Inspirational Initiative: Cherokee Nation on the Way to Eliminating Hep C

A recent initiative by the Cherokee Nation American Indian Tribe delivers a success story for knocking out a silent killer — Hepatitis C.

Most people know that hepatitis is a disease that has something to do with the liver. The name "hepatitis" means inflammation of the liver, and is commonly caused by a virus.

The liver is a vital organ that resides on the upper right side of your abdomen, protected by the lower rib cage. The liver is a gland, and produces compounds necessary for digestion, helps detox harmful substances in your body, cleans up old blood cells, and other essential functions. A healthy liver is critical to your well being.

What to Know About Hepatitis

Infection with a hepatitis virus is the most frequent cause of inflammation of the liver. Although there are five types of hepatitis, the three most common in the US are hepatitis A, B, and C. Here are some background points on each:

Hepatitis A

The Centers for Disease Control and Prevention (CDC) reports about 2,500 new Hep A infections per year. Hep A causes outbreaks and individual cases through ingestion of microscopic amounts of fecal matter in or on food, in drinks, or otherwise transferred from hand to mouth through poor hand hygiene. Hep A is common in many regions of the world, causes symptoms from weeks to months and passes without treatment if symptoms are not too severe. A vaccine is available.

Hepatitis B

Spread by sharing personal care items, exposure to body fluids, or from mother to child, Hep B causes about 19,200 new infections per year, and two out of three do not know they are infected. The CDC estimates between 850,000 to two million people are living with chronic Hep B. Hep B is a top cause of liver cancer and for 15–25% of victims, chronic infection occurs, sometimes leading to cirrhosis or liver failure. A vaccine is available.

Hepatitis C

Like Hep B, about half of those infected with Hep C do not know they are infected. There are about 30,500 new infections diagnosed each year, and approximately 3.5 million people in the US live with chronic Hep C. About three out of four people who currently have Hep C were born between 1945 and 1965 before blood screening identified the virus. Hep C is transmitted through blood transfusion, sharing contaminated equipment, outbreaks in healthcare facilities, or exchange of microscopic amounts of contaminated blood, as through an accidental needle stick. Hep C can cause mild or serious symptoms, and most of those infected develop the chronic form of the disease. Hep C is the leading cause of liver cancer and transplants according to the CDC. There is no vaccine available for Hep C.

In its different forms, hepatitis causes significant, sometimes lifelong, illness. While vaccines can prevent Hep A and Hep B, there is not currently a preventative vaccine for Hep C — making it essential to identify and treat those suffering from this silent, but sometimes deadly disease, before it goes too far.

How the Cherokee Nation Deals with a Sneaky & Silent Killer

In addition to those with chronic infection, Hep C is responsible for about 200,000 deaths per year from liver cancer or cirrhosis. People from American Indian and Alaska Native populations are the highest at-risk group for chronic Hep C (or HCV) in the US. In recent years, development of new antiviral drugs has made it possible to halt the destructive progression of the disease to the extent that the CDC notes treatment with the drugs produces an "equivalent to a cure for HCV infection."

A recent Morbidity and Mortality Report from the CDC discusses the strong steps taken by the Cherokee Nation tribe to put a structure in place to identify and treat members with the infection.

In October 2012, the Cherokee Nation Health Services put a fully planned and staffed program in place to test and treat members of the tribe for Hep C. More than just a good goal, the tribe instituted a testing policy, used rolling electronic health reminders, trained and staffed health clinics on the HCV testing policy and provided ongoing treatment to those impacted by the disease.

From 2012 to 2015, the Cherokee Nation raised the number of its members tested for HCV by five times — with 57% of those being in the Baby Boomer group considered at higher risk for Hep C infection. Of the 16,772 new patients tested for Hep C, 388 were confirmed to be suffering from chronic Hep C, and more than half of those were successfully treated.

Importantly, those with confirmed cases of HCV got access to ongoing treatment, including trained public health nurses who conduct outreach visits, education on treatment and testing, plus additional efforts to identify and treat HCV infection. The Cherokee Nation has even declared October 30 as "HCV Awareness Day."

The Cherokee Nation is the second largest tribal nation in the US, and runs the largest "tribal operated health system" in the US, covering 14 counties in Oklahoma. The well-planned and resourced Hep C initiative developed by the Cherokee Nation serves as a model for small-agency success in identifying and treating hepatitis in the US.

Members of the Cherokee Nation Tribal Council along with representatives of the CDC in Tahlequah, Oklahoma

"Various factors have combined to make elimination of hepatitis C possible," Jorge Mera of the CDC, pictured above in a lab coat said. "The development of new directly acting antiviral drugs has made hepatitis C treatment much more successful and with fewer side effects."

John Ward, Director of the CDC's Division of Viral Hepatitis, said in a press release: "The Cherokee Nation is demonstrating to other communities across the United States how to effectively test and treat those living with hepatitis C and prevent new infections so that someday the threat of hepatitis C will be eliminated."

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Cover image by Aaron Walden/Wikimedia