Hep C virus bites hard in Pacific County

Published on August 9, 2016 4:43PM

Centers for Disease Control

Hepatitis C infection in the United States by source.

WASHINGTON — Ask the average person to name a deadly, blood-borne virus, and most will quickly say, “HIV” or “AIDS.” But Washington public health experts are concerned about the rise of another such virus, Hepatitis C.
According to a new state Department of Health (DOH) study, there are now more than 600 HCV-related deaths in Washington each year — six times the number of HIV deaths. The study, which looked at HCV data from 2010 to 2014, found that state rates nearly doubled from 2013 to 2014. The rate of infection in several Southwest Washington counties is well above the state average, and Pacific County has the third-highest rate of infection in the state.
“We have lots of talks about this, because there are more and more reports of it,” Pacific County Public Health and Human Services Director Mary Goelz said on Aug. 5. Goelz collects and shares information about local cases of “notifiable conditions” like HCV with state health authorities, so she’s often one of the first to see a new health trend shaping up in the county.
According to Goelz, one possible reason why local rates are so high is that the risk for HCV is especially high among “Baby Boomers” (those born between 1945 and 1965) and injection drug users — two groups that have a fairly strong presence in the county.

What is Hep C?
Hep C is the most common blood-borne infection in the U.S. Like the unrelated Hep A and Hep B viruses, HCV affects the liver. Unlike Hep A and Hep B, it doesn’t have a vaccine.
These days, most people contract HCV from sharing needles, needle-stick injuries, or being born to an infected mother. In the past, people also caught HCV from infected blood transfusions or organ transplants, according to the federal Center for Disease Control (CDC). Less common means of transmission include sexual contact, and sharing infected personal care items like toothbrushes and razors.
About 15 to 20 percent of early-stage, or “acute” cases of HCV go away on their own, and, if detected, acute HCV is treatable. However, many acute sufferers have no symptoms, so they don’t know they’re infected. Left untreated, most cases of acute HCV turn into chronic HCV, which can cause cirrhosis, liver cancer, and liver failure. Chronic HCV can also go undetected for decades, so many sufferers do not learn they are infected until the virus has already damaged their livers.
Though better treatment options are emerging, chronic HCV is still costly and difficult to treat, and often leads to diminished quality of life, and premature death for sufferers. The DOH study found that people with chronic HCV on average lose about 19 years of life to the disease.

Local and
regional rates
According to the study, Washington had a rate of 60.7 cases of HCV per 100,000 people in 2013. In 2014, that rate suddenly jumped to 83.6. During the same period, Pacific County had 22 actual cases in 2013, and 44 in 2014, according to DOH. That meant that the rate per 100,000 nearly doubled, from 104.8 to 208.5.
Goelz said there were 44 cases again in 2015. In the first six months of 2013, 2014 and 2015, there were 21, 24 and 27 cases respectively. If the current rate of infection holds, it would add up to 54 cases by the end of the year.
In addition to looking at individual counties and the state as a whole, the study’s authors also studied data for nine regional “Accountable Healthcare Communities”, or AHCs. Known as the Cascade Pacific Action Alliance, the local AHC includes Cowlitz, Grays Harbor, Lewis, Mason, Pacific, Thurston and Wahkiakum counties.
The researchers found that Pacific was a standout in a district that already had very high HCV rates and poor health outcomes. Pacific County’s five-year average infection rate of just under 124 was well over the CPAA rate of 112, and nearly double the state rate of 72.

Hospital stays, high bills and public costs
Each year, there are more than 5,200 HCV cases reported in Washington, most of which are chronic. These illnesses lead to about 550 hospitalizations annually, with costs totaling more than $22 million. Between 2010 and 2014, almost 40 out of every 100,000 hospitalizations in the state were for HCV
Local HCV patients appear to be spending even more time in the hospital, and dying sooner than patients in all but one or two other counties. In Pacific County, the hospitalization rate was nearly 124 — the highest in the state. While the average Washington HCV patient stayed in the hospital for five days, and returned 38 percent of the time, Pacific County patients spent an average of 8.4 days in the hospital, and returned 62 percent of the time.
In all, HCV-sufferers in the CPAA district spent 1,560 days in the hospital between 2010 and 2014, and the average hospital stay cost just under $40,000 — nearly $13 million in all. Taxpayers helped foot the bill for the enormous expense of treatment — together, Medicaid and Medicare and charity were the primary payers for about 70 percent of those hospitalizations, according to the study.

Who gets HCV?
In Washington, about three-quarters of new cases occur in people who inject drugs. However, the study also found that those who are now between roughly the ages of 50 and 70 are at greater risk of having, or catching HCV. In Pacific County, the average HCV patient is about 57 years old — a year or two older than in most other counties.
Goelz said the high risk among Baby Boomers probably has something to do with the fact that many of them came of age in the 1960s and 1970s, when “free love” and recreational drug use were both on the rise — before AIDS, people weren’t very worried about about blood-borne diseases, so needle-sharing was more common, and even hospitals took fewer infection-control precautions.
“There may have been people who injected one time, who didn’t think it was a big deal,” Goelz said. “There could be people who got blood transfusions before they tested blood.”

More cases, or just better monitoring?
A few years ago, researchers began to realize that long-ago medical procedures and youthful indiscretions were coming back to haunt unsuspecting HCV sufferers just as they neared retirement age. In 2012, that lead national health authorities to recommend that all Baby Boomers be tested for HCV. And that, coupled with the fact that more people have health insurance due to “Obamacare”, may have contributed to a spike in the number of new diagnoses, Goelz said.
“It’s not necessarily this big epidemic of more people having more Hep C — it’s just more people getting diagnosed,” Goelz explained. The study noted recent changes in monitoring and diagnosis strategies, but said that, regardless, there is some evidence that the disease is still being transmitted to new people. Young needle drug users account for many of the new cases.
“It’s not all older people,” Goelz observed. “We get people in their early twenties now that are testing positive for Hep C.”
There are other factors that likely contribute to the high rates and poor outcomes in the county, including a transient population that appears to be growing, lower-than-average household incomes, lack of access to comprehensive healthcare facilities, and few affordable drug-treatment programs.

Recommendations
Combating Hep C will require policy changes, money, and extensive outreach. According to the authors, policy-makers need to do more to require insurers to pay for Hep C treatment, and healthcare providers to offer more accessible and affordable treatment options. More people need to be tested, and sooner. And citizens — especially those in vulnerable groups — need to be educated about prevention, and given easy access to testing and treatment options.
The study emphasized the need for testing, treatment, and especially needle-exchange programs that target injection drug-users, who sometimes spread infections to non-drug-users. The study noted that CDC has found that a combination of drug-treatment and needle exchange programs “can reduce transmission of HCV among people who inject drugs more than 80 percent.”
According to Goelz, users do take advantage of these programs, but there are no needle-exchanges available locally.
“We have never had one,” Goelz said. “For a period of time, we actually supported both Cowlitz and Grays Harbor needle exchange programs, but the money was kind of diverted to larger populations.”
Goelz said treatment options are getting better, so people who are at risk should definitely get tested.
“I would encourage people to talk to their providers if they think they might have been exposed at some point,” Goelz said.