Hepatitis C Incidence Increasing in Younger People

Hepatitis C Incidence Increasing in Younger People
Medscape Medical News from the:
International Conference on Emerging Infectious Diseases (ICEID) 2012

From Medscape Medical News

Emma Hitt, PhD
March 16, 2012 — Pennsylvania is reporting an increased incidence of hepatitis C infections in people 15 to 34 years of age, according to results presented at the International Conference on Emerging Infectious Diseases 2012, held in Atlanta, Georgia.

Sameh Boktor, MD, adult viral hepatitis prevention coordinator at the Bureau of Epidemiology, Pennsylvania Department of Health, in Harrisburg, presented the findings.

"This has major consequences for the control of this disease, and has implications for the long-term treatment of infected individuals," Dr. Boktor and colleagues say.

"Our findings are similar to those recently reported from Massachusetts and elsewhere," they add.
"Clinicians need to consider hepatitis C in their younger patients, especially those engaging in behaviors such as IV drug use," Dr. Boktor told Medscape Medical News.

To assess the incidence of hepatitis C, the researchers reviewed Pennsylvania's hepatitis C surveillance data from 2003 (the first full year of reportable data) to 2010. They compared age-specific rates of reported cases over time.

The number of newly confirmed or probable hepatitis C cases in people 15 to 34 years of age increased from 1384 in 2003 to 2393 in 2010 (from 43 to 72 cases per 100,000 people).
In addition, the proportion of cases in males in the that age group rose from 50% in 2003 to 63% in 2010.
In contrast, rates of newly reported cases in all age groups decreased from 85 to 72 cases per 100,000 from 2003 to 2010. In those 45 to 64 years of age, cases decreased from 185 to 142 per 100,000 during the same time period.

"The change in rates between 2003 and 2010 appears largest in some rural areas of Pennsylvania rather than in the 2 large urban centers," Dr. Boktor and colleagues point out.

According to Dr. Boktor, hepatitis C is considered a problem of middle age, owing to exposures that happened well in the past, particularly among those 45 to 64 years of age (the baby boomers).
"Many in the clinical and public health communities are unaware that there appears to be a new wave of hepatitis C among adolescents and young adults emerging, especially in those engaged in high-risk behaviors such as IV drug use," he said.

"Since this infection is becoming increasingly treatable, testing for hepatitis C is a very important step to ensure proper care, avoid long-term complications, and hopefully reduce the potential for subsequent transmission of the virus," he added.

Independent commentator John Bartlett, MD, professor of medicine in the division of infectious diseases at the Johns Hopkins University School of Medicine in Baltimore, Maryland, noted that "there really is not a good explanation for these findings."

"The greatest risk by far is injection drug use; it is unclear from the report if this was shown," Dr. Bartlett told Medscape Medical News. He added that hepatitis C can be transmitted by sex and tattooing, although neither transmit the infection very efficiently and probably can not explain the increase.
According to the Centers for Disease Control and Prevention, approximately 3.2 million people are chronically infected with hepatitis C, making it the most common blood-borne infection in the United States. Overall, the incidence of acute hepatitis C has declined from just under 2.50 cases per 100,000 in 1992 to about 0.25 cases per 100,000 in 2003 in the United States, with the incidence remaining stable after that.
This study was not commercially funded. The researchers and Dr. Bartlett have disclosed no relevant financial relationships.

International Conference on Emerging Infectious Diseases (ICEID) 2012: Board 75. Presented March 14, 2012.