Hepatitis C Epidemic, Associated with Intravenous Drug Use, in Appalachian States

An increase in the abuse of injectable drugs has caused rates of hepatitis C virus (HCV) infection to more than triple in 4 Appalachian states, according to a report from the Centers for Disease Control and Prevention.

The rates were highest among people under age 30 in rural areas of Kentucky, Tennessee, Virginia, and West Virginia, according to the report from Jon E. Zibbell et al.

Zibbell et al analyzed surveillance data on reports of acute cases of hepatitis C along with drug treatment admissions data from for persons in these states.

From 2006 through 2012, they observed a 364% increases in cases of acute HCV infection among persons in urban and nonurban areas of the 4 states, with a substantially higher incidence observed each year among persons residing in nonurban areas.

Among cases with identified risk information, intravenous drug use was most commonly reported (73%).

DrugUse_CDC

During the same period, the proportion of treatment admissions for opioid dependency increased 21.1% in the 4 states (see figure), with a significant increase in the proportion of persons admitted who identified injecting as their main route of drug administration (an increase of 12.6%).

The authors propose a geographic intersection among opioid abuse, drug injecting, and HCV infection in central Appalachia.

The increase in heroin use in the Appalachian states is consistent with national estimates of an increase in first-time heroin use, from 90,000 people in 2006 to 156,000 people in 2012, wrote CNN.

According to CNN, about 44.8% of the 1377 new cases of HCV infection in Appalachia occurred in people under 30. Over the same time period, there were large increases in the number of adolescents and young adults admitted to substance abuse treatment for opioid dependency.

Although approximately 2.7 million persons in the US have chronic HCV infection, infection has most prevalent among people born from 1945 through 1965. The outbreak among persons in this younger age group has therefore caused concern among public health officials.

Zibbell et al say there is a great need for integrated health services in substance abuse treatment settings to prevent HCV infection and ensure that infected individuals receive medical care.

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