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At the Crossroads: Hepatitis C Infection in Maine A Comprehensive Statewide
Needs Assessment February 2001 |
The
Epidemiology of Hepatitis C Infection in Maine
Hepatitis
C is the most common bloodborne infection in Maine. Through 1999, there
were more than 1,500 cases of hepatitis C reported to the Maine Bureau
of Health. The majority of
these cases (1,133) were documented between 1997 and 1999. Hepatitis C
infects people of all ages, ethnic groups, and socioeconomic classes in
all counties of Maine. It has been more commonly reported among men (65%
of reported cases in Maine) than women, and almost 70% of cases have
been reported among people aged 30 to 49 years old. The
two major risk factors for hepatitis C among infected Maine residents
are: having ever shared needles for injection drug use (even once, many
years ago) or ever receiving a blood transfusion or blood products
before 1992 (when more effective blood screening tests became
available). Other risk factors include: a history of accidental
needlestick or In
2001, the most common risk factor for newly acquiring hepatitis C
infection remains shared injection equipment (needles, syringes, cotton)
among persons injecting drugs. Because the majority of infections with
hepatitis C in Maine have occurred or are occurring among injection drug
users, special outreach education and awareness efforts are needed with
this population. Since injection drug use appears to be increasing in
some areas of Maine, this is an especially pressing concern. Prison
inmates are another population of special concern in regard to hepatitis
C infection. Although many
prisoners may have significant hepatitis C infection risk factors, most
correctional facilities do not routinely screen for hepatitis C at the
current time. The Maine
Department of Corrections [DOC] does not routinely test its prisoners
for hepatitis C. DOC only
tests inmates who are symptomatic, have diagnostic markers such as
elevated liver enzyme levels, or upon inmate request. DOC estimates that 85-90% of all inmates have abused drugs and/or alcohol and recognizes the possibility that routine screening might reveal a high prevalence of hepatitis C infection. The 2000 Maine DOC census was 1,680 inmates, with 767 annual new admissions in the 8 adult facilities around the state. If the range of hepatitis C infection prevalence rates reported by other states are applied to Maine (ranging from a low of 4.4% to a high of 42%), between 70 and 700 of Maine’s current prison population may have hepatitis C infection. Hepatitis
C is the number one killer of people living with human immunodeficiency
virus (HIV) infection. Hepatitis
C infection progresses more rapidly in patients co-infected with
HIV--leading to higher rates of liver damage and liver failure.
With improved therapies, HIV-infected patients are living longer
and are more likely to suffer and die from complications related to
hepatitis C, making this group of dually infected people a third
population of special concern. Currently,
there are an estimated 950-1300 people in Maine who are HIV positive.
Some AIDS service organization staff estimate that 25% of their
clients are also infected with hepatitis C.
A public health practitioner in
Portland estimates that 80-85% of the clients seen at the Ryan White
Title III clinic are HIV/hepatitis C co-infected.
These anecdotal reports are in sharp contrast to Maine Medicaid
data through 1999, which indicates that only 5% of Medicaid clients with
HIV are co-infected with hepatitis C infection.
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