Monday, July 6, 2015

Hepatitis C - Rise in heroin use drives needle exchange programs

Hepatitis C - Rise in heroin use drives needle exchange program

Happy Monday folks, hope your work week is off to a fabulous start. It's always a good day when hepatitis C is in the news, although today the news is tragic, truly disturbing as we focus on the soaring rates of HCV fueled in part by intravenous drug abuse.

The powerful stigma attached to having a disease associated with drug use is difficult to overcome, however, only when we rise above the intolerance and short comings of others can the stigma slowly be eradicated. 

Hepatitis C is highly transmissible by a shared needle, it only takes one time to transmit the virus. With the rise in IV drug use many states are now attempting to implement needle exchange programs to prevent the transmission of hepatitis C, and other blood-borne disease.

This isn't recent news, in May the CDC reported new cases (acute) of hepatitis C were up nationally. The report linked the increase to IV drug use, in particular in four Appalachian states; Kentucky, Tennessee, Virginia and West Virginia.  Recently, Ohio, Maine, Indiana and Florida, reported on the increase use of heroin, and what needs to be done to combat the rise in acute hepatitis C cases.

Before you read the following articles jump over to ABC 57 News to watch a brave Michiana man speak out about his own drug addiction.

“People that shoot up and use needles think that they can take bleach and can rinse the needle out or heat up some water and run the needle through some bleach, well you can’t do that. The blood borne pathogens stay in the needle.”
Watch the video, here

Side note, the article stated; He lives everyday with incurable diseases but wants to use his story to help other people who want to kick the high.

Click here to learn more about treating HCV, and here for HIV treatment.

In The News

The boom in heroin use paired with a surge in hepatitis C infections in Franklin County and across Ohio have heightened worries about the spread of other diseases, particularly HIV, and sparked conversations about a local needle exchange.
Continue reading....
While no-cost screenings are available, the state lacks treatment options, especially for low-income addicts.

Maine is undergoing its worst acute hepatitis C outbreak since it began recording cases in the 1990s. Reported cases of the disease have soared since 2013, corresponding with skyrocketing heroin use, and are more than triple the national average.

The heroin epidemic is causing many undesirable ripple effects in Maine, public health advocates say, including the spread of infectious diseases such as hepatitis C.

Another side note:
The article also reported that hepatitis C can be contracted through; intravenous drug users sharing needles. It also can be contracted through unprotected sex or other contact with infected blood.

Although this is accurate, hepatitis C is rarely transmitted through sexual contact, review links following this post for additional information. 

JEFFERSONVILLE — Clark County Public Health Officer Dr. Kevin Burke is considering declaring an HIV and hepatitis C epidemic in the county, the first step required in implementing a year-long needle exchange program.

“There is at least indirect evidence that there is a problem,” he said.

Burke told a group of residents who meet to discuss drug addiction in Clark County that recent data shows local elevated rates for the diseases. In 2014, Clark County’s rate of new HIV cases was about 37.5 percent higher than Indiana’s average. Clark County had 11 people per 100,000 with HIV, whereas Indiana had 8.

And Clark County’s new cases of hepatitis C were 40.5 percent higher than the state’s average in 2014 — 97 in Clark per 100,000 compared to 69 for Indiana.
Continue reading...

State on alert after HIV outbreak in Indiana
DES MOINES | An outbreak of HIV cases in rural Indiana delivers a dire warning to states with similar rural pockets such as Iowa, even as the number of newly diagnosed Iowans fell sharply last year.

Roughly 170 people in one Indiana county have tested positive for HIV this year. It is the largest outbreak in the state’s history.

The outbreak is believed to have been spread by drug users in rural southern Indiana who were sharing needles.

Video:Hepatitis C on the Rise in South Florida; But a Cure is Available For Some
A potentially deadly disease is seeing an alarming increase of cases being reported in South Florida. In fact, cases of hepatitis C have gone up more than 50-percent in Broward County in the past two years alone.
Read more here...

West Virginia
Cabell needle exchange program could guide other communities
by Tyler Bell, Police Reporter
Dr. Rahul Gupta, director of the state Department of Health and Human Services Bureau for Public Health, speaks Thursday at Huntington City Hall during the announcement of Cabell County’s new syringe exchange program.
“It’s important for us to follow evidence-based approaches,” said Dr. Rahul Gupta, director of the state Department of Health and Human Services Bureau of Public Health, at a press conference Thursday. The conference, held at the Huntington City Hall and attended by law enforcement, medical professionals and media outlets from across the state, brought together state and local officials to announce the state’s first-ever syringe exchange program.  
The state’s heroin epidemic creates a host of secondary problems for West Virginia, not least of which is a steadily increasing rate of hepatitis and HIV infections.
Continue reading...

