Story highlights
- 2,436 new hepatitis C infections were reported in 2015 but CDC estimates it's really about 34,000
- Hepatitis C infections among pregnant women increased 89% from 2009 through 2014, study says
(CNN)New hepatitis C virus infections in the United States nearly tripled
between the years 2010 and 2015.
The number of new nationally reported infections with the virus swelled from
850 in 2010 to 2,436 cases in 2015, with the highest rates among young
people, mainly 20- to 29-year-olds, who inject drugs, according to a new
report released Thursday by the Centers for Disease Control and Prevention.
However, the CDC estimates the true number is much higher-- about 34,000
new infections nationally for 2015 -- since hepatitis C has few symptoms and
most newly infected people do not get diagnosed.
An estimated 3.5 million people, mainly baby boomers, in the United States
currently have an infection with hepatitis C, which damages the liver. Symptoms
can include fever, abdominal pain, loss of appetite, nausea, vomiting, joint pain
and jaundice. Last year, the agency reported a record number of fatalities from
the virus occurred in 2014.
"Recent CDC research has identified increasing injection drug use -- tied to the
US opioid epidemic -- in rural and suburban areas across the country," said
Dr. John Ward, an author of the new report and director of the division of viral
hepatitis at the CDC.
He said hardest hit areas in terms of
new infections are parts of Appalachia and rural areas of the Midwest and
New England. Rural areas in other states are also experiencing a similar,
though smaller rise in new hepatitis C cases.
Seven states -- Indiana, Kentucky, Maine, Massachusetts, New Mexico,
Tennessee and West Virginia -- have rates at least twice the national average
, CDC researchers found. In addition, 10 states have rates above the national
average: Alabama, Montana, New Jersey, North Carolina, Ohio, Oklahoma,
Pennsylvania, Utah, Washington and Wisconsin.
"These new infections are most frequently among young people who transition
from taking prescription pills to injecting heroin, which has become cheaper
and more easily available in some cases," said Ward. "In turn many -- most, in
some communities -- people who inject drugs become infected with hepatitis
C."
Hepatitis C, a blood-borne virus, has primarily been transmitted from person to
person via shared needles since the early 1990s, when donated blood
screening and other precautions were put into place to prevent health care
related spread, said Ward.
"Much less frequently, hepatitis C is also transmitted through sexual contact
or during pregnancy between a mother and baby," Ward said.
There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by
avoiding behaviors that can spread the disease, especially injecting drugs,
Ward and his colleagues believe states can reduce the number of people
risking a hepatitis C infection by adopting laws and policies that would increase
access for IV drug users to services intended to prevent and treat the
infection.
For the new report, then, Ward and his colleagues assessed state laws and
Medicaid policies that impact IV drug users.
To decide whether a state had comprehensive needle laws, the CDC explored
five questions: Did the state explicitly authorize a needle exchange program?
Did the state exempt syringes from the definition of drug paraphernalia? Did
the state decriminalize possession and distribution of needles for participants
of needle exchange programs? Did the state permit a person to disclose
possession of a needle to an arresting officer to avoid criminal prosecution?
Finally, did the state allow the sale of needles, without prescriptions, to injected
drug users?
With regard to Medicaid, the researchers looked at whether a state imposed
sobriety requirements on drug users before approving treatment for an
infection. Permissive Medicaid treatment policies, as defined by the CDC,
would mean states either do not require a period of being sober or only
require screening and counseling for a person to receive treatment.
The CDC found three states -- Massachusetts, New Mexico, and Washington
-- with both comprehensive laws and permissive Medicaid policies capable
f improving access to preventive and treatment services for injected drug
users. All three states, Massachusetts, New Mexico, and Washington, are
among those with the highest rates of new infections.
"Even though certain states may have the most comprehensive policies
providing access to [syringe service programs], they still may experience
steep increases in cases," said Ward, adding that some states changed their
policies only recently to address increasing rates.
This appears to be the case with five states: Massachusetts, New Mexico,
North Carolina, Pennsylvania, and Washington. Though they have adopted
permissive Medicaid treatment policies, they still rank among the 17 states
with highest rates of new hepatitis C virus infections.
