Hepatitis C Prevalent in Prison Population, but Numbers Are Declining

Nearly one-third of the population in the US who have hepatitis C are people who are incarcerated; however, prevalence of the disease among this group has dipped in recent years, according to a survey study conducted at Emory University.

A similar decline of people with hepatitis C virus (HCV) has been reported among the nation’s general population. Results from a national survey indicated that an estimated 2.7 million people in the US are chronically infected with HCV, a drop from 3.2 million in 2002. That survey excluded people who were incarcerated or homeless, two populations said to be at high risk for the disease, according to the Centers for Disease Control and Prevention.

Hepatitis C is a blood borne virus that can lead to cirrhosis and cancer of the liver but symptoms often don’t appear for years until the virus has severely damaged the liver. Today, the virus is spread from one person to another mostly by sharing needles or other drug injection materials.

The CDC recommends screening for baby boomers because they may have the virus and not know it. Before 1992, the nation’s blood supply was not widely screened for HCV, which was commonly spread through blood transfusions and organ transplants.

Nationally, an estimated 17.4 percent of all prisoners have been exposed to the virus, according to Anne Spaulding, MD, lead researcher for the study conducted at Emory’s Rollins School of Public Health and published in the March-April issue of Public Health Reports. That number is down from a decade ago when researchers estimated that 25 percent of prisoners had the virus.

Spaulding’s research team investigated routine HCV surveillance conducted in state prison systems in order to update previous national estimates. They surveyed all U.S. state correctional departments to determine which state prison systems had performed routine HCV screening since 2001.

Among 12 states that performed routine screening from 2001 to 2012, seroprevalences of HCV ranged from 9.6 percent to 41.1 percent. Researchers looked at data midpoint of the 11-year span and estimated that correctional populations represented 28.5 percent to 32.8 percent of the total US hepatitis C cases in 2006, down from 39 percent in 2003. States involved in the screening were Indiana, Iowa, Maryland, Michigan, Montana, Nebraska, New Mexico, New York, North Dakota, Oregon, Pennsylvania, and Washington.

A portion of the decline may be attributed to deaths of some who had the disease as well as the aging of the birth cohort, Spaulding said. While baby boomers born from 1945 to 1965 are at higher risk for HCV they are also less likely to land in jail than their younger counterparts.

“As people get older they tend not to get into problems with the law as much,” Spaulding said. “Baby boomers are in their 40s, 50s and 60s, they’re not getting into new problems with the law… they’re less likely to be going back and forth to jail.”

Spaulding and her colleagues determined that out of approximately 4.5 million persons in the U.S. with ongoing Hepatitis C disease, there are 1.4 million who are jailed or in prison at some point over a given year. Her total US population estimate is higher than the CDC because hers includes people who are in prison, homeless or have marginal housing. The CDC surveys persons living in households.

"These findings are very significant at this time due to the conversation about the new hepatitis C drugs on the market," Spaulding said in a statement about the study. "Although the new drugs cost up to $1,000 a pill, and each course of treatment will be about $100,000 per person, they are much more effective than previous regimens -- some regimens cure over 90 percent of patients. If the number of persons needing treatment is lower than previously thought, undertaking treatment is less daunting.”