Despite being curable, hepatitis C leading to more hospitalizations, deaths in R.I.

PROVIDENCE – Hepatitis C, the nation’s most common bloodborne infection, was associated with the deaths of 102 Rhode Islanders, a fivefold increase in the last decade, according to a report issued earlier this month by the Rhode Island Department of Health and the Rhode Island Public Health Institute.

The DOH encourages all individuals born in the United States between 1945 and 1965 who have not been tested for hepatitis C to do so. More than 3 million people in the United States have hepatitis C, and 75 percent of them are baby boomers, a DOH press statement advised. Between the 1950s and 1980s, high rates of hepatitis C transmission occurred, as the disease was not discovered until 1989, the DOH stated. Most baby boomers who are infected unknowingly contracted the infection decades ago and do not believe they are at risk of contracting hepatitis C.

The state’s first comprehensive epidemiological report addressing hepatitis C from diverse sources of data, “Epidemiological Profile: The Hepatitis C Epidemic in Rhode Island,” asserted that the state must do more to improve hepatitis C surveillance, prevention, testing, diagnosis and treatment. To that end, DOH plans to collaborate with Rhode Island’s community organizations, health care providers, health systems and colleges and universities to gather more information and insights.

From there, DOH Director Dr. Nicole Alexander-Scott, wrote in the report, the “next step is to continue to work on finalizing a Rhode Island Hepatitis C Strategic Plan that will address four priority areas: “Expansion of hepatitis C screening, care, treatment and cure, with a focus on reducing and preventing liver disease and hepatitis C-related morbidity and mortality; strengthening hepatitis C surveillance; education of health care providers and communities about hepatitis C screening, care and cure; and reduction in the transmission of hepatitis C that is a consequence of substance abuse.”

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The report also found:

  • Hepatitis C-related deaths rose from 25 in 2005 to 102 in 2014, based on data from death certificates, which may underreport hepatitis C-related deaths.
  • Between 2005 and 2014, there was a sixfold increase in the number of inpatient hospitalizations with a primary discharge diagnosis of hepatitis C.
  • Since 2009, clinical and lab reports suggest significant increases in hepatitis C diagnoses at hospital systems in the state, and both inpatient and outpatient settings’ screening data suggest that hepatitis C prevalence is much higher than previous estimates.
  • Since 2013, the Rhode Island Department of Corrections has significantly expanded its screening and treatment efforts for inmates.
  • Safe, highly effective hepatitis C medications offer significant opportunities to reduce rates of hepatitis C and cure the virus in a few weeks or months.
  • “The rise in hepatitis C-related death rates is alarming. However, … we have medications that can cure people living with hepatitis C,” Dr. Amy Nunn, director of RIPHI, said in the statement accompanying the report. “The first step in curing Rhode Islanders of hepatitis C is screening. Both baby boomers and anyone who is at high risk, such as people who have used injection drugs or … received blood transfusions prior to 1992, should ask their physicians to screen them for hepatitis C. People should then seek evaluation and treatment if they have hepatitis C.”

    A contagious liver disease, hepatitis C has symptoms that may range from a brief, mild illness to a lifelong serious illness, including liver damage, liver failure or liver cancer. The disease, which can be chronic or acute, occurs through infection with the hepatitis C virus, spread primarily through contact with an infected person’s blood.

    Individuals affected with chronic hepatitis C may not experience its symptoms and health impacts until later in life. Increased hospitalizations and deaths, asserted the DOH, may be due to the cohort of aging and infected baby boomers who don’t know they have hepatitis C have contributed, while other increases in diagnoses may be due to more hepatitis C testing and more illegal drug injections.

    “Testing is especially important for baby boomers, who are five times more likely to have hepatitis C than other older adults, said Alexander-Scott. The DOH also recommends testing for other individuals with risk factors for the disease. They include those who:

  • Have ever injected illegal drugs, including those who injected only once many years ago;
  • With a history of intranasal drug use, including those who snorted only once many years ago;
  • With HIV infection;
  • Received clotting factor concentrates made pre-1987;
  • Received a blood transfusion or solid organ transplants pre-1992;
  • Have ever received long-term hemodialysis treatment;
  • With signs or symptoms of liver disease (e.g., abnormal liver enzyme blood tests);
  • Were born to hepatitis C-infected mothers; or
  • Received unsafe medical injections such as steroids.
  • Without testing, people can’t know if they have advanced hepatitis C, as late-stage disease is often symptom-free. People should visit their primary care providers to get tested for hepatitis C or visit www.health.ri.gov/find/hepatitistestingsites/ for information on accessing confidential, free testing throughout the year.

    DOH is working closely with the Rhode Island Department of Corrections and with insurers, including Medicaid, to continue expanding access to hepatitis C treatment for Rhode Islanders who would benefit from it.

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