Hepatitis C Among Baby Boomers: How Local Health Departments are Working to Address this Quiet Epidemic
Washington, DC, June18, 2018 — Hepatitis C is a global public health issue affecting 71 million people around the world. In the United States, there are approximately 3.5 million people living with hepatitis C. It kills more Americans than all other infectious diseases combined, and baby boomers – people born from 1945-1965 – are five times more likely to have hepatitis C than other adults. Hepatitis C is also a growing problem.
From 2010 to 2016, reported cases of acute, or new, hepatitis C virus more than tripled. Newer cases of hepatitis C can largely be attributed to injection drug use, which is an increasing and urgent concern associated with the opioid epidemic. While populations of baby boomers and people who inject drugs are significantly affected by the same hepatitis C virus (HCV), each requires a unique focus and corresponding set of strategies to effectively address this epidemic.
Local health departments are on the frontlines of our nation’s efforts to address and ultimately eliminate hepatitis C as a public health threat. The National Association of County and City Health Officials (NACCHO), representing the nation’s nearly 3,000 local governmental health departments, supports local efforts to address hepatitis C and advocates for increased funding to address this large and growing issue.
What Is Hepatitis C?
Hepatitis C is a blood-borne virus. Acute hepatitis C refers to the first several months after someone is infected; the symptoms can range in severity from a very mild illness with few or no symptoms to a serious condition requiring hospitalization. For reasons that are not known, about 20% of people are able to clear, or get rid of, the virus without treatment in the first six months. Unfortunately, for approximately 80% of people who become infected with HCV, it becomes a long-term, chronic infection. Over time, chronic hepatitis C can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. Hepatitis C is a leading cause of liver cancer and the number one cause of liver transplants.
Hepatitis C is often referred to as the silent epidemic, because many people with hepatitis C do not have symptoms; an estimated 50% of people with HCV do not know they are infected. Expanding HCV testing is critical to addressing this epidemic, and a blood test is the only way to know if a person has been infected. The blood test, known as a Hepatitis C Antibody Test, looks for antibodies to HCV. However, since antibodies remain in the bloodstream even if the virus is cleared, a second test is necessary for those that have a positive antibody test. This second test is known as an RNA test, often referred to as a confirmatory test, and it determines if a person is currently infected with HCV.
Why Baby Boomers, and What Can They Do About It?
HCV was not discovered until 1989, but it had been spreading undetected within the population for decades beforehand. Baby boomers may have acquired the infection through blood transfusions or other medical procedures, before effective blood screening or present-day safety precautions were implemented, or through previous injection drug use. Since hepatitis C can remain asymptomatic for many years, if not decades, many people who are infected may have no idea that they were ever at risk and may not understand the need to be screened for the virus. Baby boomers with hepatitis C are now dealing with the adverse health consequences of the undetected chronic infection, including liver damage and liver cancer.
Since 2012, the Centers for Disease Control and Prevention (CDC) has recommended one-time testing for HCV for everyone born between 1945-1965. Testing is the first step in accessing care and treatment for hepatitis C. Prior to 2013, treatment for hepatitis C was lengthy, had serious and sometimes debilitating side effects, and was not always effective. Unlike so many other diseases, we can now cure hepatitis C, a groundbreaking advancement that opened the conversation about elimination. New treatments, which are referred to as direct-acting antivirals, have cure rates of nearly 100%, typically only require 8-12 weeks of all-oral therapy (i.e., pills), and have few and more tolerable side effects than earlier treatment regimens.
Local Health Department Efforts to Address Hepatitis C
Local health departments are on the frontlines of addressing hepatitis C in baby boomers, as well as people who inject drugs and other priority populations. Many of these efforts overlap. However, a unique and dedicated focus is required for each population. For baby boomers, increasing awareness of hepatitis C among this population, ensuring implementation of the CDC screening guidelines by healthcare providers, and linking people with hepatitis C to care and curative treatment are key priorities. These actions are supported by the following local health department functions:
- Surveillance: Collecting, analyzing, and interpreting hepatitis C data to plan, implement, and evaluate programmatic activities. An essential component of HCV surveillance is establishing a better understanding of the impact on populations with HCV, so that strategies can be effectively developed to address population-specific health disparities.
- Screening, Diagnosis, and Linkage to Care: Local health departments play an important role in developing and maintaining the infrastructure for providing high-quality care and treatment by supporting a comprehensive screening and diagnosis approach that includes both clinical and community settings. Local health departments can also facilitate access to hepatitis C care and treatment by following up with people who have hepatitis C, connecting them to a healthcare provider, and supporting adherence to treatment.
- Education: Developing and disseminating educational tools, trainings, and resources to increase community and healthcare provider awareness of prevention, testing, and treatment methods.
- Elimination Planning: Collaborating with federal, state, and community partners to develop coordinated, comprehensive, and integrated plans to eliminate hepatitis C.
NACCHO Supports Local Efforts to Respond to Hepatitis C
“Given the sheer volume of domestic cases, and the fact that incidence of infection is trending significantly higher year after year, it is extremely important to support and strengthen the efforts of local health departments to address hepatitis C,” said NACCHO Chief Executive Officer Lori Tremmel Freeman, MBA. To do so, NACCHO developed two key resources to increase local health department capacity, including:
- Hepatitis C and Local Health Departments Educational Series, an online, self-paced program to increase knowledge of HCV-related topics, provide information and examples of how local health departments can leverage existing resources to address HCV, and share successful local health department practices and policies for expanding HCV services in their communities.
- Hepatitis C Public Health Detailing Kit, a collection of tools and resources to support local health departments in implementing public health detailing as a strategy to increase healthcare provider awareness and uptake of effective practices for HCV screening, diagnosis, and linkage to care and treatment. Public health detailing is a method of providing outreach education for healthcare professionals to promote clinical preventive services.
To learn more about NACCHO’s efforts to address hepatitis C, visit its Viral Hepatitis webpage. Additionally, check out CDC’s Know More Hepatitis campaign, which is designed to raise awareness and encourage hepatitis C testing in the baby boomer population. NACCHO also has several resources and projects underway to address hepatitis C among persons who inject drugs. This information is available on its Infectious Diseases and the Opioid Epidemic webpage.
The National Association of County and City Health Officials (NACCHO) represents the nation’s nearly 3,000 local governmental health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities. For more information about NACCHO, please visit www.naccho.org.