Back HCV Epidemiology High Rate of HCV Infection Shows Young Drug Injectors Need Better Prevention Interventions

High Rate of HCV Infection Shows Young Drug Injectors Need Better Prevention Interventions

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Young infection drug users (IDUs) continue to become infected with hepatitis C at an alarming rate, underscoring the need for new and better prevention efforts, according to a study described in the October 28, 2011, issue of the CDC's Morbidity and Mortality Weekly Report.

Hepatitis C virus (HCV) is easily transmitted through blood-to-blood exposure, as can occur when people share syringes or other equipment for injecting drugs. Many "Baby Boomers" who were infected with HCV years or decades ago are only now developing advanced liver disease. Some studies have indicated that hepatitis C rates have fallen over the past 2 decades, a trend thought to be attributable in part to needle exchange programs and other prevention efforts.

One recent study, however, found that HCV infections among Massachusetts residents aged 15 to 24 years increased from 65 to 113 cases per 100,000 persons between 2002 and 2009. Researchers with the Massachusetts Department of Public Health (MDPH) and Centers for Disease Control and Prevention (CDC) therefore sought to identify hepatitis C risk factors in this population.

The analysis included 28 people aged 18 to 24 years who were interviewed to obtain detailed information about their demographic, clinical, and risk characteristics. This small group was drawn from a population of 394 individuals identified by MDPH as having hepatitis C between July 1 and December 31, 2010. Out of 193 people with valid telephone numbers, 101 did not answer 3 call attempts, 19 were either in a drug treatment facility or incarcerated, another 19 refused to participate, 31 agreed to participate but did not show up for their scheduled interview, and 23 (12%) completed an interview. An additional 5 people with diagnosed HCV infection were interviewed at a correctional facility. Incentives were not offered for participating in the study.

Just over half of the 28 participants were women, most (82%) were white, and the average age was 22 years. About one-third (32%) had never finished high school and 32% were unemployed, but a large majority (89%) said they had health insurance.

Results

  • Almost all participants (93%) reported drug use, and within this group:
    • 100% had used marijuana, starting at a median age of 13 years;
    • 92% reported using opioid analgesics (e.g., oxycodone), starting at a median age of 17 years;
    • 89% reported heroin use, starting at a median age of 18 years.
  • During the preceding 6 months, the most frequently injected drugs were heroin (50%) and opioid analgesics (30%).
  • 70% of participants said they shared syringes and other drug equipment with networks of injection drug users.
  • 43% said they did so within networks that included people known to have HCV.
  • 39% were tested for HCV while in a drug treatment program or incarcerated.
  • 25% said they were never informed by their healthcare provider that they had HCV.

"Health-care providers should routinely ask about prescription and illicit drug use and screen all persons with risk factors for HCV infection, regardless of age," the report authors wrote.

"Drug treatment programs and prisons are potential venues for education regarding the risk for hepatitis C from sharing needles and other injection paraphernalia and for providing vaccination against hepatitis A and B," they recommended. "School and community-based education programs also are needed to prevent initiation of illicit and prescription drug use."

A recent meta-analysis of harm reduction interventions did not show a statistically significant decrease in new HCV infections from a single strategy, the researchers noted, but "the results did indicate that combined interventions were effective."

Thus, they concluded, "combining current interventions and identifying new evidence-based approaches to preventing drug use and unsafe injection practices in young adults are needed to control and prevent HCV infections."

Investigator affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Prevention, Atlanta, GA.

11/1/11

Reference

D Church, K Barton, F Elson, S Holmberg, et al. Notes from the Field: Risk Factors for Hepatitis C Virus Infections Among Young Adults -- Massachusetts, 2010. Morbidity and Mortality Weekly Report 60(42):1457-1458. October 28, 2011.