According to a report by the Centers for Disease Control and Prevention hepatitis C infection rates have more than tripled in four Appalachian states over the last four years.

The cause? An increase in injectable drug abuse.

The infections are hitting people under the age of 30, mostly in rural areas and particularly in the states of Kentucky, Tennessee, Virginia and West Virginia.

In the four states the infection rates rose 364% during the six years, according to the report.

“Demographic and behavioral data accompanying these reports show young persons (30 and under) from nonurban areas contributed to the majority of cases, with about 73% citing (injection drug use) as a principal risk factor,” the report found.

Heroin is the main culprit, which is sadly consistent with national reports that found an increase in first-time heroin use from 90,000 people in 2006 to 156,000 people in 2012.

While Hepatitis infection is high, HIV infection remains low. However CDC officials are concerned that Appalachia could see a sudden spike in HIV similar to what is happening in Indiana, the site of nation’s largest HIV outbreak in 20 years.

Rural America in particular refuses to use modern risk reduction strategies, such as needle exchanges, to stop a potential outbreak before it occurs. In Indiana needle exchanges are still technically banned and only allowed on a case by case basis.

Injectable drugs are the main factor behind the Indiana outbreak which mean Appalachia has all the ingredients necessary for an outbreak of the deadly disease.

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