YORK - Prison officials say that nearly 10,000
inmates in New York and thousands of other prisoners
across the region are infected with hepatitis C, an
insidious liver infection that is difficult to treat,
has no definite cure and, over many years, kills 5
percent of those who contract it. Prison and public
health officials are wrestling with how to respond to
the alarmingly high rates of infection, trying to
figure out both how to contain its spread, and how and
when to provide expensive treatment that, in most
cases, does not work. Some states are treating
hundreds of prisoners infected with hepatitis C, while
others are treating none.
beyond concerns about how to manage the problem inside
the prisons - guards, for instance, fear being
infected through contact with inmates' blood - public
health officials worry that prisoners may spread
hepatitis C through intravenous drug use when they are
study to be submitted to Congress this fall estimates
that 18 percent of inmates nationwide, or about
360,000 prisoners, are infected with the virus.
are still legitimate scientific questions about who
the treatment will ultimately benefit," said Dr.
Robert Greifinger, a senior fellow for the Centers for
Disease Control and Prevention, who led the study for
the Justice Department. "On the other hand, the
infection rates are very, very high. I just don't
think it's very clear yet how to manage the
Greifinger based his study on projections from several
state studies. Many states are only just beginning to
survey inmates for the infection. In New York, a
first-ever survey recently estimated that 14 percent
of the state's 70,000 prisoners have hepatitis C. In
Pennsylvania, 5,900 of the state's 36,500 prisoners
are infected. In Connecticut, the rate is believed to
be 15 percent of 17,500 inmates. New Jersey has not
broadly tested for the disease.
Northeast is hardly alone in grappling with this
health problem. In California, officials estimate that
33 percent of the state's 161,000 prisoners have the
disease. In Texas, nearly a third of the state's
157,000 prisoners are believed to be infected.
simmering and brewing and if it boils over, the
medical costs will be catastrophic," said Dr.
Frederick Maue, chief of clinical services for the
Pennsylvania Department of Corrections, which has
aggressively treated inmates who have hepatitis C.
"There will be liver transplants, multiple
hospitalizations to treat liver failures, and
increased numbers of deaths." Doctors say the
problem is not that large numbers of prisoners are
contracting hepatitis C while incarcerated; most were
infected through intravenous drug use and shared
needles years ago. It is that the infection's breadth
and power are only now becoming clear. New screening
tests developed in the early 1990s have found that far
more people are infected than was ever expected,
although many people who contract it suffer no ill
some people who were infected as long ago as the 1960s
are dying today, underscoring the fact that the
disease can prove fatal over the course of 20 to 30
years. Hepatitis C, which causes liver disease in 20
percent of its victims, kills 5 percent over two to
three decades. Because of such statistics, doctors
describe the infection as more of a potential medical
time bomb than an immediate public health threat.
2.7 million people are infected with the virus in the
United States, nearly three times as many as have HIV,
the virus that causes AIDS. A total of 8,000 people
die from illnesses related to hepatitis C each
year.The blood-borne virus is the leading cause of
liver transplants in the United States. Aside from
intravenous drug users, hundreds of thousands of other
people are believed to have contracted the disease
from blood transfusions before the early 1990s, when
effective screening tests were developed.
disease may be gradually spreading in prisons. Studies
show that 3 percent to 21 percent of inmates say they
engage in intravenous drug use while incarcerated; 44
percent of those who reported drug use said they had
shared needles. The infection's death toll is rising.
question of how best to treat the infection has
provoked debate in medical circles. For some people,
no treatment is required. But for people who show
signs of developing liver disease, it is generally
accepted that some form of treatment is advisable.
new drug treatments, costing from $10,000 to $20,000
per patient annually, show signs of curbing the
infection. But they are effective in only 15 to 45
percent of cases.
in various states, including at least five in New
York, are suing prison systems and claiming that they
are being denied treatment. Last year, a federal judge
in Kentucky ordered prison officials to treat an
inmate for the disease at a cost of $25,000 a year.