Tag Archives: HAV

2017 Year in Review

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As it tradition for HEAL Blog, the final post for 2017 will be a look back at the topics we’ve covered over the year and a look forward to the future.

2017 Year End, Turning into 2018

Photo Source: AGH University

HEAL Blog releases 50 posts a year (including this post), and those posts fell within one of five categories: Hepatitis Increases, Incarceration, HCV Drug Discussions, Opioids, and Other. Posts related to Hepatitis Increases focused primarily on reports of increased infection/morbidity rates in various states and population, including Hepatitis A, B, and C. Those related to Incarceration focused primarily on increased infection rates and treatment within incarceration settings (prisons, jail, and juvenile detention centers). Posts related to HCV Drug Discussions focused on pricing, availability, and treatment outcomes. Opioid-related posts focused on the toll of the opioid epidemic in the U.S. and the role they play in increasing rates of infection for HIV and Viral Hepatitis (VH). Posts that fell outside of those specific topics are categorized as “Other.” The distribution of those posts are as follows.

  • Hepatitis Increases – 17
  • Incarceration – 4
  • HCV Drug Discussions – 15
  • Opioids – 9
  • Other – 4

As the incidence of Viral Hepatitis infections continues to rise, there are specific patterns – most of the highest rates exists in states that are primarily rural or suburban (with few densely populated metropolitan areas); new Acute Hepatitis C (HCV) diagnoses tend to be in younger populations (ages 18-45) and are increasingly linked to Injection Drug Use (IDU) as the primary risk factor for infection within this age demographic. Prescription opioid abuse and heroin are playing an increasing role in the spread of HCV, not only in America, but across the globe. In the U.S., many of the rural states where HCV rates are exploding are racially and ethnically homogenous (read: primarily Caucasian/White). Despite this, even in states with low numbers of racial and ethnic minorities, African-Americans are disproportionately impacted by HCV infections as a percentage of the population – despite being fewer in number, the percentage of African-Americans infected is higher than other racial and ethnic groups.

In addition to HCV-related infection increases, homeless and indigent populations are facing vast increases in Hepatitis A (HAV) infections, particularly in metropolitan areas where homeless encampments are more densely packed and infections are more easily spread. Arizona, California, and Minnesota have all experienced high rates of HAV within their respective homeless populations, with California facing the highest rates of both morbidity and mortality. California’s HAV crisis is also quickly spreading along the coastline, heading northward. HEAL Blog will continue to monitor the situation.

As for the forecast into 2018…it’s not looking good for the U.S. With the installation of the Trump Administration’s various secretaries and their approach to management and governance, both healthcare advocates and institutional healthcare presences are considerably concerned with the path being laid before us. In addition to concerns about the appointments being made by the Trump Administration (of which there are many concerns, and far fewer appointments), the Legislative Branch’s stewardship under Republican majority in both houses has proven both hostile to the healthcare concerns of Americans, and incredibly clumsy in their attempts to address virtually any issue put before them. Both the Executive and Legislative Branches have inspired little confidence that anyone – healthy or otherwise – are going to come away from their agendas unscathed.

Both branches have, in 2017, created an environment of legislative and administrational chaos and uncertainty, both of which are reflected in the higher increases in health insurance premiums offers on the Affordable Care Act’s (ACA) insurance marketplaces. Between shortened enrollment periods and all-but-eliminated advertising and outreach budgets, enrollment is expected to fall short of its goals for insuring Americans in 2018. Moreover, this type of chaos, unreliability, and unpredictability tend to breed contempt, which may result in Republicans losing their majority in one or both houses during the 2018 midterm elections.

Of significant concern is the Republican Senate’s approach to bill crafting, which has largely been conducted in secret, without input from Democratic lawmakers, and is heavily influenced by the very special interest groups against which many of these politicians campaigned. After failing twice to repeal the ACA in 2017 despite having a majority in both houses, Senate Republicans have repeatedly attempted to cripple the law through various means, the most recent of which involved slipping into their “Tax Reform” bill an effort to repeal the individual mandate provision that requires virtually every American to purchase some sort of qualifying health insurance plan in an effort to stabilize costs once sicker clients entered the market.

In the Administrative Branch, the heads of the various Departments nominated by President Trump have done little to inspire confidence, as well. Tom Price, who was Trump’s initial pick for the Department of Health and Human Services, was forced to resign after reports indicated that he racked up $400,000 in privately chartered flights for personal and professional reasons. This was a significant departure, as previous heads took commercial flights, save for rare exceptions. Now that Price is out of the way, Trump has nominated Alex Azar, a former pharmaceutical company executive whose tenure at Eli Lilly saw a three-fold increase in the cost of the insulin over a ten-year period. Needless to say, it is less than certain that a person who oversaw such price increases will be the “…star for better healthcare and lower drug prices,” as President Trump stated in his tweet announcing his pick for the position.

Given the chaotic and unsteady stewardship of the country, it is hard to express any optimism going forward unless circumstances change dramatically.

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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.

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Increase in HCV Cases Calls for Updated Screening Protocols

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
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).

Hepatitis Screening

Photo Source: JAMA

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:

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.

References

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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.

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Hepatitis A Outbreak Expands Throughout Southern California

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In mid-September 2017, HEAL Blog wrote about the extreme measures taken by San Diego County and city to combat a severe outbreak of Hepatitis A (HAV) among the county’s homeless, indigent, and illicit drug user populations (Hopkins, 2017). At that time, the HAV outbreak consisted of 421 confirmed cases, 292 hospitalizations, and 16 deaths. That initial outbreak, which began in November 2016, has continued to grow with 481 confirmed cases, 337 hospitalizations, and 17 deaths (Sisson, 2017). The outbreak is also spreading.

