprehensive community-wide platforms can prevent these illness, they can reduce drug use and they can save lives and ultimately save money aswell.Thank you. Next move. Thank you, Dr. Mermin. I just want tothank you so much for all of your work on these important issues. Yourleadership there at Core for Disease Control and Prevention is reallycritical as we all work together to respond. So thank you so much. Produced bythe US Department of Health and Human Work at taxpayer expenditure ..