"The rise in hepatitis C among women of reproductive age and pregnant
women parallels this opioid epidemic," said Ward. "And as hepatitis C has
increased among young women, the newest generation of Americans are
now at risk."
Hepatitis C transmission to infants
Between 2009 and 2014, rates of hepatitis C virus infection among US women
giving birth doubled, according to a second CDC study published Thursday.
"In 2014, 35 infants a day were exposed to the virus," said Dr. Stephen W.
Patrick, author of the study and assistant professor of pediatrics and health
policy at Vanderbilt University School of Medicine. He explained the risk of
transmission from mother to infant is estimated to be just about 6%, but
research suggests follow-up on infants is poor.
"My worry is that some infants will convert to having hepatitis C without anyone
knowing, or treating the infant," said Patrick.
For their study, he and his colleagues used birth certificate and hospital billing
data to analyze trends in the rates of hepatitis C infection among women giving
birth during the years 2009 through 2014.
Hepatitis C infections present when pregnant women delivered their babies
increased 89% during the study period -- from 1.8 to 3.4 per 1,000 live births.
In 2014, the highest infection rate -- 22.6 per 1,000 live births -- was in West
Virginia, while Tennessee had 10.1 per 1,000.
"Our study found substantially higher rates of HCV among pregnant women in
rural and Appalachian counties in Tennessee," said Patrick.
Diving deeper, Patrick and his colleagues examined individual features
associated with hepatitis C infection in Tennessee.
They found the odds of an infection were about three times higher among
women residing in rural counties than among women in large urban counties,
4.5-times higher among women who smoked cigarettes during pregnancy
, and nearly 17-times higher among women with concurrent hepatitis B virus
infection.
The study was not designed to determine the exact cause of the increase in
hepatitis C among pregnant women or why it has disproportionately impacted rural areas, explained Patrick.
"We suspect it is linked to the ongoing opioid epidemic in the US," said Patrick,
explaining his team previously found a 5-fold increase in infants having opioid
withdrawal after birth with newborn opioid withdrawal occurring at higher rates
in rural areas.
"As the opioid epidemic has continued to evolve, there has been an uptick in
heroin and now fentanyl-related complications," said Patrick. "Heroin is
generally injected and this comes with a risk of HCV and HIV."
Stemming the tide
Dr. Raymond Chung, a member of the committee of the American Association
for the Study of Liver Diseases that provides hepatitis C treatment guidance
to doctors, said there are several impediments to treating the drug-using
population.
First, it's simply difficult to identify and then treat people who inject drugs, said Chung, who did not participate in the CDC research.
"All too often these persons have fragmentary or fleeting interactions with health
care and never do quite make it back to have diagnosis either made or
confirmed and more import, to have a care plan outlined," said Chung.
Second, there's a lack of accessibility to the treatments themselves due to
limitations on reimbursement of payment for medications to treat the virus.
While Medicaid-based payors are frequently footing the bill for IV drug users, reimbursement restrictions vary within states and between states. "So the
ability to access those medications is highly variable," said Chung.
Currently there are a number of FDA-approved regimens "and the beauty is
that these regimens are now virtually uniformly successful" in bringing about
a cure of the infection, said Chung.
When they first appeared on the market, these treatments made headlines and
garnered criticism for their high price tags. Today, the price of these treatments
generally range from about $60,000 to $90,000 for a standard 12-week course
of treatment. However, Chung says deals and different arrangements between
the pharmaceutical drug providers and payors have been made considerably
reducing the cost.
With treatment for hepatitis C, there must also be counseling to get these
patients into care for their addiction to avoid an "exercise in futility" by treating
only "a consequence of the substance use disorder." according to Chung.
Coordinated effort is needed to get patients plugged into care so they beat
their addictions and avoid becoming reinfected with hepatitis C.
Yet there have been several studies performed on rates of reinfection among
IV drug users and they range from about 10% to 20%, said Chung. The results
are not yet "water-tight," said Chung, but reinfection rates can be viewed from
another angle: "Success can be had -- and durable success can be had -- in
most of these patients."
cnn.com
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