Hepatitis C and Injection Drug Use Top Targets of CDC Prevention Efforts

In a continuing effort to curb the spread of hepatitis C among the riskiest populations, government health officials recently held a webinar to discuss links between opioid injection drug use and increased cases of the liver disease.

“We absolutely are having an epidemic of hepatitis C infections but it’s concentrated among certain states, not ubiquitous among all the states in the country,” said Jon Zibbell, a medical anthropologist with the US Centers for Disease Control and Prevention’s Division of Viral Hepatitis.

Surveillance summary data released in recent weeks indicate that out of the 41 reporting states in the country, there were 12 that together accounted for roughly 70 percent of the acute hepatitis C cases in 2013. Those states are California, Florida, Indiana, Kentucky, Massachusetts, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, and Tennessee.

Researchers documented a 75% increase in reported cases of acute hepatitis C from 2010 to 2012, according to the CDC. The number of new cases is growing even faster among young people who inject drugs.

Still, many policy makers are unaware that the prescription opioid drug epidemic is fueling new hepatitis C infections. Hepatitis C is a bloodborne virus that can spread among people who inject drugs, not just through sharing tainted needles but also through use of equipment to prepare drugs for injection, according to Zibbell.

Government data shows that opioid sales have increased since the late 1990s, noted Zibbell, as well as accidental opioid related deaths. Over the same time period there has been a rise in hepatitis C infections, indicating that the prevalence of opioid use has been the driver in spread of the disease, he said.

The climb in new cases of thevirus is disproportionately highest among young adults ages 18 to 29. It is a demographic that can challenge prevention efforts among health officials partly because of stigma associated with the virus and drug use, Zibbell said.

As part of a prevention campaign, the CDC has released a fact sheet about hepatitis C and injection drug use, which discusses how the virus is transmitted and notes that the best way to prevent it is to stop using drugs. It also addresses how to reduce risk of getting infection for people who are unwilling or unable to stop injecting drugs.

Many people who inject drugs may be unaware that there are other risks besides sharing a tainted needle. In one study 57% of drug injection users reported sharing needles but 82% reported sharing equipment, Zibbell said.

“This harkens back to what I was talking about that people are still sharing equipment,” he said. “I think this is one of the reasons why needle exchange (programs) has not shown the same reduction in incidence with hepatitis C as it has with HIV. There are numerous reasons for that and I think this is one of them.”

It’s important to talk about “bloody fingers” when it comes to preventing spread of hepatitis C among people who inject drugs, concluded Zibbell. As mentioned in the CDC fact sheet, blood on fingers and hands can contaminate the injection site, cotton, “cookers,” ties and swabs enabling the virus tospread from one person to another.