Hepatitis C over dialysis

This woman, who've received a hepatitis C-infected kidney, was cleared of the virus after treatment.

(The Associated Press)

In the hepatitis C epidemic across the country, Oregon is No. 1.

Oregon has a higher hepatitis C death rate than any other state, national data published this week show. The state also has a high ratio of people infected with the virus, which can cause cirrhosis and cancer of the liver.

Many don't know it.

"This is an important public health problem," said Patrick Sullivan, an epidemiology professor at Emory University in Atlanta. "Half of the folks living with hepatitis C aren't aware of their infection."

Sullivan is an author of the hepatitis C study, published in the journal of Clinical Infectious Diseases. It draws on data from the Centers for Disease Control and Prevention. As part of the study, Emory University is hosting a website comparing viral rates across the country.

More people died in 2013 from hepatitis C in the United States – about 20,000 -- than from 60 other infectious diseases combined. That makes hepatitis C the deadliest infection in the country, surpassing HIV, tuberculosis and pneumococcal disease.

The data show that the overall U.S. rate is six deaths per 100,000 people from hepatitis C. But in Oregon, the death rate is 15 per 100,000 -- more than 500 people a year.

Oregon also has a high infection rate: 3,050 per 100,000 people compared with 1,700 nationwide, according to Emory's analysis.

"This is very sobering," said Dr. Ann Thomas, an Oregon public health physician. "It's something that has been smoldering along for a long time without drawing enough attention."

Public health officials don't know why Oregon's rates are so high.

The virus is spread through contaminated blood. Most people infected in Oregon and elsewhere were born between 1945 and 1965 – long before the virus was identified around 1989. Widespread blood screening didn't start until a few years later. It wasn't until 2005 that labs in Oregon were required to report new cases to state health authorities.

The virus is typically spread through sharing dirty needles in illicit drug use. But many baby boomers could have contracted the virus before blood supplies were screened through blood transfusions or other medical procedures.

The virus isn't easily transmitted through sexual activity, according to the federal Centers for Disease Control and Prevention.

Some people – 10 to 25 percent, Sullivan said – naturally clear hepatitis C from their systems. For the rest, the virus can hibernate for decades before causing chronic disease or death.

There are so many newly diagnosed cases in Oregon – 5,000 to 6,000 a year – that the state doesn't investigate them, Thomas said.

"We don't have the resources to investigate to see whether it's a newly acquired case or not," Thomas said.

Two years ago, Oregon released a report on hepatitis C, calling attention to the state's the high rates. At the time, Dr. Katrina Hedberg, Oregon's health officer, sent a note to health providers recommending that baby boomers get tested.

The state also recommends that other groups get tested, including people with HIV, drug users and patients undergoing dialysis.

An initial test looks for antibodies to the virus, indicating exposure at some point to the virus. After that, the person can be tested to see if the virus is in the blood.

In June, Oregon health authorities will conduct an awareness campaign in the metro area, putting ads on buses and on radio that urge people to get tested.

In recent years, a number of drugs have been approved that clear the virus from the body. They can cost as much as $80,000 for a course of treatment but may be at least partially covered by insurance.

The Oregon Health Plan cost of treating hepatitis C has soared over the past few years, rising to nearly $40 million in 2015.

-- Lynne Terry