The incidence of Hepatitis C has tripled in the past five years, with millennials making up the fastest growing group of those infected, health officials say.
And about half of those infected may not even know they have the potentially fatal disease.
Up to 3.9 million people have Hepatitis C, or HCV, according to the U.S. Centers for Disease Control and Prevention. There were about 34,000 new infections in 2015, with the number reaching a 15-year high in five years.
In South Carolina, the number of chronic HCV cases grew from 3,258 in 2011 to 4,668 in 2015, with the rate increasing from 70.4 per 100,000 population to 97.8, according to the state Department of Health and Environmental Control.
While three quarters of sufferers are baby boomers, new infections are increasing fastest among those 20 to 29, CDC reports.
The numbers are up across all age groups in South Carolina, but nearly doubled from 280 to 542 among those 18 to 29 between 2011 and 2015, according to DHEC.
“Historically, most at risk are the baby boomers,” said Dr. Robert Johnson, a Bon Secours physician at Powdersville family practice.
“But millennials are now the fastest growing age group.”
The spike is largely a result of IV drug use stemming from the opioid epidemic, with users engaging in high-risk behaviors like sharing needles, said Dr. Melissa Overman, assistant state epidemiologist with DHEC.
“This is spread by blood-to-blood contact,” she said. “A needle in one vein then going to another vein is a high-risk exposure route.”
Every day in the U.S., more than 650,000 opioid prescriptions are dispensed, 3,900 people begin abusing prescription opioids, 580 people start to use heroin, and 78 people die from an opioid-related overdose, the CDC reports.
And about a third of IV drug users between 18 and 30 are infected with HCV, a blood-borne virus that causes an infection of the liver, according to the agency.
Symptoms include fever, fatigue, dark urine, abdominal pain, nausea, vomiting and jaundice, according to CDC. But only about a quarter of those infected have symptoms.
Infection can lead to chronic and long-term health problems, including cirrhosis and cancer. And it kills more Americans than any other infectious disease — nearly 20,000 people in 2015, CDC said.
Most infections result from exposure to infected blood by drug users sharing needles or other drug paraphernalia, the agency reports.
Less commonly, it can be transmitted through blood transfusions, needle sticks in the health care setting, birth to an infected mother, sex with an infected person, exposure to contaminated health care equipment, and sharing contaminated personal items such as razors or toothbrushes, according to CDC.
At least three quarters of those infected go on to develop the chronic form of the disease, which progresses slowly without symptoms over several decades, CDC reports. As many as 3.9 million Americans have chronic HCV.
“Acute hepatitis will either resolve on its own or it will turn into chronic Hepatitis C,” said Overman, “And our chronic numbers are going up.”
'A big challenge'
Dr. John Ward, director of CDC’s Division of Viral Hepatitis, said stopping the spread of HCV will reduce a huge disease and economic burden for the country.
“We have a cure for this disease and the tools to prevent new infections,” he said. “Now we need a substantial, focused and concerted national effort to implement the National Viral Hepatitis Action Plan and make effective prevention tools and curative treatment available to Americans in need.”
Tackling HCV is a big challenge for public health, said Tony Price, prevention program manager for DHEC’s STD/HIV Division.
Tony Price (Photo: SC DHEC)
Using federal funds, South Carolina has prevention programs aimed at millennials through the state Department of Alcohol and Other Drug Abuse Services, for instance providing naloxone to counteract overdoses, he said. That can also lead to counseling, support and treatment, he said.
The state also got federal funding last November for HCV education and awareness, but it pays for less than two staffers and supports no testing, Price said. DHEC is also planning grants to community-based prevention programs that have access to at-risk communities, he said.
“This population is not always involved in health care systems,” he said. “They need extra support.”
CDC funds also are passed through to federally-qualified health centers like New Horizon Family Health Services in Greenville to increase HCV testing, he said.
Screening is recommended for baby boomers and IV drug users. Without being tested, infected people can spread HCV their entire adult lives, Johnson said.
Testing and treatment
To fight the opioid epidemic, U.S. Department of Health and Human Services strategies include improved access to treatment, recovery, and overdose-reversing drugs; support for pain and addiction research; better pain management; and comprehensive syringe service programs that can help prevent hepatitis and other injection-related infectious diseases.
South Carolina has no needle exchange programs, Price said. And Johnson said that while they decrease the rate of transmission, they don’t curb drug use.
“You need to go to the root of the problem, which is why people are using drugs,” he said. “And that’s a whole philosophical debate.”
Federal health officials say syringe service programs can help link people to treatment, testing and medical care.
HHS also touts programs that help those infected get treatment. New HCV treatments have nearly a total cure rate, Johnson said.
“When I was in training, cure rates were less than 50 percent. It was a yearlong therapy and half the patients couldn’t tolerate it,” he said. “Now we’re looking at 98 percent cure, or long-term sustained remission.”
But the drugs cost $80,000 to $100,000.
South Carolina has no program to provide those medications to those who can't afford them, Price said. More federal support is needed here and around the country, he added, to develop a comprehensive approach to reducing HCV.