For nearly a decade the rate of new acute hepatitis C infections in Maine has increased dramatically, according to data from the U.S. Centers for Disease Control and Prevention. The national average has also increased. Figures are per 100,000 population.

Maine has consistently had the highest rate of new acute hepatitis C infections in the nation going back to 2020, however there may be more factors to consider when looking at why it’s so high, such as the state’s push to get more people tested and the rise of injectable drug use.

Hepatitis C causes liver inflammation, and can cause liver damage, cirrhosis, liver cancer and premature death.

For several years, Maine’s infection rate was relatively low, though still higher than the national average. In 2019, the rate almost doubled from 1.7 cases per 100,000 population in 2018 to 3.2 cases, according to data on the U.S. Centers for Disease Control and Prevention website.

That rate ballooned to 11.9 cases per 100,000 population in 2020, much higher than the national average’s 1.3 cases per 100,000 population that year, according to CDC data. Florida had the second-highest rate of new infections that year with 6.1 cases per 100,000 population.

In 2021, Maine had a rate of new hepatitis C infections of 9.8 cases per 100,000 people, according to data on the CDC’s website. Florida again had the second highest rate in the nation that year of 7.1 cases per 100,000 population. The national average of new infections that year was 1.6 cases per 100,000 population.

The rate of new Hepatitis C infections in Maine for 2022 was 6.8 cases per 100,000 population, according to data on the CDC’s website. Once again, Florida had the second highest rate of new infections in 2022 with 6.6 cases per 100,000 people. The national rate of new infections that year was 1.5 cases per 100,000 population.

Though the rate of new infections has been decreasing in Maine since 2020, hepatitis C infections have been rising nationally over the years but still not to the same level as rates seen in Maine.

New infections started increasing nationally about 25 years ago when the opioid crisis began, according to Dr. Dora Mills, MaineHealth public health physician and chief health improvement officer.

With the rise of opioid use, the practice of injecting drugs also increased, which is one of the primary ways hepatitis C is contracted, she said. Maine is one of states hardest hit by the opioid epidemic.

“We know that hepatitis C infections have increased across the county the last 20 years due to opioid crisis, because the opioid crisis has led to a lot of injectable drug use and injectable drug use is one way that hepatitis C is transmitted,” she said.

In 2020, the CDC expanded its recommendation of who should get tested, according to Maine Department of Health and Human Services spokesperson Jackie Farwell. 

It recommends that everyone be tested at least once in their life for hepatitis C and AIDS/HIV, and people with higher risk factors should be tested frequently. People should be tested with each pregnancy. This combined with more available testing has led to an increase in testing, according to Mills. 

Other common ways of infection are through blood products and blood-to-blood contact. A baby can contract the virus from its mother during birth, Mills said. More people die of hepatitis C than AIDS/HIV. Hepatitis C symptoms can begin within weeks or months after exposure.

Testing for the virus was also less common two decades ago and not as readily available to people, she said.

Though she does not know the exact reason why the rate of new infections increased, Mills said she thinks these two factors played a big role.

“In Maine, I think we did a particularly good job of testing,” she said. “So, the health systems, the community health centers and …  public health – Maine CDC – have worked very closely together the last 10 years or so to make sure that people do get tested. So, I think we’ve had very good success in testing.”

However, since 2020 that new acute infection rate has decreased every year, down to 6.8 cases per 100,000 population in 2022, which is the most recent data, according to information on the CDC’s website.

State estimates place the 2023 rate of new acute infections in Maine at 5.6 cases per 100,000, with a 39% decrease in the overall number of new infections compared to 2022, according to Maine Department of Health and Human Services spokesperson Lindsay Hammes.

However, state and federal infection rate data cannot be compared exactly because both gather infection data differently, Hammes said. State data includes probable infections whereas federal data only counts confirmed cases. Confirmed cases are determined through RNA testing, whereas positive antibody tests are considered probable cases.

Mills said she thinks the state is seeing a decrease in overall new acute infections since 2020 because many people have already been tested, resulting in fewer people who need testing. She also thinks a modest decrease in illicit drug use, an increase in administering treatments and the cure, along with an increase in resources for safe use, such as syringe services programs, have attributed to the decline.

The number of drug overdose deaths has decreased in the past couple of years, which could indicate that fewer people are using illicit drugs, she said.

Nearly a decade ago if someone tested positive for the virus they had it for the rest of their lives, but now there is a treatment that cures people, she said. There are also many more programs around the state that give people using injectable drugs clean needles. It makes them less likely to reuse needles, therefore reducing the risk of infection.

It is important to give people the tools to help them stay healthy – even if they use illicit substances – for their own health and to protect others, Mills said. If there are fewer people who have higher risk factors with the hepatitis C virus in Maine, then people in the general population who do not have high risk factors are less likely to contract the disease as well.

“It reduces the transmission amongst those who are drug addicted, who use … injectable drugs as well as everybody else,” she said.

Symptoms of acute hepatitis can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice, according to a May 30, Maine Department of Health and Human Services news release.

DHHS recommends people talk to their health care providers about being tested, get vaccinated for hepatitis A and B, and wash their hands frequently. Maine provides a confidential online form to connect people to a hepatitis navigator to seek testing and treatment.