Drug abuse fuels steep rise in hepatitis B in Appalachia, study shows

LOUISVILLE — Three Appalachian states have seen a huge surge in the potentially-serious liver infection hepatitis B, driven by the relentless scourge of injection drug abuse in the region, a new study says.

The research, released by the U.S. Centers for Disease Control and Prevention on Thursday, found that acute hepatitis B rose 114% in Kentucky, Tennessee and West Virginia from 2009-2013, even as incidence remained stable nationally. Injection drugs were factor in three-quarters of cases in those states from 2010 onward.

“I wish I could say this is a surprise, but it’s not,” says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. “All of the blood-borne pathogens are a concern because of how they spread…Nine in 10 people who abuse prescription pills or heroin are injecting them intravenously, and many are using dirty needles.”

Hepatitis B spreads when someone comes in contact with blood, semen or other bodily fluids from an infected person. For some patients, it’s a short-term illness, but others develop long-term, chronic infections. About 2.2 million Americans live with chronic hepatitis B, which can lead to cirrhosis or liver cancer.

Unlike hepatitis C, which is caused by a similar virus and can be spread in similar ways, hepatitis B can be prevented with a vaccine, which is recommended for infants at birth, people with multiple sex partners and injection drug users, among others. But federal surveys show that hepatitis B vaccination coverage is low among adults nationally.

Researchers say they fear the rising hepatitis B cases in Appalachia could foreshadow a larger, national problem. Drug overdose is the leading cause of accidental death in the United States, federal statistics show, with more than 47,000 drug overdose deaths in 2014, about 19,000 linked to prescription pain pills and 10,600 tied to heroin.

Researchers also point to a large outbreak of HIV, the virus that causes AIDS, in the rural southeastern Indiana county of Scott last year. With 185 cases, it was Indiana’s worst-ever HIV outbreak, fueled mostly by addicts shooting up the powerful painkiller Opana. Health officials say it's essential to work on preventing blood-borne diseases among addicts in hard-hit states and across the nation.

“The increase in (hepatitis B infections in Appalachia) has the potential to impede the nation’s hepatitis B elimination strategy,” researchers wrote in Thursday's study, adding that better vaccination coverage, testing for the disease, and educational campaigns targeting addicts “are urgently needed.”

States in the study have been trying to prevent further spread of the disease. Tennessee has partnered with county jails since 2012 to increase hepatitis B vaccination among inmates. West Virginia has collaborated with addiction centers on hepatitis prevention training and is establishing a pilot hepatitis B vaccination project in the 17 counties with the highest incidence. And Kentucky has boosted awareness campaigns and education for health care providers.

In addition, Kentucky’s legislature last year passed a law giving local communities the authority to institute needle exchange programs, which Ingram called an important weapon in the fight against hepatitis B and C and HIV. Louisville and Lexington have already started exchanges, and Ingram says they’ve been approved in three counties in other parts of the state.

Health officials also expect to see more programs nationally, since Congress effectively lifted the nation’s long-standing ban on federal funding for needle exchange programs. Though the funds still can’t be used for syringes themselves, they can go toward the costlier expenses associated with these programs, such as staff, vans, and substance abuse counseling.

“These programs do more than just give out needles,” Ingram says.

Needle exchanges are also operating in West Virginia, which State Health Officer Rahul Gupta says are part of a larger strategy to tackle addiction and disease prevention in his state. That strategy includes, among other things, boosting surveillance, providing hepatitis B vaccine to household contacts of people infected with the virus, and targeting high risk residents in places they are likely to visit, such as substance abuse treatment centers.

"This is something we have been focusing on at all levels..." Gupta says. "We certainly are very hopeful that the comprehensiveness of our approach will now help us get a handle on this."