Tennessee's worrying rise in pregnant women with Hep C

Rural parts of Tennessee have been hit hard by a nationwide rise in Hepatitis C infections in pregnant women, likely a result of the opioid abuse epidemic, according to new study from Vanderbilt University Medical Center and the Tennessee Department of Health.

The presence of Hepatitis C at birth increased 89 percent to 3.4 per 1,000 live births from 2009 to 2014. Tennessee had nearly three times hepatitis C in 2014 -- at 10.1 per 1,000 live births, per the study.

West Virginia, which has been ravaged by opioids, had the highest rate at 22.6 per live births.

The odds of a hepatitis C infection at birth was about three times higher for women in rural counties, according to the study.

Dr. Stephen Patrick, co-lead author and pediatric health policy expert at VUMC, said the increase in infections present at birth did not begin in a vacuum and is likely tied to the rise opioid addiction and abuse.

Rural communities hit the hardest

Rural counties and Appalachia were hit harder than other areas. In some counties in Tennessee, almost 8 percent of women were infected with Hepatitis C, a virus that can impact the liver, at the time of birth.

"I would have expected there would have been an increase but the amount of increase and the prevalence in some communities is pretty striking," said Patrick.

Infants can't be screened for Hepatitis C at birth because they still have a lot of their mom's antibodies so they have to be tracked, said Patrick, who was co-author of the study. It's traditionally been about 18 months before Hepatitis C is testable although there are some newer technologies that can do it earlier, he said.

The infants have to be followed in order to diagnosed in the future, but the systems to do that "don't appear to be robust," said Patrick. A study out of Philadelphia found that only 15 percent were adequately followed to see if they had Hepatitis C, he noted.

The worrisome part, Patrick said, is that the children could go on to have liver problems because of the infection, which is often a silent infection. Someone may have hepatitis C but not be ill, although it can lead to liver inflammation that results in cirrhosis and cancer.

The cost of Hepatitis C

Hepatitis C is often curable — new medications are successful on roughly nine out of 10 patients. But costs are high, one course of treatment can cost upwards of $84,000, and it can't be used on small children.

"Many people who are infected don't know they are infected," said Patrick. "We need to be more aware of it. Providers need to be more aware of it."

The rise of hepatitis C is linked to injection drug use. Its ability to be present but not make someone ill underscores the need for expanded programs for prevention and treatment options for people with addiction, said Patrick.

"No one gets pregnant and starts using opioids. It starts before," he said.

The state is mired in an opioid abuse epidemic. Overdose deaths reached a record level in 2015, and as prescriptions are getting harder come by there is a rise in street drugs and injections.

The state's had a variety of initiative, including a legislative task force, to tackle the problem and Patrick wants the momentum to continue -- even if it stalls on the national stage.

Taming the hepatitis C surge will have to be alongside opioid efforts, Patrick said.

"There is no way to tackle this problem with one solution. It really requires a comprehensive public health approach. The (opioid) problem seems to be getting worse not better, and it needs to be all hands on deck," said Patrick. "I think our response to this is tied pretty closely to our response to the opioid epidemic. I'm seeing, increasingly, our sisters, brothers, neighbors impacted by this."

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.

Tennessean


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