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Hepatitis A & C: Arkansas' outbreak and 'hidden epidemic'

An Arkansas Department of Health lab technician tests samples for Hepatitis C at the state's main laboratory in Little Rock. (Photo: KATV)

Since February, Arkansas has recorded the most Hepatitis A cases the state has seen likely since the virus's vaccine was approved in the United State back in the mid 1990s. The elevated number of Hep A cases, part of a nationwide outbreak predominantly affecting northeast Arkansas - but public health officials say Hepatitis C infections far outweigh the number of people with Hepatitis A in the Natural State.

"In a normal year we'll see three to five cases of Hepatitis [A]," said Dr. Dirk Haselow, Ph.D. state epidemiologist for the Arkansas Department of Health.

As of November, more than 200 cases of Hepatitis A have been reported in Arkansas; a large majority of those cases have been concentrated in Greene, Clay, Craighead and Lawrence counties.

While the spread of Hep A had previously been associated with improper hand-washing and transmission of fecal matter, research has found an increase cases tied to injection drug use in addition to other risk factors like chronic homelessness, men who have sex with other men and incarcerated populations.

"We have people with these risk factors throughout the state," said Haselow. "The fact that it hasn't spread from there is to some extent good fortune, and we are trying our hardest to contain it where it is."

Hepatitis A vaccinations have been required for children in Arkansas since 2013 and had been suggested by the American Association of Pediatrics for about a decade prior. It's why the Hep A outbreak in Arkansas is mostly affecting people between the ages of 20-65.

Tackling the Hep A outbreak has been difficult for the state, primarily due to the infection's incubation period.

"It's typically between three weeks and three months," said Haselow. "I don't remember what I ate yesterday - most people don't. And to think that you would have a precise memory going back three weeks or three months of what you might have been exposed to makes it really difficult to track down people like this."

In the state's response to the Hepatitis A outbreak and subsequent screening, tests have shown that roughly one-third of those testing positive for Hepatitis A are also testing positive for Hepatitis C.

"Hepatitis C has been described by Newsweek and Time Magazine as the hidden epidemic," said Haselow. "Roughly two-percent of Americans have Hepatitis C and many not know it. So in Arkansas, you know two-percent of three-million people is quite a few - 60,000 people."

Part of the reason Hepatitis C is likely more widespread across Arkansas than Hepatitis A is the self-limiting nature of Hep A, as well as the availability of vaccines.

"You end up with a diarrheal illness and it goes away," said Dr. Ryan Dare, an infectious diseases doctor and professor at UAMS.

The Hepatitis A outbreak has required roughly half of Arkansans infected to be hospitalized, according to Haselow, the disease will likely only last a month, with symptoms and the disease clearing the patient's system. On the flip side, Hepatitis C typically lays dormant until it isn't and can result in liver disease and liver failure if left untreated.

"You live with it for life, unless we provide treatment to get ride of it," said Dare.

Hepatitis C is somewhat similar to HIV, only in the way the diseases are transmitted and how most patients are unaware of their diagnosis without being screened. Dare said the Centers for Disease Control now recommend a large portion of Americans, regardless of risk factor, be tested for Hepatitis C, and the main reason for that is that main difference between Hep C and HIV - there's a cure.

"We have a tolerable, one-month to two-month treatment course that will cure the patient of the infection, which from a public health standpoint is amazing that we've been able to do this in such a short period of time," said Dare, noting that Hepatitis C wasn't really discovered in the late 1980s.

In 2016, the CDC conducted a nationwide study to determine which counties were at the highest risk of spreading HIV and Hepatitis C among people who use injection drugs. Two Arkansas counties made the list.

"They identified the top 220 counties throughout our country at the highest risk for transmission, and two counties in Arkansas were identified via that study - Sharp and Lawrence," said Mike Cima, Ph.D, chief epidemiologist of outbreak response at the Arkansas Department of Health.

Since that study, ADH has received federal funding to increase Hep C & HIV surveillance and further study what portions of the state may be at a higher risk for transmission of those diseases through drug use.

"We have access to much more local data that can give us a better idea of which counties in particular here in the state are at the highest risk," said Cima.

"I think the study is going to shed a light on areas that have a high burden of these diseases so that we can further direct resources from the Department of Health to help those that are on-going, as well as preventing further outbreaks in the future."

As for the current Hepatitis A outbreak, Haselow says ADH is using every resource at their disposal to try and identify close contacts of confirmed cases to help stop the spread.

"We use our disease intervention specialists, we use our communicable disease nurses - we're even partnering with EMTs and paramedics up in the area to help deliver vaccines."

For more information on Hepatitis A and the current outbreak in Arkansas, click here to be directed to the Arkansas Department of Health website - and for more information on Hepatitis C prevention, click here.

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