Propelled by the opioid epidemic, Maine’s hepatitis B cases have surged this year, more than doubling the five-year average, according to the Maine Center for Disease Control and Prevention.

Hepatitis B cases – both chronic and acute – through Oct. 31 surpassed the total number of cases reported for all of 2016. There were 163 chronic hepatitis B cases through Oct. 31, with 67 acute cases during the same time period. For calendar year 2016, there were 157 chronic and 52 acute cases of hepatitis B. The 2017 hepatitis B cases far outpace five-year averages, which were 88 chronic cases and 10 acute cases for the same January-to-October time period.

Hepatitis C cases have also increased, although not as dramatically, with 1,596 cases of chronic hepatitis C through October. Annual hepatitis C cases have increased from about 1,200 cases five years ago to between 1,400 and 1,600 cases per year since 2014.

Health experts say that the rise in hepatitis B and C cases coincides with the state’s heroin crisis, as sharing dirty needles is a major risk factor. Other risk factors are unprotected sex and unsanitary conditions.

“We think it’s the main driver of hepatitis B cases, as the cases we’ve investigated have been linked to drug use,” said Dr. Siiri Bennett, Maine’s epidemiologist.

Chronic means the disease – an inflammation of the liver commonly caused by a viral infection – has lasted longer than six months, while acute cases are new infections.

Hepatitis B has symptoms that include fever, nausea, vomiting, fatigue, abdominal pain, dark urine and jaundice. Chronic cases can lead to cirrhosis or liver cancer. Hepatitis C has the same symptoms.

Meanwhile, Maine has seen a recent increase in hepatitis A cases, with four during the past three months, the Maine CDC reported on Monday.

While the year-to-date number of hepatitis A cases – six – is normal, “this increase in cases is unusual for this length of time,” the Maine CDC said in a news release.

There were eight cases of hepatitis A per year for the previous three years, 2014-16, according to the Maine CDC website.

Health policy experts say there’s a clear link between increased intravenous drug usage and hepatitis B and C, and Maine’s opioid epidemic has substantially worsened over the past five years. Intravenous drug use is less closely tied to hepatitis A, but it is also a risk factor for the disease, according to the U.S. Centers for Disease Control and Prevention.

Maine’s drug overdose deaths reached an all-time high in 2016, with 376 deaths, and there were 185 overdose deaths through the first half of 2017.

There is a vaccine for hepatitis B and A, but not for hepatitis C, which can cause long-term health problems, even death.

“You can get vaccinated for hepatitis A and B in one shot, and we’re encouraging people to do so,” Bennett said. “Hepatitis B cases are rapidly increasing, and it’s very worrisome.”

Zoe Odlin-Platz, community health promotion specialist at the Portland Needle Exchange, said the hepatitis B numbers are “very concerning.”

Odlin-Platz said the needle exchange promotes the use of sterile needles and helps people use safely while seeking recovery. But at the same time hepatitis rates are climbing, the needle exchange clinic in Lewiston closed, leaving the state with only five needle exchange sites – Portland, Augusta, Ellsworth, Bangor and Machias.

For the hepatitis A cases, Bennett said even though the Maine numbers are similar to previous years, the Maine CDC issued a news release to be proactive, after seeing outbreaks in other states, such as California and Kentucky.

“Outbreaks in several other U.S. states and European countries have shown that, while anyone not vaccinated against hepatitis A can get the illness, certain groups are at greater risk than others,” the Maine CDC said. “Symptoms can range from a mild illness to a severe sickness that can last several months.”

Hepatitis A symptoms are similar to those of hepatitis B.

Hepatitis A spreads “from person to person by swallowing something that is contaminated with feces, from someone who is infected with hepatitis A (for example, contaminated food and water, or through fecal-oral sexual contact). Most infections occur from contact with a household member or sex partner who has hepatitis A,” said the Maine CDC.

The agency recommends that to protect against hepatitis A, people should get vaccinated and always wash hands after using the bathroom, changing a diaper, having sex, and before preparing or eating food.

Joe Lawlor can be contacted at 791-6376 or at:

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