By: Karen Spataro
Virginia A. Caine, MD, director of the Marion County Public Health Department, declared a public health emergency on May 17 and called for the establishment of a syringe exchange program to combat a dramatic increase in the number of hepatitis C cases that is linked to injected opioid abuse.
Naga Chalasani, MD, director of the Division of Gastroenterology and Hepatology and associate dean for clinical research at Indiana University School of Medicine, joined other IU School of Medicine faculty and leaders from throughout the city to stand with Dr. Caine during the announcement.
Dr. Chalasani answered common questions about hepatitis C and what is driving the increase.
Q: What is hepatitis C?
A: Hepatitis C is a virus that can cause serious liver injury including cirrhosis, liver failure, and liver cancer. It generally spreads via dirty needles. It is the most common cause of liver cirrhosis and liver cancer in the United States.
Q: Why are we seeing an increase in Marion County?
A: Due to the ongoing opioid epidemic, Indiana has seen a dramatic increase in the number of acute hepatitis cases over the last four to five years. We are seeing a similarly dramatic increase in cases of acute hepatitis C in Marion county. This is believed to be due to sharing dirty needles by persons who are injecting heroin and other drugs. The problem with acute hepatitis C is that it can cause acute liver failure in some but the majority of individuals will develop chronic hepatitis and may eventually develop cirrhosis.
Q: What methods can be used to stop the outbreak?
A: While undertaking effective measures to curtail the ongoing the opioid epidemic is important, immediate measures such as a needle exchange program as well as testing and treating newly diagnosed hepatitis C cases can be used to slow down the outbreak.
Q: Does this outbreak pose a health risk for individuals who are not using intravenous drugs?
A: As hepatitis C is a blood-borne infection, there is not significant risk for individuals who are not using intravenous drugs.
Q: How is hepatitis C treated, and what is the prognosis?
A: There are very effective medications to treat hepatitis C and it can be cured in most patients. Its prognosis is excellent if cured before developing cirrhosis.
What IU School of Medicine faculty leaders are saying about the public health emergency:
“I applaud the decision to establish a needle exchange in Marion County. In addition to reducing the spread of hepatitis and HIV, needle exchange programs also connect individuals with substance use disorders to important treatment resources that can help them work toward recovery from injection drug use. We know that people who engage with treatment providers are many times more likely to recover from substance use disorders.” – Leslie A. Hulvershorn, MD, Assistant Professor of Psychiatry
“As we have seen before in Indiana, an increase in cases of hepatitis C can also be a precursor to a rise in HIV infections. As an infectious disease specialist, addressing HIV and hepatitis C and preventing new infections are my highest priorities, and a syringe exchange is a major step toward this objective.” – Bree A. Weaver, MD, Assistant Professor of Clinical Medicine and Clinical Pediatrics
“As a physician and researcher who specializes in liver diseases, I support the establishment of a needle exchange program in Marion County. Once acquired, both hepatitis C and HIV can become lifelong diseases with major consequences not just for suffering individuals and their families, but for tax payers as well. Needle exchange programs have repeatedly been shown to be effective in reducing the rates of hepatitis C and HIV infections.” – Naga Chalasani, MD, Director, Division of Gastroenterology and Hepatology