Thursday, October 19, 2017

Hepatitis C outbreaks related to opioid crisis

Christine Teague screens a patient for hepatitis C in Spencer, W.Va.
(Washington Post photo by Philip Andrews)
Health providers all over the country are seeing a rise in health problems triggered by the opioid epidemic, including increases in hepatitis B, sexually transmitted diseases like syphilis and gonorrhea, an infection of the heart called endocarditis, more emergency room visits for abcesses, hospitalizations for soft-tissue infections, and small increases in HIV. Some of those are direct consequences of needle injection, and some are "consequences of impaired judgment," says West Virginia Public Health Commissioner Rahul Gupta.

But perhaps most troubling of all is an outbreak of hepatitis C, spread by heroin users sharing needles. Though hepatitis C is spiking in urban drug users, many of the newly infected live in rural and suburban areas. Diagnosed new cases of the liver disease have almost tripled in the past few years, from 853 in 2010 to 2,436 in 2015, according to the Centers for Disease Control and Prevention. Hepatitis C can be asymptomatic, so tens of thousands more probably have it and don't know it, Katie Zezima reports for The Washington Post.

West Virginia has been particularly hard-hit. It has the country's highest rate of opioid overdose deaths, and new hepatitis B and C infections. The state's numbers are so high, Gupta believes, because health officials are aggressive in identifying new cases, expanding testing at the states' syringe exchanges, jails and prisons.

"Because a treatment that cures the disease costs tens of thousands of dollars, is limited by insurance and Medicaid, and is mostly unavailable to people who are still using illicit drugs, there probably will be financial and public health ramifications for decades to come," Zezima reports.

Judith Feinberg, a professor of behavioral medicine and psychiatry at the West Virginia University School of Medicine, told Zezima: "If we don’t cure a significant number of the people who are injecting, in 20 years from now, the hospitals in this part of the world will be flooded with these people with end-stage liver disease, which has no cure."

Officials are also worried that infected pregnant women may be unknowingly spreading the disease to their babies, since hepatitis C is not a routine test administered to pregnant women. "The prevalence of hepatitis C among women who gave birth from 2009 to 2014 increased 89 percent, according to a study by Vanderbilt University and the Tennessee Department of Health. West Virginia has the highest rate of births to infected mothers, with 22.6 per 1,000 live births. The disease can be passed to an infant during birth, and about 6 percent of babies born to infected mothers contract the disease," Zezima reports. There is no treatment for the disease during pregnancy, and children can't be tested for hepatitis C until they're 18 months old.

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