Hepatitis C in North Carolina: Two Epidemics With One Public Health Response

Hepatitis C virus (HCV) infection, the most common blood-borne infection in the United States, is most frequently transmitted through injection drug use [1]. Although HCV infection can be acute and self-limiting, approximately 75%–85% of infected persons will develop chronic illness. Of the estimated 3.5 million persons in the United States with chronic HCV infection, approximately 75% were born during the period 1945–1965 (ie, baby boomers) [1-3]. Chronic HCV infection has been referred to as a silent epidemic. Approximately 50% of those with chronic infection are unaware of their status and do not receive recommended medical care and treatment, increasing the possibility of progression to liver disease, cirrhosis, liver cancer, and death [1, 2]. Concurrent with the ongoing epidemic of chronic HCV infection, an emerging epidemic of acute HCV infection has been recognized among young persons who inject drugs and live in rural, resource-poor areas [4]. Opioid injection is on the rise in the United States, with a 200% increase in injection drug use fatalities since 2000 [5]. In North Carolina, opioid- and heroin-related hospitalizations and fatalities have increased 3-fold during the past 10 years [6]. New hot spots of acute HCV infection have been identified in central Appalachian states among persons who injection drugs who are aged 30 years and younger and from nonurban areas [4]. Acute cases of HCV infection are reportable by law to the North Carolina Department of Health and Human Services (NC DHHS) as part of statewide communicable disease surveillance [7]. Through public health investigations, reports…