The number of young adults contracting deadly hepatitis C infections in the region is growing so rapidly that some state and local health officials fear the silent epidemic may be poised to ravage an entire generation.
Most new cases of the viral infection that damages the liver and can be fatal if left untreated occur predominantly among young, white males and females with a history of injection drug use, coinciding with the dramatic surge in heroin and opioid drug overdoses that now kill more people in Ohio than car accidents, according to surveillance data from the Centers for Disease Control and Prevention.
Statewide, confirmed hepatitis C infections have nearly doubled from a little more than 10,000 cases in 2013 to just over 19,000 last year, based on preliminary 2015 data from the Ohio Department of Health.
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During the same period, the rate of infections spiked 58 percent, from 86.6 per 100,000 residents to 137.3 per 100,000 from 2013 to 2014 — the most recent years for which the state health department has solid, verified data on hepatitis C cases, according to Debbie Merz, ODH’s hepatitis and STD surveillance program manager.
“Every county in the state has reported hep C cases,” Merz said. “It’s hard to say for sure whether its due to injection drug use because we very rarely get any risk behavior (such as needle sharing) reported with hep C. But it seems to be due to the opiate and heroin problem. Both of them (hepatitis C and opioid overdoses) have been increasing at the same time.”
In general, the very southern tip of Ohio near the Appalachian region has higher hepatitis C infection rates than most other parts of the state, according to Merz.
A recent study from the CDC identified 11 counties in southern Ohio, including Adams, Scioto and Clinton, among 200 counties in the U.S. with the greatest risk for an outbreak of HIV and hepatitis C infections related to intravenous drug use.
Still, this region is not immune: While infection rates in the local area are generally at or below the state level, the total number of infections has increased exponentially over the past three years.
In Montgomery County, for example, there were 629 confirmed cases in 2015, equating to a infection rate of about 118 per 100,000. But the total number of cases was up 23 percent from 511 in 2013, according to figures provided by the health department itself, which differ slightly from the state’s preliminary figures for 2015.
If you look beyond just confirmed cases, the numbers are even more startling.
The total number of confirmed, suspected and probable cases in Montgomery County rose 86 percent from 697 in 2013 to 1,295 in 2015, raising the infection rate to about 243 per 100,000 residents last year, based on figures compiled by the neighboring Clark County Combined Health District.
The health department — which serves Clark and Champaign counties — tracks infections in all the surrounding counties.
“If you look at acute and chronic cases, both confirmed and suspected, there has has definitely been a significant increase, and I would say we can attribute a lot of the increase to intravenous drug use,” said Gabriel Jones, an epidemiologist at the combined health district.
The numbers are likely even higher because most victims show no symptoms of hepatitis C and go undiagnosed for long periods, increasing the chances they will transmit life-threatening hepatitis C infections to others.
According to local health officials, that’s what happened in Scott County, Ind., in 2014 when undiagnosed HIV and hepatitis C infections spread from unwitting intravenous drug users to nearly 200 residents. More recently, Wayne County, Ind., which is just over the Ohio border in Richmond, declared a public health emergency earlier this month for its high rate of hepatitis C infections tied to intravenous drug use.
The unprecedented outbreaks in small, rural communities that normally see only a handful of cases each year are consistent with CDC surveillance data that show hepatitis C cases are growing fastest in suburban and rural communities in the Midwest and East Coast.
“Last year, we had double the instances (of hepatitis C) than we had in 2013,” said Nan Smith, director of nursing for rural Preble County’s health department. “It just continues to go up, and this year we’re on a pace to be even higher. We have over 36 cases already, and we found that the vast majority of cases are from injectable drug use related to heroin.”
In sparsely populated Darke County, infections rose nearly 90 percent from 34 in 2014 to 64 last year, according to Dennis Wein, public health nurse at the county health department, and infections are on pace to meet or exceed last year’s totals.
“I would say it will be up around 64 again this year,” Wein said. “When we investigate and ask questions, several of them have been dirty needle users, or heroin users. And they’re a lot younger. It used to be 10 years ago, when I would call people about it, it would be a 50-year-old person going in for a hepatic panel and finding out by surprise they had this in their system. Now we’re having 18-, 19-, 25-, and 28-year-olds with it.”