title: Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012.
abstract: BACKGROUND
  Reports of acute hepatitis C in young persons in the United States have increased. We examined data from national surveillance and supplemental case follow-up at selected jurisdictions to describe the US epidemiology of hepatitis C virus (HCV) infection among young persons (aged ≤30 years).
  
  
  METHODS
  We examined trends in incidence of acute hepatitis C among young persons reported to the Centers for Disease Control and Prevention (CDC) during 2006-2012 by state, county, and urbanicity. Sociodemographic and behavioral characteristics of HCV-infected young persons newly reported from 2011 to 2012 were analyzed from case interviews and provider follow-up at 6 jurisdictions.
  
  
  RESULTS
  From 2006 to 2012, reported incidence of acute hepatitis C increased significantly in young persons-13% annually in nonurban counties (P = .003) vs 5% annually in urban counties (P = .028). Thirty (88%) of 34 reporting states observed higher incidence in 2012 than 2006, most noticeably in nonurban counties east of the Mississippi River. Of 1202 newly reported HCV-infected young persons, 52% were female and 85% were white. In 635 interviews, 75% of respondents reported injection drug use. Of respondents reporting drug use, 75% had abused prescription opioids, with first use on average 2.0 years before heroin.
  
  
  CONCLUSIONS
  These data indicate an emerging US epidemic of HCV infection among young nonurban persons of predominantly white race. Reported incidence was higher in 2012 than 2006 in at least 30 states, with largest increases in nonurban counties east of the Mississippi River. Prescription opioid abuse at an early age was commonly reported and should be a focus for medical and public health intervention.
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Anil G
authors.initials: AG
authors.lastname: Suryaprasad
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Jianglan Z
authors.initials: JZ
authors.lastname: White
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.affiliation: Bureau of Epidemiology, Florida Department of Health, Tallahassee.
authors.forename: Beth-Ann
authors.initials: BA
authors.lastname: Eichler
authors.affiliation: Bureau of Epidemiology, Florida Department of Health, Tallahassee.
authors.forename: Janet
authors.initials: J
authors.lastname: Hamilton
authors.affiliation: Philadelphia Department of Health, Pennsylvania Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia.
authors.forename: Ami
authors.initials: A
authors.lastname: Patel
authors.affiliation: Philadelphia Department of Health, Pennsylvania.
authors.forename: Shadia Bel
authors.initials: SB
authors.lastname: Hamdounia
authors.affiliation: Massachusetts Department of Public Health, Jamaica Plain.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Church
authors.affiliation: Massachusetts Department of Public Health, Jamaica Plain.
authors.forename: Kerri
authors.initials: K
authors.lastname: Barton
authors.affiliation: Michigan Department of Community Health, Lansing.
authors.forename: Chardé
authors.initials: C
authors.lastname: Fisher
authors.affiliation: Michigan Department of Community Health, Lansing.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Macomber
authors.affiliation: Wisconsin Division of Public Health, Madison.
authors.forename: Marisa
authors.initials: M
authors.lastname: Stanley
authors.affiliation: Wisconsin Division of Public Health, Madison.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Guilfoyle
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Kristin
authors.initials: K
authors.lastname: Sweet
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Kashif
authors.initials: K
authors.lastname: Iqbal
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Rania
authors.initials: R
authors.lastname: Tohme
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Umid
authors.initials: U
authors.lastname: Sharapov
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kupronis
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: John W
authors.initials: JW
authors.lastname: Ward
authors.affiliation: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D055030:Drug Users; D005260:Female; D005500:Follow-Up Studies; D062306:Geography, Medical; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology* / Q000266:history; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: analgesics; hepatitis C; incidence; opioid; young adult