Kentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths—a majority of which are from prescription drugs—in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

Americans do need to worry about Ebola: not about daily risk, but about the future if it is not contained, expert says

The Ebola virus isn't a risk to Americans now, but will be "down the road" if the epidemic is not contained, says a crisis communication consultant who's been working for decades on how people and government officials respond to disease outbreaks.

Peter Sandman assured Nancy Shute of NPR that the risk to Americans does not approach any of the current hype, saying that "even if we have 10 Ebola cases a month," the U.S. can handle it.

The real risk is in the future, Sandman said. If the epidemic in West Africa is not placed under control, "a lot of sparks fly and ignite epidemics in other parts of the world" that lack health systems to handle it.

Sandman said it's normal to personalize and localize a new worry, but he would rather see Americans worry about the larger risk and work to do something about it. He also suggested that the people who are telling Americans to stop worrying should instead use this as a "teachable moment."

"If they succeed in getting people to stop worrying, they will regret it, because there's a lot to worry about it," he said. "Calming us down shouldn't be a goal."

Sandman offers four suggestions to stop the "sparks" from flying:
1. Put pressure on the government to push harder on vaccine research.
2. Make a personal contribution or urge the government to contribute toward "spark suppression."
3. Volunteer, either with your time or money.
4. Tell the CDC that you don't want 20 CDC experts in New York, you want 20 CDC experts in Nigeria to help get ready to put out the next spark and the one after that and the one after that.

"You have reason to worry that your daily life a year or two from now could be significantly worse if Ebola is all over the world," he told Shute. "And you have reason to work to prevent that, and reason to prepare for it. But what should you do in your daily life now to protect yourself against catching Ebola, assuming you're not a health care worker with an Ebola patient? Absolutely nothing. The risk to the U.S. isn't now, it's down the road."

As for the recent decisions by governors who are trying to impose quarantines on returning health-care workers, which drew open disagreement from the CDC and the White House, Sandman said, "There's certainly a case to be made that quarantine is excessive, that active monitoring would be good enough. But it seems to me to be a pretty open debate on whether quarantine is excessive or appropriate, and it depends on how cautious you want to be. Saying that the science proves incontrovertibly that quarantine is wrong — it's bad communication and it's bad science."

As of October 31, New York,  New Jersey Maine, Georgia, Illinois, California, Connecticut, Michigan, Florida, Delaware, Minnesota and Texas have varying policies on Ebola quarantines, with other states like Alaska and Kentucky still working on their policies, reports Julie Watson of the Lexington Herald-Leader.

"Kentucky officials are still hammering out an Ebola protocol but said it would likely be unnecessary given the small number of people who arrive to the state from affected countries," Watson reports.

How contagious is ebola? Not very, experts say

This story was updated Monday, Oct. 13
Several days ago, Thomas Eric Duncan died from ebola after arriving in Dallas from Liberia. He didn't appear to be ill during his journey or soon after he arrived. "Various news outlets are reporting that travelers arriving in the United States from West Africa would have their temperatures taken and be asked to answer questionnaires ascertaining any possible exposure," Kris Hickman writes for the Association of Health Care Journalists.

This story, among other ideas circling the news, has caused worry, but do people really have a reason to panic? Contagion potential is indicated by the reproduction number, which refers to the number of individuals to whom an infected person is likely to pass a disease. Epidemiologists have estimated that ebola's reproduction number is between 1.5 and 2. Measles, one of the most contagious diseases in the world, has a reproduction number of 18, and HIV has a reproduction number of 4.

The calculations are based on how long infected individuals are contagious and how much of the virus is needed to pass the diseases, among other factors, "but these data indicate that ebola is, in fact, controllable with appropriate and timely responses from the public health sector," Hickman writes.

Ebola is transmitted through contact with bodily fluids, but only when the patient is showing symptoms. The fatality rate is approximately 50 percent, particularly without proper treatment. "Reporters tapping into public health experts who can explain the concept of reproduction number should be able to show how containable the disease is and put it into proper perspective," Hickman writes.

While it is well-documented and understood how e-bola is spread, Peter Jahrling, chief scientist at the National Institute of Allergy and Infectious Diseases, is concerned that the disease has mutated to become more contagious, Julia Belluz reports for Vox.

Jahrling is worried that the "mutations of the virus that are circulating now look to be more contagious than the ones that have turned up in the past, " Belluz writes.  His Liberian team has found that the patients in Liberia have a much higher "viral load," which means that they have more virus in their blood - and that could make them more contagious. He told Bulluz that they were continuing to run test on their patients in Liberia, and they continued to show high "viral loads." When asked what this means, he said, "Right now, we just don't know."

The state Department for Public Health has prepared materials to" help hospitals, public-health agencies, health-care organizations and other coalitions in their preparedness for Ebola, Jack Brammer reports for the Lexington Herald-Leader. The materials are online at www.Kyha.com/kha-ebola-updates.