By: Marcus J. Hopkins, Blogger
We, here at HEAL Blog, attempt to provide coverage of local outbreaks of Viral Hepatitis (VH), as well as to investigate and report them using evidence-based data to accurately characterize the issues at play. What consistently comes to the forefront of Hepatitis C (HCV) infection is the issue of Injection Drug Use (IDU) and the People Who Inject Drugs (PWID). More than any other risk factor, IDU in consistent across Hepatitis A (HAV), Hepatitis B (HBV), and HCV. According to the Centers for Disease Control and Prevention (CDC), in 2015, IDU was reported as a risk factor in 36.1% of all Acute HAV cases, ~34.3% of all Acute HBV cases, and 64.2% of all Acute HCV cases (CDC, 2017).
In the five of the states with the highest rates of HCV – Massachusetts (MA), West Virginia (WV), Kentucky (KY), Tennessee (TN), Maine (ME), and Indiana (IN) – these data are undeniable:
- In MA, 22.8% of Acute HCV infections listed IDU as a risk factor in 2015; for 2012-2015, that number is 61.6% (Massachusetts Department of Public Health, 2017)
- In WV, 43% of Acute HCV infections listed IDU as a risk factor in 2016 (Bureau for Public Health, 2017)
- KY and TN both list IDU as the primary risk fact for infection, though we were unable to find any recent publications by either state giving exact numbers
- In ME, 67% of Acute HCV infections listed IDU as the major risk factor in 2015 (Division of Infectious Disease, 2016)
- In IN, 30% of Acute HCV listed IDU as the risk factor for 2015 (Indiana State Department of Health, n.d.)
And yet, none of these states have amended their HCV screening protocols to include compulsory “Opt-Out” screening in every healthcare setting. This is folly, at best, and dereliction of duty, at worst. If a state’s responsibility is to ensure the health and welfare of its citizens, it is incumbent upon them to take non-extraordinary steps to expand screening protocols. Moreover, they must begin regularly surveilling and reporting, including detailed risk-factor reporting.
If this sounds “revolutionary,” it’s simply not. Given the high rates of infection, mortality, co-morbidities, and the fact that there is a functional cure for the disease, there is simply no excuse for failing to expand testing to include compulsory “Opt-Out” screening for HCV, particularly in states where IDU is high. Is it expensive? Yes. But, again, when it comes to the health and welfare of people, sometimes short-term expenditures outweigh long-term costs of care. This is why there are grants; this is why people pay taxes.
Some of the most successful screening efforts are being conducted not in traditional healthcare settings, but at Syringe Services Programs (SSPs), which remain controversial among those who say that they promote and encourage drug use. These services are, however, vital to stemming the spread of disease. Perhaps the least successful screening efforts are conducted in incarceration settings, despite having essentially a captive demographic. These efforts are hampered, again, by cost concerns, as, if the results come back “Positive,” they are required by law to treat.
While expanding screening may be initially costly, it is the best way for us to go about eliminating HCV in the U.S.
- Bureau for Public Health. (2017, August 16). WEST VIRGINIA Viral Hepatitis Epidemiologic Profile 2017. Charleston, WV: West Virginia Department of Health and Human Resources: Bureau for Public Health. Retrieved from: http://www.dhhr.wv.gov/oeps/disease/ob/documents/viral-hep-profile-2017.pdf
- Centers for Disease Control and Prevention. (2017, June 19). Viral Hepatitis Surveillance – United States, 2015. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: https://www.cdc.gov/hepatitis/statistics/2015surveillance/pdfs/2015HepSurveillanceRpt.pdf
- Division of Infectious Disease. (2016, May 23). Infectious Disease Epidemiology Report –Hepatitis C in Maine, 2015. Augusta, ME: Maine Department of Health and Human Services: Maine Center for Disease Control and Prevention: Division of Infectious Disease: Infectious Disease Epidemiology Program: Hepatitis. Retrieved from: http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/hepatitis/documents/2015-HCV-SurvReport.pdf
- Indiana State Department of Health. (n.d.). Indiana Hepatitis C Epidemiologic Profile 2015. Indianapolis, IN: Indiana State Department of Health: Public Health Protection and Laboratory Services: Epidemiology Resource Center: Infectious Disease Epidemiology: Diseases and Conditions Resource Page: Hepatitis C. Retrieved from: http://www.in.gov/isdh/files/2015 Hepatitis Epidemiologic Profile FINAL.pdf
- Massachusetts Department of Public Health. (2017, January). Hepatitis C Virus (HCV) Infection – Data Summary 2007-2015. Boston, MA: Massachusetts Department of Public Health: Bureau of Infectious Disease: Division of Epidemiology and Immunization. Retrieved from: http://www.mass.gov/eohhs/docs/dph/cdc/reporting/surveillance-report-hepatitis-c.pdf
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.