Hepatitis A is on the rise in the nation and has significantly worsened in Louisiana, with a reported 331 cases and one death in the state. The state usually sees eight to ten cases a year, but the statistics have drastically risen in the last year-and-a-half. Three of these cases have been reported in the Acadiana area.
According to the Department of Health website, hepatitis A is described as “a highly contagious liver infection caused by the hepatitis A virus. It is a vaccine-preventable illness that is easily spread through close contact, as well as from sharing injection and non-injection drugs.
“Hepatitis A usually spreads when a person unknowingly ingests the virus from objects, food or drinks contaminated by small, undetected amounts of stool (feces) from an infected person. Hepatitis A can also spread from close personal contact with an infected person such as through sex or caring for someone who is ill.
“An infected person can transmit the virus to others up to two weeks before symptoms appear, and even those who do not experience symptoms can transmit the virus to others.
“Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain and jaundice (yellowing of the skin and eyes).”
Dr. Tina Stefanski, regional medical director for the Office of Public Health, said the recent outbreak began at the end of 2018, and since January 2018, there have been 331 cases of hepatitis A, 328 of which are linked to the outbreak. “It does not look like it’s slowing down at this point,” she said.
Dr. Stefanski said the state of Louisiana purchased a large amount of hepatitis A vaccine and is working with the Office of Public Health to vaccinate individuals in each community to slow the outbreak. They are focusing on the most at-risk individuals such as prisoners, the homeless, and drug users. Anyone can get a vaccine at the health unit, but one should call and make an appointment first.
So far, zero cases have been reported for Evangeline Parish, however several cases have been reported in surrounding parishes, specifically St. Landry, Allen, and Acadia.
Hepatitis C, on the other hand, is a chronic inflammation of the liver, and it is only spread through blood. Hepatitis C is a large concern in the United States, including Louisiana. According to a recent press release, Governor John Bel Edwards joined Secretary Rebekah Gee of the Louisiana Department of Health, Secretary James LeBlanc of the Louisiana Department of Corrections, and Asegua Therapeutics LLC, a wholly-owned subsidiary of Gilead Sciences, Inc., to announce a deal that will allow the implementation of an innovative payment model for hepatitis C treatment, part of Louisiana’s plan to eliminate the disease.
“This new model has the potential to save many lives and improve the health of our citizens. It is an important day for our state, for our partner Asegua Therapeutics, for providers, but most importantly for the patients and their families who will benefit from treatment,” said Governor Edwards. “Asegua was willing to come to the table to work with us to help Louisiana residents and we are pleased to initiate this five year partnership. Ultimately, our goal is to eliminate this disease in Louisiana, and we have taken a big step forward in that effort.”
In the United States, hepatitis C kills more people than all other infectious diseases combined. At least 39,000 people in Louisiana’s Medicaid program and prison system suffer from hepatitis C infection. There are millions of cases nation-wide.
Dr. Stefanski said, “Louisiana is the first in the nation to implement the hepatitis C treatment program. There is no vaccine. The cure is in the form of a pill taken once a day for 12 weeks. The subscription model will go live July 15.” She added, “One of the highest risk groups is Baby Boomers. People born between 1945-1965 are five times more likely to have hepatitis C than other adults. One of the theories is infection control practices were much different than they are now, and there could have been infected blood products. By 1992, a widespread cleaning of the blood supply eliminated the virus from the supply.”
Dr. Rebekah Gee, secretary of the Louisiana Department of Health, said, “An elimination plan and innovative payment model will ensure that we can cure this deadly disease and prevent long-term illness and disability in those who have it. The Department of Health’s goal is to treat at least 31,000 people by the end of 2024 and eventually eliminate this disease.”
After extensive research and work with policy experts across the nation, the Department of Health released a solicitation of offers in January of 2019 in search of a pharmaceutical company willing to partner with Louisiana on a subscription model. Asegua Therapeutics was announced as the selected partner in April, and through subsequent discussions the parties have agreed to a modified model.
“We are pleased that Asegua has the courage to be a pioneer and chart a new path forward that will allow us to save many lives and improve the health of our citizens,” added Gee.
The innovative payment model for Louisiana addresses the needs of patients and joins the goals of both Louisiana and Asegua to extend a cure to those in need.
“This partnership will have a direct and immediate impact on the most vulnerable populations with hepatitis C – people who are on Medicaid or who receive care through the state corrections system. These populations are disproportionately affected by hepatitis C and often face the greatest difficulty in accessing care,” said Gregg Alton, Chief Patient Officer at Gilead Sciences. “We are committed to supporting efforts to eliminate hepatitis C in communities around the world and are excited to partner with the visionary leaders in Louisiana to make this public health opportunity a reality in this state.”
The innovative payment model allows the state to provide an unrestricted amount of Asegua’s direct-acting antiviral medication, the authorized generic of Epclusa® (sofosbuvir/velpatasvir) to treat patients within Louisiana’s Medicaid and Department of Corrections populations and caps the State’s medication costs.
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NANCY DUPLECHAIN Associate Editor