Both Santa Cruz and Los Angeles Counties have begun seeing outbreaks of HAV related to the initial outbreak in San Diego County, with 68 confirmed cases in Santa Cruz County (Health Services Agency, 2017) and 12 confirmed cases in Los Angeles County, 9 of which required hospitalization (Acute Communicable Disease Control, 2017). These cases do not include all of the reported HAV cases; only those connected to the San Diego outbreak. These cases are primary among the same populations in these counties as they were in San Diego County – homeless, indigent, and illicit drug users.

Hepatitis A Facts

Photo Source: MedChitChat.com

According to Kaiser Health News writer, Stephanie O’Neill, poor access to restrooms and sinks in homeless encampments is largely to blame for these outbreaks (O’Neill, 2017). San Diego County responded to their outbreak by installing 40 portable hand-washing stations throughout the downtown areas hardest hit by the outbreak, leaving public restrooms open overnight, and power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution in an effort to stop the spread of the virus (O’Neill).

Southern California’s HAV outbreak is being described as “unprecedented” and “the largest outbreak in the U.S. that is not related to a contaminated food product” since the U.S. first introduced a vaccine for hepatitis A in 1995 (O’Neill). This trend is unlikely to be restricted to Southern California. According to the National Law Center on Homelessness and Poverty (NLCHP), “Despite a lack of affordable housing and shelter space, many cities have chosen to criminally or civilly punish people living on the street for doing what any human being must do to survive” (NLCHP, n.d.). Additionally, the NLCHP notes that, since 2006, bans on camping city-wide have increased by 69%, bans on sleeping in public have increased by 31%, bans on sitting or lying down in public have increased 52%, bans on loitering, loafing, and vagrancy have increased 88%, and bans on living in vehicles have increased 143% (NLCHP). Furthermore, most cities in the U.S. close public restrooms at dusk, leaving homeless people with nowhere to relieve themselves.

While the intention of these bans is to move cities’ homeless populations out of the line of sight and create “safer” public spaces for homed populations, the real-life effect has resulted in creating conditions ripe for the spread of diseases like HAV. People who lack access to restroom and handwashing facilities are forced to relieve themselves in the open, creating biohazardous waste and fostering the spread of HAV to potentially anyone who comes in contact with their refuse.

It is also likely that, as more cities are hit with HAV outbreaks related to homelessness and illicit drug use, responses will vary between highly effective public health responses like those put in place by San Diego County, and highly ineffective criminalization responses that end up creating worse circumstances than they purport to fix.

References:

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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.

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Hepatitis A: Extreme Sanitation Measures in San Diego

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As a blog designed to talk about issues related to Viral Hepatitis and HIV, we do our best to stay focused on the topic of Hepatitis C (HCV). Recent developments in San Diego, CA, however, have captured our attention and merit coverage and discussion.

Since early 2017, the Public Health Services Division (PHSD) in the San Diego Health and Human Services Agency (HHSA) has been investigating a significant outbreak of the Hepatitis A (HAV) virus. As of September 12, 2017, there have been 421 confirmed cases of Acute HAV which have resulted in 292 hospitalizations (69%) and 16 deaths (3.8%). The majority of these cases have been within San Diego’s homeless and/or illicit drug user populations, although some cases have been neither (HHSA, 2017).

Hepatitis A Outbreak Spreads Beyond Homeless in San Diego

Photo Source: San Diego Informer

HAV is spread primarily by ingesting the virus by way of contact with objects, food, or drinks contaminated by feces or stool from an infected person, and the symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and/or jaundice (yellowing of the skin or eyes). Moreover, HAV is very hardy and is able to live outside the human body for months, making it particularly easy to spread (CDC, 2016).

In response to this outbreak, San Diego has taken the unusually proactive step of implementing extreme health measures in order to combat the spread of HAV including the installation of 40 handwashing stations in areas with high concentrations of homeless people, sanitization efforts in those areas, holding 256 mass vaccination events and 109 “foot teams” of public health nurses who go into the aforementioned areas to offer vaccinations, distributing over 2,400 hygiene kits that include water, non-alcohol hand sanitizer, cleaning wipes, clinic location information, and plastic bags, and implementing street cleaning protocols that require sanitation department workers to power-wash streets and buildings with chlorine and bleach (Bever, 2017).

While these measures may seem extreme, the reality of combating an HAV outbreak once it’s already taken hold means that extraordinary steps must be taken. Despite the availability of HAV vaccinations since 1995, much of the homeless and indigent population either lack access to those healthcare resources, or are too old to have been vaccinated as children. During the mass vaccination events, county health officials have vaccinated 19,000 people, including 7,300 considered to be at-risk of contracting the disease (Warth, 2017). Additionally, the city has agreed to extend public toilet hours to 24/7 in order to allow homeless people access to the restrooms, rather than defecate in the open, whether others may come in contact (Montes, 2017).

While these proactive measures will certainly help to combat the spread, the most important step will be reaching, vaccinating, and educating hard-to-reach/hard-to-treat homeless, indigent, and/or illicit drug user populations in an effort to effect behavioral changes in order to prevent further spread of the disease. This means teaching proper handwashing techniques, proper hygiene, and proper sterilization of equipment used to partake in illicit drug use. San Diego, despite the dire circumstances it currently endures, is taking the right steps to ensure safer streets for their homeless population.

References:

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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.

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