The epidemics of hepatitis C disease and incarceration intersect. About one in three persons with hepatitis C viremia in the US spends time in jail or prison for part of the year.1 In 2005, mortality among justice populations from hepatitis C began surpassing that for HIV. Prevalence of hepatitis C in this setting has not been letting up. Without attention to the corrections portion of the US hepatitis C epidemic, disease elimination will be elusive.
HepCorrections represents a collaboration of academics, public health practitioners and advocates interested in the elimination of hepatitis C disease in the United States. The goal of this website is to provide “best estimates” of hepatitis C in key populations of the United States, starting with the most current estimates of the prevalence of hepatitis C antibody positivity among persons serving time in state prison systems. We intend to improve the accuracy and reliability of the estimated numbers as more data become available. Please contact us if you have data that can be added to our effort.
While some of the estimates come from peer-reviewed publications,1,2 other numbers have not. This map would not be possible without data contributed by Siraphob Thanthong-Knight, who wrote his 2018 thesis for an M.S. from the Columbia University Graduate School of Journalism on the controversy surrounding treating hepatitis C in prisons. We welcome ongoing input from persons collecting data from correctional systems—providers, health care managers, health policy experts, etc. Please email the Emory Center for the Health of Incarcerated Persons, care of This email address is being protected from spambots. You need JavaScript enabled to view it., with suggestions and updates.
The values on the first map represent antibody positivity, which follows exposure to the hepatitis C virus. The presence of antibodies does not necessarily indicate ongoing infection. About 1 in 4 persons exposed to hepatitis C clear their viral infection on their own; virus persists in roughly 75% of persons.3 In some instances, persistent viremia can run much lower than 75%. For example, a recent survey of persons leaving the Georgia prison system found that 9.7% of persons had antibodies to HCV and 6.0% were viremic (manuscript in preparation.) Also, after treatment, antibodies persist, while viremia is cleared. For more information on the course of hepatitis C, we recommend visiting www.cdc.gov/hepatitis.
The maps demonstrate heterogeneity, which reflects regional variation in the hepatitis C epidemic, fueled by variation by geography and time in the opioid epidemic. Also, the criminal justice systems vary by state. A state with high incarceration will have a broader cross-section of its population in prison; a jurisdiction with disproportionate minority confinement will have overrepresentation of one or more racial/ethnic minority groups. The concept of heterogeneity is important to grasp. If all incarcerated populations had the 10% seroprevalence of antibodies to HCV, and 6% prevalence of viremia, seen in Georgia prisons, among the 10 million individuals going through the criminal justice system each year, there would be 600,000 infected individuals. If 40% had antibodies, approximately prevalence seen in New Mexico, and 30% had viremia, then 3 million individuals would be viremic. For an illness that affects roughly 2.7 million persons living in households,3 the number of infected persons would increase somewhere between 25% and 212% if it included persons passing through jails and prisons, which is a very wide range. Clearly the heterogeneity of the epidemic in correctional populations needs to be reflected in state level estimates of the disease.
Our long-term objective is to develop state and local level estimates of hepatitis C that include populations that are not captured in surveys of community-dwelling adults. Some investigators estimate that up to 90% of persons living with hepatitis C have ever been arrested and nearly three-quarters have ever been incarcerated.4 Eventually, we would like estimates, by year, for all states, for prison data. To supplement these estimates, we would separate maps by locality for jail data. Until the flow of persons in and out of the criminal justice system is considered, an accurate estimate of the size of the hepatitis C epidemic in the United States will be elusive. Furthermore, an accurate of understanding of the scope of the epidemic will greatly aid efforts to make hepatitis C a rare disease.
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Anne Spaulding MD MPH
This email address is being protected from spambots. You need JavaScript enabled to view it.
Center for the Health of Incarcerated Persons
Associate Professor
Rollins School of Public Health Department of Epidemiology
Emory University School of Medicine Division of Infectious Disease
Atlanta GA
References
1. Varan A, Mercer D, Stein M, Spaulding A. Hepatitis C seroprevalence among prison inmates since 2001: still high but declining. Public Health Reports 2014;129(2):187-195..
2. Spaulding AC, Adee MG, Lawrence RT, Chhatwal J, von Oehsen W. Five Questions Concerning Managing Hepatitis C in the Justice System: Finding Practical Solutions for Hepatitis C Virus Elimination. Infectious Disease Clinics of North America. 2018;32(2):323-345
3. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Annals of Internal Medicine. 2014;160(5):293-300.
4. Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. The Lancet Global Health. 2017;5(12):e1192-e1207.
