Spike in Adult Hepatitis Cases Linked to Surge in Homelessness, Opioid Crisis

As adult viral hepatitis infections are on the rise in 22 states, some experts attribute the outbreaks to an increase in homelessness and the opioid crisis.

Within the states experiencing a relentless growth in hepatitis A, the highest number of reports are in Ohio (3,766), Tennessee (3,167), Indiana (2,660), South Carolina (2,233), and Georgia (1,990).

Concurrently, the same states also suffer among the worst homelessness rates and opioid-related deaths in the country.

Ohio is ranked in the top 10 United States for destitute populations. Montgomery County in the southwestern part of the state had the highest rates of drug overdose-related deaths in 2017, the majority of which have been attributed to opioid addiction.

In the Carolinas, some working in homeless outreach say the dilemma is inseparable from the country’s drug abuse problem.

“Everybody thinks this is an economic issue [but] 65 to 85 percent of homeless adults have a substance abuse problem,” Anthony Marciano II, president of the Charlotte Rescue Mission told The Epoch Times.

He explained that after years of working with displaced people, post-traumatic stress disorder, mental illness, domestic violence, and recreational drug abuse are all too common in the cases he’s encountered.

Between 2019 and 2020, the homeless population in the country increased by 2 percent, but the number of sheltered individuals with chronic patterns of homelessness increased by 20 percent from 2020 to 2021. And with that, came a new wave of hepatitis infections.

“To our surprise, starting in 2018-2019, there has been an extended nationwide outbreak of hepatitis A, particularly among homeless people,” Dr. William Schaffner told The Epoch Times.

Schaffner is a professor in infectious diseases at the Vanderbilt University School of Medicine in Nashville.

He says that one of the reasons the homeless population is driving the spread of hepatitis A is because of how it’s transmitted.

California Midnight Mission
A homeless man zips up his tent in front of the non-profit Midnight Mission’s headquarters in the Skid Row neighborhood of downtown Los Angeles, on Nov. 25, 2021. (Apu Gomes/AFP via Getty Images)

“Hepatitis A is different from hep. B and C in that it’s an intestinal virus. It’s spread through close contact and occasionally through contaminated water and contaminated food.

“So, as you can imagine, this is spread through close personal contact … and homeless people live in very unhygienic circumstances, frequently very closely together,” Schaffner noted.

Before the COVID-19 pandemic shutdowns disrupted operations in nearly every industry, homelessness in the United States was already becoming an epidemic. More than 580,000 people were homeless in the United States in January 2020, at the start of the pandemic.

Once the scope of the pandemic was realized, with its subsequent restrictions and economic freefall, more people found themselves in dire straights and without a home.

The restrictions also delayed access to testing and critical treatment for those suffering from viral hepatitis.

Despite progress in the country’s economic recovery, as of 2022 the number of people experiencing homelessness was still well over 500,000.

“We know the pandemic has only made the homelessness crisis worse,” Department of Housing and Urban Development secretary Marcia Fudge said after the institute released a study on displaced people.

She added the numbers were “devastating” and said the nation had a “moral responsibility to end homelessness.”

NTD Photo
A nurse loads a syringe with a vaccine against hepatitis at a free immunization clinic for students before the start of the school year, in Lynwood, Calif., on Aug. 27, 2013. (Robyn Beck/AFP/Getty Images)

Since 2016, 37 states have reported 44,241 cases of hepatitis A, with an alarming 61 percent requiring hospitalization. From that total, 420 patients died from the contagion, according to the Centers for Disease Control and Prevention (CDC).

To date, all varieties of hepatitis remain a dangerous and potentially life-threatening viral infection that causes liver inflammation and symptoms like nausea, vomiting, abdominal pain, and fatigue.

Those afflicted with the disease can easily mistake its broad range of symptoms for other ailments, delaying critical diagnosis and treatment.

Of the five different strains, hepatitis A, B, and C are the most commonly reported.

In 2019, the CDC highlighted a 133 percent surge in acute hepatitis C incidents. In 2020, the CDC reported new cases of hepatitis C were four times higher than in 2010.

And there’s one unique characteristic that distinguishes the A strain from B or C.

“Those are blood-borne infections. Hep. B can be transmitted by a whole variety of different ways, but it’s blood-borne. Hepatitis C is almost exclusively blood-borne,” Schaffner noted.

He and other experts assert the recent spikes in hepatitis B and C cases are a direct result of the nation’s raging opioid crisis.

One study links the use of contaminated equipment, like needles for intravenous opiate usage, directly linked to a rise in hepatitis B cases since 2017.

President of the Durham Rescue Mission, Robert Tart, told The Epoch Times the combination of the pandemic and the influx of drugs has created a “one-two punch” effect on the homeless community that’s been absolutely crushing.

“My personal knowledge of people that have overdosed over the past few years has tripled [from] what we’d be used to seeing under normal circumstances,” Tart said.

In March 2022, the CDC said it wanted to expand its vaccination protocols since new hepatitis B infections were increasing among adults.

Acute infections can lead to a chronic form of the disease in an estimated 2–6 percent of cases, resulting in cirrhosis, liver cancer, and death.

“We’re losing ground. We cannot eliminate hepatitis B in the United States without a new approach,” said Dr. Mark Weng of the CDC.

Though a vaccination exists for hepatitis A and B, there isn’t one for C.

Complicating things further, people can live with B or C for years before the virus is detected.

Up to 2.2 million people in the United States are currently living with undetected hepatitis B. That number increases to 2.4 million—on the low end—for those living with hepatitis C.

Some government research says the number of those living with hepatitis C could be as high as 4.7 million people.

“As a consequence … within the last several months the CDC advisory committee on immunization practices has recommended that we now extend universal vaccination from the 19th birthday all the way up to 60,” Schaffner said.

Another panel of researchers in 2019 showed the prescription opioid OxyContin played a leading role in the rapid spike of hepatitis C infections in the United States.

The reformulation of OxyContin, which was initially intended to reduce overdose deaths from prescription opioids by making the pills harder to crush or dissolve, had unintended consequences. As a result, hepatitis C infection rates rose three times faster in states with above median rates of initial OxyContin misuse versus states with below median rates.

Before the reformulation of the drug, which forced those suffering from addiction to rely more on intravenous delivery, there was nearly no difference in hepatitis C infections across the two groups.

From The Epoch Times