Hep C reaches epidemic level in Cherokee

by Jul 20, 2016Health, NEWS ka-no-he-da0 comments





Hepatitis C virus (Hep C or HCV) is a viral infection that affects the liver.  The disease, transmitted “primarily through large or repeated percutaneous – passage through the skin – exposures to infectious blood” according to the CDC, has reached epidemic status in Cherokee according to health officials.

Christy Duke, a senior epidemiologist with USET, gave a report to the EBCI Health Board on Wednesday, July 20 in which she outlined a study she performed on the prevalence of Hep C within the population of the Eastern Band of Cherokee Indians.  She started by telling about the difference between acute (short term, no lasting liver damage) and chronic (long-term, can cause significant liver damage) Hep C.

“About 30 percent of those with acute Hep C will go on to develop chronic Hep C,” said Duke who analyzed the RPMS (Resource and Patient Management System) figures for the EBCI for her study.

She related that the number of EBCI patients diagnosed with chronic Hep C has steadily increased from 2011-15 as such: 2011, 70 patients; 2012, 103 patients; 2013, 143 patients; 2014, 196 patients; and 2015, 204 patients.

The CDC estimates that between 2.7 and 3.9 million Americans have chronic Hep C.

Duke also gave EBCI rates for acute Hep C per 1,000 population including: 2011, 1.9 percent, 19 patients; 2012, 1.6 percent, 16 patients; 2013, 2.4 percent, 21 patients; 2014, 1.6 percent, 17 patients; and 2015, 1.2 percent, 13 patients.  Conversely, she gave the rates for the state of North Carolina for three years including: 2011, .006 percent, 60 patients; 2012, .006 percent, 63 patients; and 2013, .008 percent, 79 patients.  The EBCI patients were not counted in the state totals.

“The rates here on the reservation,” said Tribal Council Chairman Bill Taylor, “it’s scary.  It’s an epidemic.”

He said patient education about the disease is vital especially when it comes to intravenous drug users.  “You’ve got the IV users out there now, they’re not sharing needles.  They’ve got their own needles, but they don’t understand the process that when they’re loading the needles that they’re still sharing a needle.  I’ve done my homework on this, and that’s where it’s happening.  They think just because they’re using their own needle, they’re safe, but they’re not.”

According to the CDC, roughly one-third of injection drug users (IDUs) age 18-30 are infected with Hep C.  “Older and former IDUs typically have a much higher prevalence (approximately 70-09 percent) of HCV (Hep C virus) infection, reflecting the increased risk of continued injection drug use.”

In discussing a possible needle exchange program, Vickie Bradley, EBCI Secretary of Public Health and Human Services, related, “It is the only proven, effective way to curb an epidemic of Hep C.”

Laura Davis, a public health nurse with Cherokee Community Health, explained needle exchange programs a little more.  “It’s not just a straight needle that they get.  They get what they consider a cooking kit.  It’s cotton, it’s the little cookers.  All of those come individually to the person using so they’re not sharing the equipment.  So, when we say needle exchange, I think sometimes people think, ‘oh, we’re just going to give them a pack of needles’, but it’s also things that are shared among users.”

During Wednesday’s discussion, the question was raised as to the cost of treating someone with Hep C.

Casey Cooper, Cherokee Indian Hospital CEO, commented, “I don’t have a total cumulative cost, but we know that the treatment is extremely expensive.  The new drugs are very effective.  The last estimate I heard was $20,000 a month for a three-month treatment.”

He went on to say, “We have some numbers that are significantly different.”

Cooper said Duke tried to meet with them, but they were unable to get together on it.  “We’ve got numbers that are more than twice of what she is able to extract out of the system, and I think that we may have numbers and ledgers that are not in the RPMS database.  The magnitude of this is even much larger than what you’re seeing.  The most recent number I have is 539.”

Chairman Taylor commented that it’s important to get the proper numbers and put a dollar figure for treatment to it.  “If we can save a life, then I’m all for it.  That 539 is just the ones that have been tested or came into the hospital for a reason and were tested.  That’s nowhere near the number that’s walking around out here that don’t even know they have it.”

Big Cove Rep. Richard French told of a recent visit to Hastings Hospital in Oklahoma where they are doing innovative work with Hep C patients.  “We need to reach out to these people in Indian Country.  It’s not just here.  It’s all over, and if there’s someone that’s got information that is working, we need to open up and start calling them and reaching out.”

Cooper related that the Cherokee Indian Hospital will provide a more thorough report on Hep C and its treatment to the Health Board next month.

Following is some information from the CDC on Hep C:


Hep C and Injection Drug Use fact sheet