Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012.

BACKGROUND Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the US epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years). METHODS We examined trends in incidence of acute hepatitis C among young persons reported to the Centers for Disease Control and Prevention (CDC) during 2006-2012 by state, county, and urbanicity. Sociodemographic and behavioral characteristics of HCV-infected young persons newly reported from 2011 to 2012 were analyzed from case interviews and provider follow-up at 6 jurisdictions. RESULTS From 2006 to 2012, reported incidence of acute hepatitis C increased significantly in young persons-13% annually in nonurban counties (P = .003) vs 5% annually in urban counties (P = .028). Thirty (88%) of 34 reporting states observed higher incidence in 2012 than 2006, most noticeably in nonurban counties east of the Mississippi River. Of 1202 newly reported HCV-infected young persons, 52% were female and 85% were white. In 635 interviews, 75% of respondents reported injection drug use. Of respondents reporting drug use, 75% had abused prescription opioids, with first use on average 2.0 years before heroin. CONCLUSIONS These data indicate an emerging US epidemic of HCV infection among young nonurban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in nonurban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention.

[1]  R. Valdiserri,et al.  Breaking the Silence on Viral Hepatitis , 2014, Annals of Internal Medicine.

[2]  T. Richards,et al.  Methods for improving the quality and completeness of mortality data for American Indians and Alaska Natives. , 2014, American journal of public health.

[3]  D. Holtzman,et al.  Confronting the emerging epidemic of HCV infection among young injection drug users. , 2014, American journal of public health.

[4]  Deborah D Ingram,et al.  2013 NCHS Urban-Rural Classification Scheme for Counties. , 2014, Vital and health statistics. Series 2, Data evaluation and methods research.

[5]  S. Holmberg,et al.  Estimating acute viral hepatitis infections from nationally reported cases. , 2014, American journal of public health.

[6]  C. Cunningham,et al.  Changes in testing for human immunodeficiency virus, sexually transmitted infections, and hepatitis C virus in opioid treatment programs. , 2013, JAMA.

[7]  R. Schinazi,et al.  Treatment as prevention and cure towards global eradication of hepatitis C virus. , 2013, Trends in microbiology.

[8]  V. Moyer,et al.  Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement , 2013, Annals of Internal Medicine.

[9]  M. Hellard,et al.  Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals , 2013, Hepatology.

[10]  J. Hahn,et al.  Injection drug use and hepatitis C virus infection in young adult injectors: using evidence to inform comprehensive prevention. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Leonard J. Paulozzi,et al.  Vital Signs: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women — United States, 1999–2010 , 2013, MMWR. Morbidity and mortality weekly report.

[12]  T. Liang,et al.  Current and future therapies for hepatitis C virus infection. , 2013, The New England journal of medicine.

[13]  J. Havens,et al.  Individual and network factors associated with prevalent hepatitis C infection among rural Appalachian injection drug users. , 2013, American journal of public health.

[14]  Kenneth E. Carlson,et al.  Geographic variation in opioid prescribing in the U.S. , 2012, The journal of pain : official journal of the American Pain Society.

[15]  J. Havens,et al.  Hepatitis C viremia and genotype distribution among a sample of nonmedical prescription drug users exposed to HCV in rural Appalachia , 2012, Journal of medical virology.

[16]  Rebecca L Morgan,et al.  Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. , 2012, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[17]  J. Bruneau,et al.  The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users. , 2012, Addiction.

[18]  R. Monina Klevens,et al.  The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007 , 2012, Annals of Internal Medicine.

[19]  Grant T. Baldwin,et al.  CDC grand rounds , 2012 .

[20]  D. D. Ingram,et al.  NCHS urban-rural classification scheme for counties. , 2012, Vital and health statistics. Series 2, Data evaluation and methods research.

[21]  Christopher M. Jones,et al.  CDC Grand Rounds: Prescription Drug Overdoes - A U.S. Epidemic , 2012 .

[22]  D. D. Des Jarlais,et al.  Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject Drugs , 2011 .

[23]  Hepatitis C virus infection among adolescents and young adults:Massachusetts, 2002-2009. , 2011, MMWR. Morbidity and mortality weekly report.

[24]  Leonard J. Paulozzi,et al.  Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. , 2011, MMWR. Morbidity and mortality weekly report.

[25]  W. Christian,et al.  Viral Hepatitis and Injection Drug Use in Appalachian Kentucky: A Survey of Rural Health Department Clients , 2010, Public health reports.

[26]  L. Paulozzi,et al.  Emergency department visits involving nonmedical use of selected prescription drugs - United States, 2004-2008. , 2010, MMWR. Morbidity and mortality weekly report.

[27]  R. Klevens,et al.  Population-based Surveillance for Hepatitis C Virus, United States, 2006–2007 , 2009, Emerging infectious diseases.

[28]  J. Boivin,et al.  Hepatitis C virus incidence among young street-involved IDUs in relation to injection experience. , 2009, Drug and alcohol dependence.

[29]  J. Ferrante,et al.  Family physicians' knowledge and screening of chronic hepatitis and liver cancer. , 2008, Family medicine.

[30]  Use of enhanced surveillance for hepatitis C virus infection to detect a cluster among young injection-drug users--new York, November 2004-April 2007. , 2008, MMWR. Morbidity and mortality weekly report.

[31]  Rohan Jayasuriya,et al.  Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. , 2006, Addiction.

[32]  D. Vlahov,et al.  Variability in the incidence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among young injecting drug users in New York City. , 2003, American journal of epidemiology.

[33]  M. Busch,et al.  Hepatitis C virus seroconversion among young injection drug users: relationships and risks. , 2002, The Journal of infectious diseases.

[34]  Juliea Morris,et al.  Statistics in Medicine: Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates , 1988, British medical journal.