The CDC released a pair of Morbidity and Mortality Weekly Report (MMWR) articles on hepatitis C virus (HCV) infections in the United States on May 12, including one report(www.cdc.gov) highlighting a sharp spike in these infections -- a near tripling from 2010 to 2015. This article also discussed how states and communities are addressing this issue, which the CDC found was closely tied to injection drug use and the current heroin epidemic.
The other MMWR article(www.cdc.gov) examined how HCV infections are growing among women of childbearing age.
The first MMWR report, titled "State HCV Incidence and Policies Related to HCV Preventive and Treatment Services for Persons Who Inject Drugs -- United States, 2015-2016," said HCV is associated with more deaths in the United States than 60 other infectious diseases reported to the CDC combined. To decrease the skyrocketing rate of HCV infection, the CDC recommended creating and/or strengthening public health laws and policies aimed at reducing transmission among injection drug users.
Furthermore, the agency evaluated factors that affect access people have to HCV preventive and treatment services by looking at state laws that govern access to safe injection equipment and Medicaid policies related to sobriety requirements for approving HCV treatment for injection drug users.
- The CDC released two Morbidity and Mortality Weekly Report (MMWR) articles on May 12 that address hepatitis C virus (HCV) infections in the United States, which nearly tripled from 2010 to 2015.
- One MMWR report discussed how states and their communities are addressing HCV infections, which the CDC said are closely tied to injection drug use and the current heroin epidemic.
- The other MMWR article examined how HCV infections are growing among women of childbearing age.
"By testing, curing and preventing hepatitis C, we can protect generations of Americans from needless suffering and death," said Jonathan Mermin, M.D., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, in a related May 11 press release.(www.cdc.gov)
"We must reach the hardest-hit communities with a range of prevention and treatment services that can diagnose people with hepatitis C and link them to treatment," he added. "This wide range of services can also prevent the misuse of prescription drugs and ultimately stop drug use -- which can also prevent others from getting hepatitis C in the first place."
State-level Support Findings
The CDC found that 18 states had laws that CDC analysts categorized as "least comprehensive" in preventing HCV transmission among injection drug users. Specifically, these states had no laws to
- authorize syringe exchange programs,
- decriminalize possession and distribution of syringes and needles, or
- allow retail sale of syringes without a prescription.
Three states (Maine, Nevada and Utah) had what analysts deemed the "most comprehensive" set of laws related to prevention. Each of these states had laws that authorized syringe exchange without jurisdictional limitations, removed barriers to possessing and distributing syringes and needles through drug paraphernalia laws, and allowed for the retail sale of syringes to people who inject drugs.
Twenty-four states had restrictive Medicaid treatment policies that required some period of sobriety before beneficiaries were able to receive HCV treatment through Medicaid, including 11 of the 18 states that had the least comprehensive prevention laws.
In contrast, 16 states had permissive Medicaid HCV treatment policies that did not require a period of sobriety or only required screening and counseling to receive HCV treatment through Medicaid. Among the 17 states that had a high incidence of HCV infection, five (Massachusetts, New Mexico, North Carolina, Pennsylvania and Washington) had permissive Medicaid treatment policies.
Notably, only three states (Massachusetts, New Mexico and Washington) had both a set of HCV prevention laws categorized as "most comprehensive" or "more comprehensive" and a permissive Medicaid treatment policy that allowed greater access to both preventive and treatment services.
"Medicaid treatment policies with strict sobriety requirements can delay or even prevent access to effective and curative treatment, although access to HCV treatment cures infection, reducing viral transmission and ultimately, incidence, among persons who inject drugs," said the MMWR article.
State Medicaid programs have had budgetary concerns about the costs associated with providing HCV treatment in the past, the report noted. But these costs have declined in recent years, making treatment more cost-effective and beneficial in limiting transmission among injection drug users and, thus, throughout the communities in which they live.
HCV Infection in Women of Childbearing Age
For the second MMWR report, titled "Hepatitis C Virus Infection Among Women Giving Birth -- Tennessee and United States, 2009-2014," CDC researchers used U.S. birth certificate data to analyze trends and geographic variations in rates of HCV infection among women giving birth during 2009-2014. Tennessee birth certificates also were used to examine individual characteristics and outcomes associated with HCV infection.
Data were obtained from the National Vital Statistics System and Tennessee Department of Health vital records. The specific outcome of interest was HCV infection in pregnant women at the time of delivery (maternal HCV infection) as indicated on the infant's birth certificate.
The analysis consisted of two phases:
- The first phase examined rates of maternal HCV infection reported on birth certificates to approximate HCV infection among pregnant women in the United States.
- The second phase used Tennessee vital records data to assess sociodemographic characteristics, gravidity, health behaviors, and other infections during pregnancy that were associated with HCV infection in pregnancy.
During the 2009-2014 period, HCV infection present at the time of delivery among pregnant women from states that report HCV infection on birth certificates nearly doubled -- increasing from 1.8 to 3.4 per 1,000 live births.
West Virginia had the highest infection rate in 2014 (22.6 per 1,000 live births); the rate in Tennessee was 10 per 1,000 live births.
In adjusted analyses of Tennessee births, the HCV infection rate was about three times higher among women in rural counties than those in large urban counties. Additionally, the rate of HCV infection was 4.5-fold higher among women who smoked cigarettes during pregnancy and nearly 17-fold higher among women with concurrent hepatitis B virus infection.
"The increase in maternal HCV infection coincides with the rising heroin and prescription opioid epidemics occurring in the United States that have also disproportionately affected rural and white populations," the report observed.
The MMWR article also noted that although HCV infections have historically been associated with heroin use, a recent outbreak of HIV and HCV infections in rural Indiana demonstrated that such infections can also be transmitted through use of injectable forms of prescription opioids.
"Ensuring that women of childbearing age have access to HCV testing and treatment and consideration of universal screening among women of reproductive age residing in areas with high HCV prevalence might mitigate risk and prevent transmission," the report concluded.
National Viral Hepatitis Action Plan
It should be noted that on Jan. 19, HHS' Office of HIV/AIDS and Infectious Disease Policy released its National Viral Hepatitis Action Plan, 2017-2020,(www.hhs.gov) which sets goals for improving prevention, care and treatment of viral hepatitis and puts the nation on a course to eliminate new hepatitis infections.
The National Academies of Sciences, Engineering and Medicine further bolstered the importance of eliminating hepatitis C as a public health threat by issuing a June 2016 report(www.ncbi.nlm.nih.gov) that stated eradication is feasible if the right steps are taken.
"Stopping hepatitis C will eliminate an enormous disease and economic burden for all Americans," said John Ward, M.D., director of the CDC's Division of Viral Hepatitis, in the May 11 CDC news release. "We have a cure for this disease and the tools to prevent new infections.
"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."
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