The California Department of Public Health, or CDPH, reported that between 2007 and 2015, newly reported hepatitis C infections increased 55 percent among men 20-29 years of age and 37 percent among women in the same age group.

The state said the data is consistent with increases in hepatitis C across the country and highlights the importance of hepatitis C testing, treatment and prevention. Injection drug use among young adults increases their risk of both hepatitis C transmission and infection. 

“As a physician, I have seen firsthand the deadly effects of hepatitis C,” said CDPH Director and State Public Health Officer Dr. Karen Smith. “Patients with advanced liver disease may not know they are infected until it’s too late,” said Dr. Smith. “However, this is preventable. New treatments can cure hepatitis C in as little as two months. I urge people to speak with their doctors about getting tested.”

An estimated 400,000 Californians live with chronic hepatitis C, but many do not know they are infected. Hepatitis C-related deaths now outnumber those due to HIV, CDPH said.

In Lake County, the data showed that from 2011 to 2015 the number of newly reported cases rose by 29.6 percent.

Lake County Public Health Officer Dr. Karen Tait said that, in reviewing the data, it did appear that there was a trending up of cases, but she also noted wide fluctuations in the data that called for further study to feel confident in the information.

Her analysis showed that there were 1,520 total cases reported in that four-year period, of which 656, or 43 percent, were confirmed, 17 were concluded to not be hepatitis C and 661, or 43.5 percent, had been previously reported.

Of the 656 confirmed cases, 41 percent were female and 59 percent were male, with a mean age of 53, she said.

“I am concerned that I have noted some cases being reported in populations younger than the baby boomers,” said Tait. “This raises questions about the risk factors and concern over injection drug abuse specifically. The syringe exchange program, Any Positive Change, certainly worries about Hepatitis C transmission.

Tait said trends in opioid use have, for a number of years – even before prescribing got tighter – demonstrated increases in heroin use because it is now less expensive than prescription opioid drugs. 

“However, if you look at the age breakdown by each year, you can see that there was an apparent shift toward some younger cases starting in 2012,” she said. “That seems fairly sustained in the subsequent years. So, even though the mean age by year didn't really change, the breakdown does demonstrate a concerning shift toward younger cases.”

Tait also offered cautions about the data. 

For one, she explained that the increased overall number of cases reported by year does not necessarily mean that Lake County had a true increase of that magnitude. Rather, it probably reflects the push toward more screening now that there is an effective treatment for hepatitis C.

Other limitations in the data Tait pointed to include that the infection in many reported cases may have been acquired elsewhere, been present for many years and only shows up in local data when testing is done on people when they live in Lake County.  

“There is a great deal of duplication of reports because people who are repeatedly tested show up as a case every time they have a positive result,” she said. “That means they might be reported in multiple counties.”

Tait said it takes a huge amount of work for the state to sort out all of these duplicate reports so that they can assign a case to the county they resided in when they were first diagnosed.

“This is why I try not to over-interpret hep C data,” she said. “However, I do think that the young people diagnosed may be reflecting recent-enough infections that there is cause for concern.”

Tait pointed to needed interventions including education of all age groups about the risks of injection drug use, more screening of at-risk younger people and referral for treatment, since there are now very good drugs that can cure Hepatitis C with a high rate of success.

CDPH said prevention strategies, including access to sterile syringes and safe injection equipment and treatment for opioid use disorders, can reduce the rate of new hepatitis C infections among young people who inject drugs by 60 percent.

The U.S. Food and Drug Administration recently approved the use of new treatment for adolescents 12 years and older, raising hopes for teenagers infected with hepatitis C. 

Although young Californians – ages 20 to 29 – make up an increasing number of newly reported infections, baby boomers account for about one out of two newly reported chronic hepatitis C cases, according to CDPH.

“Two groups are top priority for hepatitis C testing – young people who inject drugs and baby boomers,” said Dr. Smith. “Drug users may be at high risk for transmitting hepatitis C to others if they are not being treated, and baby boomers may be at risk for developing serious liver disease, even if they have no symptoms.”

CDPH urges all Californians who have ever injected drugs, even once, and all people born between 1945 and 1965 to talk to their doctors about getting tested for hepatitis C. Patients who test positive should receive care from an experienced provider.

CDPH reported that it is working to address hepatitis C on multiple fronts, including monitoring hepatitis C trends, producing data reports, educating health care providers on hepatitis C screening and treatment guidelines, and supporting hepatitis C testing and access to care in settings where at-risk people are served. 

The agency also supports coordinated HIV and hepatitis C testing in non-traditional settings, such as mobile health vans. In 2016, about 7,200 people received hepatitis C testing through these programs.

The California Legislature allocated $2.2 million in July 2015 for three-year pilot projects to help ensure people with hepatitis C are aware of their infections and linked to care.

CDPH is working with partner organizations including the AIDS Service Network of San Luis Obispo and Monterey Counties, Butte County Health Department, Family Health Centers of San Diego, San Francisco Department of Public Health and St. John's Well Child and Family Center (serving Central and South Los Angeles and Compton) on pilot projects.

For more information about viral hepatitis prevention in California, visit the CDPH Office of Viral Hepatitis Prevention Web page.

Email Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it. . Follow her on Twitter, @ERLarson, or Lake County News, @LakeCoNews.