Rhode Island has seen a significant increase in hepatitis C virus-related hospitalizations and deaths in the last decade, underscoring the importance of diagnosis and treatment, according to a new report released Thursday by the Rhode Island Department of Health (RIDOH) and the Rhode Island Public Health Institute (RIPHI).

“Building healthy communities and a healthy, thriving Rhode Island means working to eliminate infectious diseases such as hepatitis C,” said Director of Health, Nicole Alexander-Scott, MD, MPH. “As the first comprehensive epidemiological profile of hepatitis C in Rhode Island, this report will be an invaluable tool in our work in the areas of hepatitis C prevention, testing, diagnosis, and treatment, which together will saves lives.”

Image/ National Atlas of the United States
Image/ National Atlas of the United States

Some key findings of the report include: • Hepatitis C-related deaths rose from 25 in 2005 to 102 in 2014, based on death certificate data, which may underreport hepatitis C-related deaths. • The number of inpatient hospitalizations with a primary discharge diagnosis of hepatitis C increased six-fold between 2005 and 2014. • Clinical and laboratory reports since 2009 suggest significant increases in hepatitis C diagnoses at hospital systems throughout Rhode Island, and screening data from both inpatient and outpatient clinical settings suggest that hepatitis C prevalence is much higher than previously estimated. • The Rhode Island Department of Corrections has significantly increased its efforts in the areas of screening and treatment since 2013. • Safe, highly effective hepatitis C medications are now available. These medications create an opportunity 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, the good news is, we have medications that can cure people living with hepatitis C,” said Dr. Amy Nunn, Director of RIPHI. “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 people who 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 .”

Hepatitis C virus can cause a liver disease that ranges in severity from a mild illness lasting a few weeks (acute hepatitis C) to a serious, lifelong illness (chronic hepatitis C). Health impacts of hepatitis C can include liver damage, liver failure, and liver cancer. This results from infection with the hepatitis C virus, which is spread through direct blood-to-blood contact with the blood of an infected person. Hepatitis C is the most common blood borne illness in the United States. Between 3 and 5 million people in the United States have chronic hepatitis C.

All Baby Boomers (people born in the United States between 1945 and 1965) who have not been previously tested for hepatitis C should do so at least once. Approximately 75% of the people who are living with hepatitis C in the United States were born between 1945 and 1965. This is because of high rates of transmission of hepatitis C between the 1950s to 1980s, before the discovery of hepatitis C in 1989. Most Baby Boomers were infected decades ago, do not believe themselves to be at risk, and have never been screened.

The increases in hospitalizations and deaths are partially attributable to the fact that, as Baby Boomers age, the illness is progressing in those who are infected and are unaware of their infection. The symptoms and health impacts of chronic hepatitis C are often not experienced until later in life. Increases in diagnoses may also be attributable to increased testing and increased use of injection drugs.

Image/Video Screen Shot
Image/Video Screen Shot

Other people who should be tested, in addition to Baby Boomers, include: • People who have ever injected illegal drugs, including those who injected only once many years ago. • People with a history of intranasal (through the nose, or snorting) drug use, including those who snorted only once many years ago. An example is snorting cocaine. • All people with HIV infection. • People who received clotting factor concentrates made before 1987. • People who received a blood transfusion or solid organ transplants before 1992. • People who have ever received long-term hemodialysis treatment. • People with signs or symptoms of liver disease (e.g., abnormal liver enzyme blood tests). • Children born to hepatitis C-infected mothers. • People who received unsafe medical injections (steroids, for example). People should see their primary care providers to get tested for hepatitis C.

Although high prices have prompted some health plans to restrict access to treatment to individuals with more advanced stages of hepatitis C, testing is still extremely important for Baby Boomers who have not been previously tested and for people who fit into one of the categories listed above. This is because without testing leading to diagnosis, people cannot know if they have hepatitis C. Often, even people with later stage hepatitis C, who may be a priority group for receiving treatment, do not have symptoms.

RIDOH 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.