Three times as many Iowans were diagnosed with the hepatitis C liver infection in 2015 than in 2000, according to a report from the Iowa Department of Public Health. The disease is the leading cause of liver cancer and liver transplants in the U.S., data from the Centers for Disease Control and Prevention (CDC) shows.
The number of cases of hepatitis C infection in Iowa increased from 754 cases in 2000 to 2,235 cases in 2015, according to the department’s report. Preliminary 2016 data also shows a slight increase, with roughly 2,400 cases reported. Officials suspect that many more people may have the disease, but don’t know it because they have not been tested.
This is the first report to look at incidences of hepatitis C in the state. Randy Mayer, chief of the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis, attributed that fact, in part, to the availability of treatment options and a recently-available grant from the Association of State and Territorial Health Officials.
“What’s changed in the past few years is that there are very effective treatments — albeit very expensive, but the price is coming down,” Mayer said. “So there’s a better opportunity to actually make a difference and ensure that people don’t continue to transmit.”
Unlike hepatitis A and B, hepatitis C has no vaccine. Doctors do not quite understand how, but for about 15 to 25 percent of those with the virus, their immune systems are able to clear it.
Most Iowans with the disease, 63 percent, were between the ages of 45 and 64. However, the report showed a marked increase in diagnoses among those aged 18 to 30, with the number of diagnoses in the age group quadrupling since 2009. Mayer said increased opioid use has contributed to the hepatitis C uptick in the age group.
“This was the first time that we were able to pull our data together, but we have been watching reports from other states,” Mayer said. “That’s why we were looking at the under-30 age group. A lot of the Appalachian states, and other states with opioid epidemics, have seen an increase in hepatitis C.”
He pointed to an instance in Scott County, Indiana, where a jump in reported hepatitis C cases preceded an HIV outbreak. The instance led health officials to push for surveillance programs that track both HIV and hepatitis C. At least 15 states still don’t track hepatitis C cases, Mayer said.
Mayer said the increase in hepatitis C cases was expected and would likely continue as more people get tested.
In total, the report showed 21,748 Iowans were diagnosed with the disease as of Dec. 31, 2015. Because of the high percentage of cases that go undiagnosed, the report estimates the true number of Iowans with hepatitis C might be anywhere from 36,000 to 137,000.
Although hepatitis C can lead to chronic liver disease, cirrhosis of the liver and increased risk of liver cancer, many individuals with hepatitis C may not experience symptoms until the disease progresses farther and has caused severe liver damage, Mayer said. About one-quarter of liver transplants in Iowa between 2000 and 2015 were hepatitis C-related, the report showed, and hospitalizations related to the disease have increased since 2000.
The National Academy of Medicine is expected to release a report in March outlining a national strategy for eliminating hepatitis B and C. The report follows another report last spring that examined whether the goal of eliminating the the viruses was feasible.
“The answer to that was: Yes,” Mayer, who is on the committee releasing the report, said. “We feel like we have the tools. For hepatitis B we have a good vaccine; for hepatitis C it’s really the treatment and getting people who are currently using drugs and people who formerly used drugs into testing.”
In addition to awareness efforts and maintaining surveillance programs to track cases of hepatitis C, some activists have pushed for syringe and needle exchange programs — with a bill in the Iowa House and Senate this session that would support needle exchange programs.
Mayer said a needle exchange would be less effective for preventing hepatitis C than for preventing HIV, because the hepatitis C virus is more contagious. However, he said it would still be worthwhile.
“What syringe access programs give you is a point of access to people who are using drugs, to provide services and talk with them about getting into treatment,” he said. “That’s why it’s still very useful to people at risk of hepatitis C.”
The CDC recommends anyone born between 1945 and 1965 talk to a doctor about being tested for hepatitis C. Other high risk categories include:
- Anyone who has ever injected non-prescription drugs.
- Anyone treated for a blood clotting problem before 1987.
- Anyone who received a blood transfusion or organ transplant before July 1992.
- Anyone on long-term hemodialysis treatment.
- Anyone with abnormal liver tests or liver disease.
- Anyone infected with HIV.
- Health care or public safety workers who have been exposed to blood through a needlestick or other injury.