Viral Hepatitis and Young Persons Who Inject Drugs

The recent explosive increase in the misuse of opioids and heroin in this country, particularly among persons younger than 40 years of age, has sparked growing public recognition and concern about the negative health effects related to drug use. And deservedly so: hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the numerous health threats facing people who inject drugs (PWID). These blood-borne viral infections have reached epidemic proportions in most states, disproportionately affecting rural communities in addition to young persons. Persons who become infected with HBV and HCV are also at increased risk for other diseases transmitted through injection drug use, including HIV.

How Viral Hepatitis Is Spread Among PWID

Viral hepatitis is very infectious. People who have direct contact with equipment, objects, or surfaces contaminated with infected blood, even in amounts too small to see, are at risk for infection from hepatitis C and hepatitis B, chronic diseases that can cause severe liver damage and death decades after infection. Hepatitis B can also be transmitted through other bodily fluids including semen, saliva, and vaginal secretions.

PWID are at extremely high risk for becoming infected with hepatitis C and hepatitis B, both of which can be transmitted through:

sharing needles and syringes;
sharing cookers, cottons, water, ties, alcohol swabs or other equipment used to prepare and inject drugs;
reusing any equipment used to inject drugs; and
getting an accidental needle stick from used needles and syringes that are not properly discarded.

For more information on transmission, see the CDC Viral Hepatitis website.

Hepatitis C Among PWID

Cases of hepatitis C have been increasing for several years. Approximately 30,500 new cases of hepatitis C occurred in 2014 in the United States, an increase from an estimated 16,500 new cases in 2011. Most new hepatitis C cases are among PWID. The number of new HCV infections has increased nationally, with 30 states reporting increases of more than 200% compared with cases reported during 2010-2014. The largest increases occurred among young persons in nonurban counties, particularly in Appalachian states.

Hepatitis B Among PWID

Increasing numbers of PWID are becoming infected with hepatitis B, a virus that is also spread through sexual contact, health-care exposures, childbirth, and procedures that expose persons to blood. Approximately 20,000 new cases of hepatitis B occurred in 2014, an increase from an estimated 18,800 in 2011. From 2006-2013 the number of new hepatitis B infections in three states (Kentucky, Tennessee, and West Virginia) increased among young PWID by 114%, with the increases happening primarily after 2009.

CDC’s Commitment to Preventing Viral Hepatitis Among PWID

As noted in the National Academies of Science, Engineering, and Medicine report, A National Strategy for the Elimination of Hepatitis B and C, medical and substance-use disorder services, community-based services, and correctional health services must be strengthened to prevent new viral hepatitis infections. CDC also recognizes the urgent need for improved access to preventive services for PWID. Only through improved prevention (e.g., vaccination, increased access to syringe-service programs, testing, and linkage to viral hepatitis care and treatment) can HBV and HCV be eliminated in the United States. Although interventions for both infections are available, they remain underutilized. Hepatitis B vaccination is very effective in preventing HBV infection, yet many PWID and other at-risk adults remain unvaccinated. Likewise, HCV treatment of PWID can cure persons of their infection and increase the effectiveness of prevention services to stop transmission of HCV, but many PWID remain unaware of their infection and are not provided with treatment. To address these gaps, the U.S. Department of Health and Human Services (HHS) has released guidance for state, local, tribal, and territorial health departments allowing them to request use of federal funds to support syringe services programs.

CDC is providing the programmatic foundation and leadership for the prevention and control of viral hepatitis infections among PWID by identifying communities at high risk for these infections and increasing testing and linkage to preventive services and medical care among persons who inject drugs. CDC’s approach is collaborative, as partnerships are essential in marshaling the resources to stop transmission of HBV, HCV, and HIV and reducing injection-drug use and other consequences, particularly among young persons in rural communities. CDC experts in viral hepatitis, HIV/AIDS, and injury-prevention are coordinating their efforts to prevent transmission of all bloodborne infections and unintentional deaths. Partners outside of CDC include the National Institute on Drug Abuse, state and local health departments, and a variety of non-governmental organizations.

HIV and Hepatitis C Outbreak Detection and Response

The opioid misuse epidemic has substantially increased the transmission risk of blood-borne viruses, including HIV and hepatitis C virus, through injection drug use. The following documents provide guidance on how to prepare for, detect, investigate and respond to an HIV or hepatitis C outbreak among people who inject drugs.

Managing HIV and Hepatitis C Outbreaks Among People Who Inject Drugs – A Guide For State and Local Health Departments[PDF – 102 pages]

Human Immunodeficiency Virus (HIV) & Hepatitis C Virus (HCV) Outbreak Response Plan[PDF – 48 pages]

Learn more about Viral Hepatitis and Injection-Drug Use:

Visit the CDC Injury Prevention website to learn more about prescription opioids and overdose.
Visit the CDC Viral Hepatitis website, to learn more about hepatitis B, hepatitis C, and other types of viral hepatitis, and viral hepatitis and injection drug use.
Visit the CDC HIV/AIDS website for information about syringe services programs.