TRAVERSE CITY — The number of people infected with the hepatitis C virus has reached epidemic levels in northern Michigan, according to public health experts.
Michelle Klein, director of personal health for the Benzie-Leelanau District Health Department, said her office saw a 50 percent increase in positive tests for the virus between 2016 and 2018.
Eighteen cases of HCV were reported to her department in 2016, while 38 cases were reported in 2018, Klein said.
“Even if I’m looking at small numbers, a 50 percent increase is a tremendous upward trend,” Klein said. “These are alarming numbers and it has certainly become a public health issue.”
HCV cannot be spread through casual contact, according to the Centers for Disease Control and Prevention, and the risk of contracting the disease from sexual activity is small, although it does increase for people who have multiple partners.
“You don’t get it from sharing a fork or drinking out of the same glass,” Klein said. “You get it from IV drug use and from getting a tattoo in an unsanitary garage.”
Pam Lynch is the co-director of Harm Reduction Michigan, a nonprofit outreach group that works with active and recovering drug users.
“Forty percent of our tests are coming back positive,” Lynch said. “Hepatitis C can live on surfaces for two weeks and on a syringe for 64 days. It is actually easier to get hep C from an accidental needle stick than it is to get HIV."
Prior to 1992, the virus was also spread through blood transfusions and transplants, but widespread screening of the blood supply has essentially eliminated that method and today the most common way to become infected is by sharing needles or other equipment while injecting drugs.
Free HCV testing combined with syringe services programs, have shown to decrease the spread of the virus, according to results of a study published in December in the Journal of the American Medical Association.
“Yes,” said Klein, of testing and syringe services, “those are our best tools.”
States that restrict these services can expect higher incidences of HCV, the study found.
In Michigan, there is little uniformity and funding for testing and needle exchange, as well as legal and political approval, vary widely from one county to the next.
For example, state funding for needle exchanges in the form of $50,000 grants has been provided to the county and district health departments governing Grand Traverse, Lake, Crawford, and Emmet counties, but not Benzie, Leelanau, or Kalkaska counties.
Kate Kerr of Addiction Treatment Services in Traverse City also said HCV is an issue of concern here.
“We certainly see a lot of our clients testing positive,” said Kerr, ATS director of communications and outreach.
Those test numbers were alarming enough for leaders at ATS to plan a local public testing event on April 18. The Michigan Department of Health and Human Services has also taken note of the rise and sponsored a Harm Reduction Summit in Lansing on April 2.
Lynch will speak on issues related to injection drug use, including HCV transmission.
Grand Traverse County Health Department’s medical director, Dr. Michael Collins, said his office recorded 68 cases of HCV in 2016, 68 cases in 2017, and 72 cases in 2018.
“The virus is spread here almost exclusively through IV drug use,” Collins said. “It’s part of the whole war against opioids. If we can keep people from using IV drugs, we’ll stop the spread of hepatitis C.”
Epidemiologists first identified the hepatitis C virus in 1989. Today the CDC says it is the most common blood-borne viral infection in the United States, there is no vaccine, and an estimated 70,000 people in Michigan are infected.
There were 11,883 new cases reported in Michigan in 2016, according to MDHHS, a 77 percent rise since 2013. The website showed an additional 912 new cases reported statewide between January 1, 2019, and March 20, 2019.
Highly effective anti-viral drugs such as Sovaldi and Harvoni were approved by the Federal Drug Administration in 2013, and have up to a 97 percent cure rate, but have been too cost prohibitive for widespread use. A full course of treatment lasts between eight and 12 weeks and can cost as much as $100,000. A California drug manufacturer, Gilead, recently announced a generic version of Sovaldi for $24,000, a figure that is still out of reach for many.
“A lot of times, this is not the biggest issue on the list of what they’re dealing with,” Lynch said, of people with substance use disorder learning they have HCV.
She said even for people who test positive but don’t access treatment right away, frequent testing for HCV still can have a community health value.
For those who believe they may have been infected with HCV, symptoms include fever, headache, exhaustion, joint pain, nausea, vomiting, diarrhea, and abdominal pain. Between 15 and 20 percent of those infected will clear the virus on their own, while 80 to 85 percent will go on to develop a chronic version of the disease. It can be fatal — chronic hepatitis is a leading cause of cirrhosis of the liver and liver cancer — and 18,000 people in the U.S. died of the disease in 2018, according to the CDC.
The incubation period for the virus is two weeks to six months from exposure, people can have the virus for years, even decades, without experiencing symptoms.
The CDC recommends one-time HCV testing for those born between 1945 and 1965, as data has traditionally shown Baby Boomers are five times more likely than other adults to be infected.
The opioid crisis has spread HCV to a younger population, as 18- to 29-year-olds make up heroin treatment admissions, according to the MDHHS.
“A result is a responsibility,” Lynch said. “You’re now aware. You now have a responsibility to others. You have a responsibility to use latex barriers and sterile injecting equipment.”
The 22nd Annual Co-Occurring Coalition Conference
Monday, April 1, 2019, 7:30 a.m. to 3:45 p.m.
NMC Hagerty Center, 715 East Front St.
"In the Realm of Hungry Ghosts: Close Encounters with Addiction" presenter Dr. Gabor Maté.
Michigan Harm Reduction Summit
Presented by the Michigan Department of Health and Human Services
Tuesday, April 2, 8 a.m. – 4 p.m.
Crowne Plaza Hotel, 925 S. Creyts Road, Lansing, MI
Free for public safety and public health professionals and advocates.
*Registration full; for more information or to be added to the waiting list call MDHHS Viral Hepatitis Unit 517-335-8165 or email MDHHS-Hepatitis@michigan.gov.
Start Your Path to Care
Free hepatitis C screening by Addiction Treatment Services
Thursday, April 18, 9 a.m. – 2 p.m.
Addiction Treatment Services office
1010 S. Garfield Ave, Traverse City
Adults 18 years and older. People who test positive will be linked to care within a few weeks via an on-site physician or telehealth. No out of pocket costs, but insurance information will be collected. For more information, contact Julie Moore at JulieM@addictiontreatmentservices.org.