Risk Behaviors Reported by Young Adults with Chronic Hepatitis C in Florida, March-July 2012

BACKGROUND: The rate of chronic hepatitis C (HCV) cases among Floridians aged 18 to 30 years has been increasing since 2005. While the majority of chronic hepatitis C infections reported in Florida still occur among persons 45 to 64 years old (the Baby Boomer generation), the rates of newly reported chronic infections in that population have leveled off since 2008. This trend is of concern because while older adults were likely infected years or decades ago, HCV infections in younger adults represent more recent, possibly acute infections resulting from recent or current risk behaviors. The Florida Department of Health (FDOH) undertook: 1) to prospectively collect risk factor information for a sample of young adults with chronic HCV infection; and 2) to identify cases of acute HCV infection misclassified as chronic.

METHODS: Health department staff attempted to contact persons aged 18-30 years with chronic hepatitis C infection reported between March 1 and July 31, 2012 in 14 counties.  An interview tool was developed to collect specific risk factor information.  Changes were made to the state’s reportable disease surveillance system to capture the data electronically.  Data were analyzed using SAS 9.3 (Cary, NC). Proportions were calculated using a denominator that excluded ‘Missing’ responses.

RESULTS: Of 897 eligible cases, 804 were investigated, 373 were able to be contacted, and 317 completed interviews. Overall, 81% of persons reported illicit drug use and 76% of illicit drug users reported injection drug use (IDU). The most common drugs named were marijuana (88%) and oxycontin/oxycodone (75%) and 20% of drug users reported getting drugs from a licensed pharmacy.  Of those reporting recent IDU (within 6 months), 97% responded affirmatively to questions about needle sharing.  Twenty-eight percent of all persons interviewed reported having symptoms of acute hepatitis or elevated liver enzymes at the time of testing. These cases likely represent acute infections.  Extrapolating to all chronic hepatitis C cases in young adults equates to 447 acute cases incorrectly reported as chronic in Florida per year.

CONCLUSIONS: Florida administrative code requires that all liver function tests and symptoms of acute hepatitis in patients testing positive for viral hepatitis be reported to FDOH.  Data show that symptom information is often not reported to FDOH, highlighting deficiencies in acute hepatitis C reporting by providers.  Prescription drug abuse in Florida seems to be contributing to hepatitis C infections in a unique way compared with other states.