Hepatitis C Risk Factors Among Youth—Philadelphia, PA 2012

BACKGROUND:  Hepatitis C (HCV) is a blood borne viral infection that targets the liver and when chronic, is the leading cause for liver transplantation in the US. A trend of increasing new HCV infections in youth has been noted nationally. To better understand this trend locally and obtain detailed demographic, clinical, and risk factor information regarding infected youth, the Philadelphia Department of Public Health (PDPH) launched an enhanced surveillance program.

METHODS:  New positive HCV results with an event date from January 1-June 30, 2012 in individuals ≤30 years were identified, among all passively reported to PDPH, by cross-checking both state-wide and local communicable disease registries. Cases were contacted via phone for interview using a tailored investigation tool to detail demographic, clinical, and risk factor information. Data was captured in the PDPH Communicable Disease Management System (CDMS) and analyzed using SAS v.9.3.

RESULTS:  Of 284 new HCV reports, 130 were interviewed (response rate = 45%). Respondents were 68% Caucasian, 18% Hispanic, and did not differ significantly from non-respondents with respect to gender (55% female) and age (median=26 years). Most prevalent in clinical history were lifetime sexually transmitted infection (n=32), and pregnancy (n=20) or hospitalization (n=24) during incubation periods. Lifetime behavioral risk factors ascertained from 127 respondents > 13 years included history of illicit drug use (65%), with injection drug use (IDU) in 42%; tattooing (55%); and incarceration (38%). Corresponding reported exposure within the past six months were 26%; 20%; 13%; 13%. Among 53 with IDU history, median age of first use was 23 (13-29) years and median lifetime use was 2 (0.4-4) years, with heroin being both the most frequently first drug injected (80%) and current drug of choice. Among 70 with a tattoo history, 27 (39%) reported at least one performed in an unlicensed setting. Asked how they thought they had gotten HCV, interviewees responded IDU 42%; don’t know 19%; tattoo 14%. Forty six percent of respondents (N=97) indicated that they lacked a provider for HCV care.

CONCLUSIONS:  The newly established enhanced youth hepatitis C surveillance system has identified a baseline local characterization of HCV in the under 31 population. The greatest behavioral risk factors revealed are a history of tattooing, IDU, particularly heroin, and incarceration. Results suggest a need to increase education regarding all HCV risk factors, increase screening test availability for the detection of new cases, and for those infected, ensuring linkage to care.