Oklahoma has highest rate of hepatitis C infections, deaths
Oklahoma City — If you put 100 people representing the breadth of Oklahoma's population in a room, the odds are good that two of them have hepatitis C — and may not know it.
Data from the Centers for Disease Control and Prevention released Wednesday showed Oklahoma had the highest rates of deaths from complications of the virus and of people living with hepatitis C infections, other than the District of Columbia.
And new infections aren't likely to stop until more people know that they have the virus and get treatment, health officials said.
Out of every 100,000 Oklahomans, an estimated 1,820 have hepatitis C, and 14 died of complications such as cirrhosis or liver cancer in 2016, according to the CDC. Only two other states had rates in the double digits, and 20 had four or fewer deaths from the same number of people.
Injection drug use appears to be driving the increase in cases, particularly among younger people, said Kristen Eberly, director of HIV and STD services at the Oklahoma State Department of Health. More than 80 percent of new diagnoses the Health Department recorded in 2017 were in people in their 20s and 30s.
“Historically, it was considered something in the baby boomer generation, and that's where we were targeting our screening,” she said. “That paradigm's shifted.”
Megan Holderness, an epidemiologist at the Oklahoma City-County Health Department, said infections are continuing to go up in Oklahoma County. The department's clinics don't do testing, but its disease investigators get reports about positive tests at local doctors' offices and try to track down other people who might have been exposed through sex or needle-sharing, she said.
Anyone born between 1945 and 1965 should get tested at least once, because the virus spread through blood transfusions until the early 1990s, said Sally Bouse, viral hepatitis prevention coordinator at the Oklahoma State Department of Health.
Injection drug users also should get tested, as should people who could have been exposed in a health care setting, she said. Less common ways of getting the virus include having sex with an infected person or getting a tattoo or piercing from an unregulated body artist.
Many people don't experience any symptoms early in a hepatitis C infection, and those that do have nonspecific complaints like headache and nausea, Bouse said. Often, people don't realize they have hepatitis C until they have a symptom like jaundice, a sign the liver already has been damaged.
“It's really easy to miss that,” she said.
The high rate of infection is creating financial problems for state agencies.
The Oklahoma Department of Corrections reported 3,107 inmates tested positive for hepatitis C in the current budget year. It costs about $29,000, on average, to treat them with the most effective drugs, so the state would have to spend more than $91 million to cure all inmates, said Matt Elliott, the department's spokesman. That's more than twice what the state spent on all inmate health care this year, he said, so the department can only treat those who are most severely ill, while monitoring the others.
“Since it's a communicable disease and most of our inmates will get out of prison eventually, it's also a public health problem,” he said in an email. “We are currently working with lawmakers to make this happen, and the conversations have been very promising.”
The costs to SoonerCare also are substantial. In budget year 2018, the state treated 683 people for hepatitis C, at a cost of $36.2 million. It was a substantial increase, and likely reflected the state's decision to no longer require people have a certain level of liver damage before treatment. About 94 percent were cured.
Treating more people so they can't continue to spread the virus is important to stopping new infections. It also would help if the state legalized syringe service programs — commonly known as needle exchanges — which can connect drug users to counseling and other services to help them quit, Bouse said.
“It's a good gateway to treatment,” she said.