CDC Underestimates Number of Acute HCV Infections
Lara C. Pullen, PhD
July 07, 2015
Source - Medscape
Formal surveillance by the Centers for Disease Control and Prevention (CDC) does a poor job of measuring the clinical diagnosis of acute hepatitis C virus (HCV) infection, according to a new report. Case ascertainment is negatively affected by incomplete clinician reporting, limitations of diagnostic testing, problematic case definitions, and imperfect data capture, and these problems persist despite automated electronic laboratory reporting.
Continue reading...

Annals of Internal Medicine
Provided by NATAP

Worried about the transmission of hepatitis C through IV drug use?

The Facts
When you share contaminated syringes or equipment HCV can be transmitted the - first time - or - only time - you use.

Injection Drug Use: 
Injection drug use remains the most common risk factor for acquiring HCV in the United States, accounting for more than 50% of all cases of HCV. A recent study identified injection drug use as the risk factor for 84% of individuals diagnosed with acute HCV. Approximately 20 to 30% of persons who inject drugs are infected with HCV within the first 2 years of starting to inject drugs and 75 to 90% of persons who inject drugs are anti-HCV positive. 

Transmission risk is greatest with “direct sharing” of needles and syringes, but may also occur indirectly via sharing of injection paraphernalia, such as syringes, cookers, and cotton filters. The incidence of HCV in persons who inject drugs has markedly declined in the past 20 years, likely secondary to use of needle exchange programs that arose in response to the HIV epidemic and saturation of HCV infection in the population of persons who inject drugs. 

Recent reports have identified a new cohort of HCV-infected injection-drug users with the following characteristics: age 24 or younger, white race, residence in non-urban areas, and use of oral prescription opiates prior to using heroin. The prototypical new heroin user initiates some type of substance abuse, such as alcohol or marijuana at about age 13, transitions to using oral opiates, most often oxycodone, around age 17, then eventually starts using cheaper and widely available heroin by about age 18. 
Read more here...


You Can Get HCV If You.........
Share, or reuse equipment and syringes

Filters - Reusing filters can spread Hep C and also cause health problems such as cotton fever.

Tourniquets - Ties

Cookers - Reusing HCV contaminated cookers could lead to infection even if using sterile syringes

Water cups - If a person draws up water with a used syringe both the water and the cup have been contaminated

Swabs - Used to clean skin before injecting

Pads - To stop bleeding after needle withdrawal

Re-capping a needle may lead to an accidental needle-stick and HCV

I Don't See Any Blood
The amount of blood needed to pass on HCV is small and blood does not have to be visible for it to be infectious. Microscopic amounts of blood could be on the surface where the drugs and equipment are set up or on any one of the pieces of equipment. Used equipment can also cause more abscesses than new sterile equipment.

Crack Pipes
Smoking drugs can lead to open sores, burns or cuts on the lips and in the mouth, which can transfer blood to a pipe. If the pipe is shared, even a speck of blood carrying hepatitis C can transmit the virus. Sharing includes borrowing, lending, passing on, buying, selling, reusing, receiving or taking any equipment that was used by someone else. Some people do not identify risk with the word “sharing” or when reusing involves a close sexual partner (like a boyfriend or girlfriend). Risk exists, even under these circumstances.
Read More Here

Hepatitis C Sexual Transmission
We begin with sexual transmission among monogamous heterosexual couples;

The HCV partners study 

CROI2015: HCV transmission risk factors in HIV-infected MSM
The authors conclude that sexual transmission and non-injection drug use are risk factors for HCV infections. This further supports the recommendations that sexually active MSM and those who do not use injection drugs should be routinely screened for HCV as a component of their sexual health and wellness.

The present study aimed to identify and quantitatively investigate HIV-infected individuals and their main heterosexual partners regarding the risk factors of HCV transmission.

CDC - Sexually Transmitted Diseases Treatment Guidelines, 2015
MMWR Recommendations and Reports
June 5, 2015 / Vol. 64 / No. RR–3
Sexually Transmitted Diseases Treatment Guidelines, 2015
This report presents guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs). The guidelines update those from 2010. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

This country has been slow to fund needle exchange programs, the US government forbade funding for such services until 2009 when the federal funding ban was lifted. Let's hope we move forward quickly this time, lives are at risk, people, often young, desperately need access to these programs.


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