Hepatitis is a well-known disease of the liver and for which people receive vaccines as children. But the shots only combat the A and B variants. In this week’s Friday Forum, WNIJ’s Chase Cavanaugh has more on Hepatitis C and how it’s being managed across northern Illinois.
Hepatitis C attacks the liver just like variants A and B. But the virus is unique enough that no one has developed a vaccine yet. This means much more work needs to be done to screen for cases and get patients into treatment programs.
LaSalle County had about 72 cases of the disease in 2015, jumping up to 95 in 2016. Jenny Barrie, with the LaSalle County Health Department, says these are chronic cases among high-risk groups.
“In 2017, we’re reporting 88 cases; 42 of those were considered Baby Boomers, so 50 to 60+ years, and then 40 were considered young people in their 20s and also of childbearing age," she said.
The disease is spread by infected blood, and Barrie says there are three main methods of transmission in LaSalle County.
“Having a tattoo is one of the highest risk factors," she said, "followed by IV drug use, and then third, followed by incarceration.”
Some of this ties into infected needles and open wounds, but Barrie says even a small amount of blood can transmit the disease.
“So sometimes people don’t realize that even razors, nail clippers, toothbrushes, could be a source of infection as well," she said.
Baby Boomers also are at risk for chronic infection, but for different reasons. Laura Cheever is Associate Administrator for the HIV/AIDS bureau of the federal Health Resources and Services Administration. She says that, as with HIV, there was a lack of knowledge about Hepatitis C and its mode of transmission before the 1980s.
“Some Hepatitis C was transmitted via blood and blood products and instrumentation used in medicine," she said, "so people that received blood transfusions or even subjected to surgery where things weren’t sterilized correctly could have gotten Hepatitis C.”
Another problem is that infection doesn’t immediately cause sickness.
“Almost half the people with Hepatitis C in the country don’t know they have it," Cheever said, "because they’re not having symptoms and they won’t have symptoms until they progress quite far down the disease and are quite ill.”
This lack of detection and a similar transmission route means that about a quarter of people infected with HIV also have Hepatitis C. And even if a patient doesn’t have both diseases, Cheever says Hepatitis C can have lasting effects if left unchecked.
“The longer you’ve had the disease, the increasing risk you have for liver cancer," she said. "So some people that have had massive fibrosis or scarring of their liver even once we treat them, because they have that scarring, they are at increased risk for liver cancer over time."
That’s why the CDC recommends that Baby Boomers get tested for the disease. Furthermore, Hepatitis C is one of more than 70 communicable diseases that Illinois physicians are required to report to county health departments, and by proxy, the Illinois Department of Public Health.
Mai Pho is an infectious disease specialist at the University of Chicago. She works on Prelink, a pilot study with the LaSalle County Jail that screens for Hepatitis C and substance abuse. Pho says testing for the disease has progressed greatly, especially since they couldn't screen blood for Hepatitis C until 1992. But Pho says screening is also a staging process.
“The screening process will pick up on anyone who’s been exposed to Hepatitis C,” she said, "but a third of people will actually clear the infection without any intervention, just all by themselves with their immune system."
Once someone is confirmed positive for Hepatitis C, then it’s a matter of getting them treated.
Amy Smith is the Infectious Disease Coordinator at the Lee County Health Department, which reported 23 Hepatitis C cases last year, compared with 16 in 2016. She says local authorities either make use of their clinical services or, in the case of areas like Lee County, send patients to an appropriate specialist.
“Either they will refer on to a gastroenterologist or somebody dealing with the liver," she said. "Then they can get on those medications to cure Hepatitis C."
Smith said early Hepatitis C drugs were marginally effective, but treatment time and side-effects were a concern.
“About 50 to 60 percent of cases, they were on it, but it made them very ill," she said, "and they were on it for at least six months. Most cases were on it for close to a year.”
Because of this limited effectiveness, Cheever says it was critical to create new medications.
“Once [patients are] tested and found to have Hepatitis C, there are new treatments that have been available for the last few years that can cure them of their Hepatitis C," she said. "So it will not be an ongoing infection. They need to take medication between 12 and 24 weeks."
Current medications have more than a 90 percent cure rate, as long as patients take their medications as scheduled. That typically comes down to about one pill per day. But getting the pills isn’t so simple. Pho says a full course of treatment can cost up to $100,000.
“One really has to have insurance for this to even be an option," she explained, "and even if someone is insured, they have to have a plan that will cover a good substantial chunk of that cost."
Despite this complication, there are no known “outbreaks” of Hepatitis C in northern Illinois. Most reported cases are chronic and are actively managed by local health departments. For example, DeKalb County had only 16 cases last year and 10 the year before.
But to keep these cases under control, Director Todd Kisner of the Winnebago County Center for Health Protection says it’s important to remain vigilant. Winnebago County had 207 cases in 2016 and 235 in 2015. Kisner plans to keep those numbers steady by making sure patients who test positive for Hepatitis C use the Winnebago County Health Department as a referral source for further care.
“So we kind of give them the option of 'Here’s all the providers in our community,' and, depending on their insurance and all of that -- who’s primary or who’s the PPO or whatever -- they make those choices themselves and seek care from there," he said.
While these steps ultimately lead to cured patients, Kisner says testing remains the most important step in the process.
“The knowledge of having it is 99 percent of the battle with Hepatitis C," he said. "Knowing that you have it, so then you can address it through treatment, and trying to cure it."