Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012

Abstract

Hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with approximately three million persons living with current infection. Percutaneous exposure to contaminated blood is the most efficient mode of transmission, and in the United States, injection drug use (IDU) is the primary risk factor for infection. State surveillance reports from the period 2006-2012 reveal a nationwide increase in reported cases of acute HCV infection, with the largest increases occurring east of the Mississippi River, particularly among states in central Appalachia. Demographic and behavioral data accompanying these reports show young persons (aged ≤30 years) from nonurban areas contributed to the majority of cases, with about 73% citing IDU as a principal risk factor. To better understand the increase in acute cases of HCV infection and its correlation to IDU, CDC examined surveillance data for acute case reports in conjunction with analyzing drug treatment admissions data from the Treatment Episode Data Set-Admissions (TEDS-A) among persons aged ≤30 years in four states (Kentucky, Tennessee, Virginia, and West Virginia) for the period 2006-2012. During this period, significant increases in cases of acute HCV infection were found among persons in both urban and nonurban areas, with a substantially higher incidence observed each year among persons residing in nonurban areas. During the same period, the proportion of treatment admissions for opioid dependency increased 21.1% in the four states, with a significant increase in the proportion of persons admitted who identified injecting as their main route of drug administration (an increase of 12.6%). Taken together, these increases indicate a geographic intersection among opioid abuse, drug injecting, and HCV infection in central Appalachia and underscore the need for integrated health services in substance abuse treatment settings to prevent HCV infection and ensure that those who are infected receive medical care.

FIGURE 1

Incidence of acute hepatitis C among persons aged ≤30 years, by urbanicity and year — Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012 * 95% confidence interval.

FIGURE 2

Percentage of all admissions to substance abuse treatment centers by persons aged 12–29 years (N = 217,789) attributed to the use of opioids, prescription opioids, and heroin, by year — Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012 * Any opioids include heroin and prescription opioids. ^† Prescription opioids includes buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, illicitly obtained methadone, and any other drug with morphine-like effects.

FIGURE 3

Percentage of all admissions to substance abuse treatment centers by persons aged 12–29 years (N = 217,789) attributed to the injection of opioids and other drugs, by year — Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012 * Any opioids include heroin and prescription opioids. ^† Other drugs include cocaine/crack, alcohol, phencyclidine, other hallucinogens, methamphetamine, other amphetamines, other stimulants, benzodiazepines, other non-benzodiazepine tranquilizers, barbiturates, other non-barbiturate sedatives or hypnotics, over the counter medications, and other drugs not listed.