By Dan Church, Viral Hepatitis Prevention Coordinator at the Massachusetts Department of Public Health, Massachusetts Department of Public Health
In the last year, focus has been on the new Centers for Disease Control and Prevention (CDC) recommendation for a one-time hepatitis C virus (HCV) antibody test for all individuals born between 1945 and 1965. While this is important given recent trends in HCV-related mortality in this age cohort, there has been less attention on the need to continue risk-based screening due to the alarming trends of increased HCV transmission among young people who use drugs. This increase has been noted in a number of jurisdictions, including in Massachusetts, where the annual number of reported HCV infections among those 15 to 29 years of age has now exceeded those in the older age cohort. While the number of identified, confirmed acute HCV cases remains low, almost 2,000 cases of HCV infection have been reported each year in this younger age group since 2007 in Massachusetts alone. Most of these cases were likely exposed in the recent past, and surveillance data indicate that the injection of prescription opiates and heroin are driving this epidemic.
Addressing Hepatitis Infection among Young People
The Massachusetts Department of Public Health (MDPH) has been addressing this critical issue in three ways:
- Implementing full integration of hepatitis C prevention and testing services throughout the HIV/STD prevention and screening program structure.
- Educating community based providers on the issue to encourage screening and care for the at-risk population.
- Continuing to enhance surveillance and collection of data on young people with HCV infection to better understand transmission patterns and shifts in the epidemic.
In the last two years, a substantial effort was made to ensure that any program funded by the MDPH Bureau of Infectious Disease to provide HIV prevention and testing services also provides counseling and testing for HCV. This was accomplished, and MDPH also recently implemented a mechanism for these sites to participate in HCV surveillance activities. This not only allows improved collection of data on this population, but also a means to assess linkage to care for individuals found to be HCV antibody positive.
Raising Awareness about Hepatitis
Education has been a crucial component of the response. Since the trend of HCV infection among young people was first identified, MDPH staff and community partners have been providing updates on what is happening with young injection drug users and HCV infection at planning meetings, grand rounds, conferences (both local and national) and via other communication opportunities as they become available.
Enhanced data collection has been helpful in appropriate targeting of programs and determining appropriate messaging. A recent project, funded by CDC, followed-up with all people ages 18-25 years who had been reported to MDPH with HCV infection in a six month period. Sixty-three interviews were completed (23% of confirmed cases in that age group). The data indicated that most people were getting tested at drug treatment facilities, most were injecting heroin (with an average age of initiation of 18 years, range 13-24), and of those who reported injecting drugs, most had shared drug injection equipment, including syringes. This suggests that although Massachusetts has made great strides in enhancing and integrating services to this population, it is urgent that these efforts be expanded in order to effectively address the HCV education, prevention and screening needs of young drug users. A focused national approach to this issue is needed, given that an increasing number of jurisdictions have reported similar data.
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