The rates of hepatitis C infections have more than tripled in four Appalachian states from 2006 to 2012, fueled by prescription drug abuse among those who inject drugs, especially in rural areas, United States health officials said.

National data show rising rates of hepatitis C infection across the nation, with the biggest increases among people under the age of 30 living in Kentucky, Tennessee, Virginia and West Virginia, according to a new report issued by the U.S. Centers for Disease Control and Prevention.

In those four states along, hepatitis C infections rose 364 percent from 2006 to 2012 with nearly half of these new cases, or about 44.8 percent, among people under the age of 30.  Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs.

The report is the first CDC study to link the rise in hepatitis C to an increase in injection drug use, said John Ward, director of viral hepatitis prevention at the CDC, who called the rising infection rates "staggering."

"We're in the midst of a national epidemic of hepatitis C," Ward said. Nationwide, more than 20,000 Americans die from hepatitis C a year, which is more than the number who die from AIDS, he said. "The CDC views hepatitis C as an urgent public health problem."

The rate of new hepatitis C infections has also risen nationwide, more than doubling from 0.3 cases per 100,000 people in 2010 to 0.7 cases in 2013.  Kentucky had the highest rates that year, with 5.1 cases per 100,000, according to the CDC with Delaware and South Carolina reporting no new cases that year.

The CDC also warned while the rates of HIV, the virus that causes AIDS, are currently low in these four states, the increase in hepatitis C infections raises concern that HIV infections could also begin to rise, as HIV is also commonly spread by contaminated needles.

Several studies have found that needle exchange programs dramatically cut the transmission of disease among injection drug users.  Research shows that needle exchanges have helped reduce HIV infections in New York.  In 1992, 52 percent of new cases were injection drug users, but ten years later, only 3 percent were injection drug users. 

The USA needs to offer more needle exchanges in order to reduce hepatitis and HIV infections, said Paul Samuels, president and director of the Legal Action Center, which advocates on behalf of people with HIV or substance abuse disorders.

"It is critically important that needle exchange programs like the temporary one in Indiana be replicated across the country, and be permanent," Samuels said. "Studies have repeatedly proven that needle exchange programs reduce HIV, hepatitis and other infections among people who use intravenous drugs without increasing intravenous drug use, and indeed they are a bridge to treatment for some participants. Substance abuse prevention and treatment, including treatment with medications, and harm reduction - including needle exchange - are all necessary components of a comprehensive strategy for combatting the opioid epidemic and addressing the many ways it can harm people with addictions."