RIDOH initiatives aimed at preventing hepatitis

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As states across the country respond to hepatitis A outbreaks and steep increases in the number of new hepatitis C infections, the Rhode Island Department of Health (RIDOH) continues to advance several strategies to prevent new cases and eliminate viral hepatitis in Rhode Island.

Hepatitis is an inflammation of the liver. When the liver is inflamed or damaged, its ability to process nutrients, filter blood, and fight infections is decreased. In the United States, the most common types of viral hepatitis are hepatitis A, B and C. Many people living with hepatitis B and C, which can lead to cirrhosis (scarring of the liver), liver failure, and liver cancer, do not know they have it because often there are no symptoms. Hepatitis A does not cause chronic (ongoing) infection.

Hepatitis A usually spreads when people consume food or water that has been contaminated by the fecal matter of an infected person. Hepatitis B is spread when body fluids (such as semen or blood) from a person infected with the hepatitis B virus enter the body of someone who is not infected. Hepatitis C is spread through contact with the blood of an infected person, primarily through sharing needles, syringes, or other injection drug equipment.

"There are many factors in our communities that contribute significantly to viral hepatitis, including homelessness and unstable housing, lack of access to employment opportunities, and stigma and discrimination," said RIDOH Deputy Director Ana Novais. "To effectively address viral hepatitis, we need to get at these underlying determinants of health, and make sure that every community in Rhode Island is supporting health and wellness. Everyone in Rhode Island deserves an equal opportunity to be healthy and thrive."

RIDOH has several initiatives in place to help prevent hepatitis transmission in Rhode Island. They include:

l Convening a Hepatitis A Task Force to implement a Statewide action plan to prevent an outbreak, given the hepatitis A outbreaks in other states (including Massachusetts). The work of the Task Force has included organizing 27 clinics this year, in partnership with the Rhode Island Medical Reserve Corps, to vaccinate people at high risk of contracting hepatitis A, such as people experiencing homelessness and people who use drugs. Approximately 850 people have been vaccinated at these clinics in 10 different municipalities (Providence, Cranston, Newport, Westerly, Woonsocket, Middletown, Pawtucket, South Kingstown, Central Falls, and Richmond). Vaccination efforts will continue through August in additional cities and towns, including East Providence, West Warwick, Pawtucket, Bristol, and Warwick.

l Launching a multimedia campaign encouraging Baby Boomers to "Get Checked for Hep C." Most people in the United States who are living with hepatitis C were born between 1945 and 1965 and Baby Boomers have a 1 in 30 chance of infection.

l Providing brand new needles and other injecting equipment along with harm-reduction counseling for people who inject drugs, in order to prevent the spread of hepatitis B and C, as well as HIV. This work is done in partnership with ENCORE, Rhode Island's needle-exchange program, which is administered by AIDS Care Ocean State.

l Supporting the Rhode Island Department of Corrections' work to enhance hepatitis C screening among inmates with a history of injection drug use at the Adult Correctional Institutions (ACI). A $50,000 funding award from the Association of State and Territorial Health Officials (ASTHO) is helping advance this work (in addition to other initiatives in Rhode Island).

l Revisiting the core components of Rhode Island's strategic plan to eliminate hepatitis C, given recent medical advances that have made elimination a viable goal for Rhode Island. The plan is a collaborative effort among RIDOH, the Executive Office of Health and Human Services' Medicaid Program, and the Rhode Island Department of Corrections. One outcome of this work is that Rhode Island's Medicaid program now covers hepatitis C medication for all Rhode Island Medicaid beneficiaries living with the disease.

Since a new wave of hepatitis A outbreaks were identified in the United States in 2016, 25 states have reported a total of 22,295 cases; 13,184 hospitalizations; and 216 deaths. There have not been any outbreak-associated hepatitis A cases in Rhode Island. However, viral hepatitis remains a serious health concern here. In 2014, among Rhode Islanders, there were 102 known deaths associated with hepatitis C. This represents a five-fold increase when compared to the previous decade, and mirrors national trends. While Baby Boomers are particularly at risk for hepatitis C, the virus has also begun to affect younger Americans as the opioid crisis has worsened.

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