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At the Crossroads: Hepatitis C Infection in Maine

A Comprehensive Statewide Needs Assessment
The Maine Hepatitis C Infection
Needs Assessment Steering Committee

February 2001

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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 other blood exposures among health care workers,  transmission from infected women to their newborn children (uncommon), a history of long-term kidney dialysis, the receipt of clotting factors for hemophilia (before 1987), or a history of sexual contact with an infected partner (also uncommon).

Populations of Special Concern

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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