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Published on August 18, 2020

Should you get tested for this other infectious disease?

Hepatitis C

While testing for COVID-19 may be top of mind for many Americans these days, the government is now recommending testing for another, more common, infectious disease - Hepatitis C.

In March, the U.S. Preventative Services Task Force recommended nearly all adults between 18 and 79 be tested once for Hepatitis C, and all women tested with each pregnancy. This was an update from the task force’s 2013 recommendation that all persons of high risk and adults born between 1945 and 1965 be screened. In April, the federal Centers for Disease Control and Prevention (CDC) followed suit, recommending universal testing of all adults. The CDC also said anyone with certain risk factors, including history of IV drug use, HIV infection or certain medical conditions, should be tested regardless of age.

Hepatitis C is a blood-borne viral infection that slowly attacks the liver and kills more people than the combined deaths associated with the other top 60 infectious diseases reported to the federal government, including HIV, according to the U.S. Preventative Services Task Force. New cases increased 3.8 times from 2010 to 2017 and an estimated 4.1 million people have been or are infected with the Hepatitis C virus.

The disease can infect anyone, and the main cause is non-medical injection drug use. Unlike HIV infection, the disease that causes AIDS and is also spread through sharing drug needles, sex isn’t a main method of transmission.

“Twenty-five percent of (infected) people can’t identify a risk,” said Marcia Peaslee, adult nurse practitioner with Cape Cod Healthcare’s Infectious Disease Clinical Services.

The cause could be from sharing a razor or toothbrush, “or something that has microscopic traces of blood,” Valerie Al-Hachem, nurse director of Cape Cod Healthcare’s Infectious Disease Clinical Services, said in a separate interview.

There is no vaccine, but Hepatitis C is treatable and curable, if caught in time. Unfortunately, infection doesn’t give immunity, so you can become infected more than once, Al-Hachem said.

Perhaps the strongest argument for screening every adult at least once is that people may go for months or even years without realizing they’re infected. The lack of symptoms among many patients is why it is called a hidden or silent epidemic, she said.

Reaching the screening goal will be difficult, as many people don’t want to admit using IV drugs, and they may not have a primary physician, Al-Hachem said. Their contact with healthcare may only be through emergency room and walk-in clinic visits for other problems. Screening requires a blood sample that would have to be ordered by a doctor.

Doctors on Board

Al-Hachem said she hopes doctors embrace the recommendation. That effort may get assistance through a new integrated electronic health record Cape Cod Healthcare is implementing. Reminders for recommended health screenings will appear on a patient’s medical record, she said.

In the past, Al-Hachem said, there may have been an attitude among some health professionals questioning the value of treating drug users for Hepatitis C, if they’re likely to become re-infected. However, treating infections and reinfections among injection drug users is important to protect others and stem the spread of disease, she said.

The recommendation that women be tested with every pregnancy provides more opportunities to detect infection, she said, and alert the mother’s OBGYN team to take precautions against transmission of the virus during birth. Treatment drugs have not yet been proven safe to use during pregnancy, so treatment of the mother and the baby, if infected, would take place after birth.

The rate of infection from mother to child is low, about 5 percent, according to Peaslee. That rate goes up for mothers with HIV.

Although medical treatment for Hepatitis C has improved over the years and it is now considered a curable condition, “We’ve only been able to identify and engage in treatment 6-8 percent of people who need it,” she said.

Baby Boomers used to be the main population of adults infected with Hepatitis C. Many contracted the disease in their youth through injection drug use, sometimes after just a single episode. In recent years, young people ages 15-39 became the group with the most infections.

“It used to be white, older men,” Al-Hachem said. “Now it’s more racially diverse, and more fifty-fifty with gender.”

High Numbers on Cape Cod

Still, there are high numbers of older people on Cape Cod infected with Hepatitis C, Peaslee said.

According to the state Bureau of Infectious Disease and Laboratory Services, Cape Cod and the Islands consistently ranked among the highest areas of Massachusetts in rates of confirmed and likely cases during the years 2014 to 2018. In 2015, the region had the highest rate compared with the 10 mainland counties. Although the rates leveled off in 2017 and 2018, during the period 2010 – 2016, the Cape and Islands had by far the highest case rate (rate per 100,000 population) of Hepatitis C infection among 15-29 year olds compared with any other county in the Commonwealth.

“New infection rates are very high,” Peaslee said, who attributed the increase to the opioid epidemic. What happens after infection varies. Peaslee said in 15-20 percent of people – especially those who are young and otherwise healthy – the infection can be eliminated by their immune system without treatment within a few months.

Most people have no symptoms shortly after contracting the disease. Those that do may have mild yellowing of the skin and eyes (known as jaundice), and nausea and abdominal pain, according to a March article on the task force’s recommendation in JAMA, the Journal of the American Medical Association. People who recover from this initial stage of acute infection, but don’t clear the virus, develop chronic infection. They may have symptoms of malaise, fatigue and weight loss, or they may have no symptoms. Years or decades with untreated disease can cause scar tissue to build up in the liver (known as cirrhosis), liver failure and the need for a liver transplant, liver cancer or death.

“Over the course of 20 years, about 20 percent of people living with chronic Hepatitis C infection will go on to develop cirrhosis,” Peaslee said.

Drinking alcohol and taking aspirin or NSAIDS, such as ibuprofen, can worsen liver damage in people with chronic Hepatitis C, she said.

“You can feel fine and have some pretty advanced damage to your liver,” she said.