ST. GEORGE – Public health agencies and drug treatment centers nationwide are scrambling to battle an explosive increase in cases of hepatitis C, a scourge they believe stems at least in part from a surge in intravenous heroin use.
Locally, rates of new hepatitis C infections are holding steady – there have been 56 confirmed cases of hepatitis C in Southern Utah’s five-county area in 2015, said David Heaton, public information officer for the Southwest Utah Public Health Department.
“So far this is not unusual for our five-county district,” Heaton said in an email to St. George News, “based on the past 5 years.”
Unlike the national trend, the vast majority of local cases are people who contracted hepatitis C years ago, but finally got tested.
“We have seen a notable increase in questions about getting screened for Hep C,” Heaton said, “due to recent awareness campaigns encouraging people born between 1945 and 1965 to get screened. Hepatitis C was unknowingly being spread to high risk groups including IV drug users, dialysis patients, transfusion patients, and healthcare workers.”
“At least 90 percent of all positive hep C cases we track are connected to drug use earlier in life vs. recent use,” Heaton said.
People wanting to get screened should contact their primary care providers or community health clinics, he said.
The health department does not track drug usage because it does not have substance abuse programs, which is typical for local health departments, Heaton said.
Hepatitis C can result in liver failure, liver cancer and other serious complications, is the nation’s most common blood-borne infection. About 3 million Americans are infected, according to federal statistics reported by the Associated Press.
It presents as either acute, or short-term, and chronic, which can last a lifetime. Both forms are most closely linked to needle-sharing, although hepatitis C is less commonly spread through unprotected sex or other contact with infected blood.
Nationwide, the number of cases of acute hepatitis C grew 273 percent from 2009 to 2013, the CDC reported in its most recently available statistics. Tracking similarly is heroin use; the CDC reported that the number of users nationwide rose nearly 150 percent from 2007 to 2013 and that use of the drug also more than doubled among ages 18 to 25 in the decade that ended in 2013.
More than 19,000 people died from hepatitis C in 2013, up from 16,235 in 2009, according to the CDC. Although the agency hasn’t established a causal link between individual hepatitis C outbreaks and injected drug use, it notes that injected drug use is the primary risk factor for hepatitis C infection in the U.S.
Many local health agencies and health care providers have made the connection or are confident there is one, and are allowing users to turn in dirty syringes in exchange for clean ones. But many states disallow the practice and federal funding for it is banned.
The costs of prevention and treatment often fall on public health agencies when many patients don’t have insurance and can’t pay. That can add up fast when just getting a diagnosis can be $19, said Scott Stokes, executive director of the Wisconsin AIDS center.
Some rural regions struggle with drug problems because of poverty, job shortages and the difficulty of providing care in a vast area with few large population centers, said Kenney Miller, executive director of the Downeast AIDS Network.
The virus differs from hepatitis A, which is spread person-to-person or via contaminated food or water, and hepatitis B, which is transmitted by bodily fluids. There are vaccines for hepatitis A and B, unlike hepatitis C, for which there is none.
New treatments are available, but they’re expensive. For instance, Harvoni, the leading drug to treat hepatitis C, costs more than $1,300 per pill.
Even so, the number of prescriptions filled for hepatitis C drugs more than doubled to a monthly average of 48,000 during the early part of 2015.
According to the Centers for Disease Control Control and Prevention, hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants.
People can become infected with the hepatitis C virus during such activities as:
- Sharing needles, syringes, or other equipment to inject drugs
- Needlestick injuries in health care settings
- Being born to a mother who has hepatitis C
Less commonly, a person can also get hepatitis C virus infection through sharing personal care items such as razors or toothbrushes, and having sexual contact with a person infected with the hepatitis C virus.
A few major research studies have not shown hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing.
Body art is becoming increasingly popular in the United States, and unregulated tattooing and piercing are known to occur in prisons and other informal or unregulated settings. Further research is needed to determine if these types of settings and exposures are responsible for hepatitis C virus transmission.
Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
The hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to 3 weeks. It is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.
Who is at risk?
Some people are at increased risk for hepatitis C, according to the CDC, including:
- Current injection drug users (currently the most common way hepatitis C virus is spread in the United States)
- Past injection drug users, including those who injected only one time or many years ago
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
- People who received a blood product for clotting problems made before 1987
- Hemodialysis patients or persons who spent many years on dialysis for kidney failure
- People who received body piercing or tattoos done with non-sterile instruments
- People with known exposures to the hepatitis C virus, such as
- Health care workers injured by needlesticks
- Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
- HIV-infected persons
- Children born to mothers infected with the hepatitis C virus
Associated Press contributed to this story.
- Southwest Utah Public Health Department website
- Southwest Prevention website
- Centers for Disease Control hepatitis C information Web page
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