Hepatitis cases in Boston surge

Hepatitis C cases soared by 300 percent in Boston during the past four years, mirroring state and national trends, the city's Public Health Commission reported yesterday.

But those figures speak more to the past than the present, because hepatitis C can lie dormant for decades before symptoms as serious as liver failure manifest themselves. The dramatic increase in hepatitis C, as well as a significant jump in local hepatitis B cases, probably is evidence that public health campaigns designed to get people tested for the illness have succeeded with unusual vigor.

Those initiatives were introduced in the late 1990s as medical authorities began to recognize the implication of hepatitis infections in the United States - infections that are often the legacy of tainted blood transfusions and recreational drug use in the 1960s and 1970s. Billboards, bus placards, and television ads all conveyed the same message, often bathed in a yellow hue evocative of the jaundice that sometimes comes with the disease: If you think you might be infected, get tested.

''It's entirely an artifact of testing, but it is not an artifact that is accidental,'' said Dr. Bela Matyas, medical director of the epidemiology program at the state Department of Public Health. ''We have spent the last three to five years aggressively trying to get people tested for hepatitis C because it is an unrecognized disease in terms of its scope. We knew the burden of hepatitis C was much, much larger than what had been identified.''

That burden grew from 380 cases among Bostonians in 1998 to 1,139 in 2001. Hepatitis B cases during the same period rose from 339 to 550. Historically, 70 percent of those who test positive for hepatitis B exhibit symptoms, while only 20 percent of people with hepatitis C suffer from them.

The city intends to issue an alert to infection-control authorities at hospitals and neighborhood health centers in coming weeks, urging doctors to share information about prevention and testing, said Dr. Anita Barry, director of communicable disease control at the Boston Public Health Commission.

Both variants of the liver disease are caused by viruses that can be transmitted person to person or through the sharing of infected drug needles. Sexual contact is identified as a common route of infection of hepatitis B, but the US Centers for Disease Control and Prevention regards Hepatitis C as difficult to contract through sexual activity.

The CDC estimates 3.9 million people in the United States are infected with hepatitis C, while 1.25 million are believed to be chronic carriers of hepatitis B, which can now be prevented with a vaccine.

The infected can harbor the viruses for decades without knowing it, which explains the urgency of campaigns to encourage people to be tested. Some carriers will never fall ill, but still have the capacity to spread the illness.

''The more testing and the more positives that are being identified, the greater the impact of the public-health message that we've been trying to circulate,'' said Miriam Alter, a hepatitis specialist at the CDC in Atlanta. ''Both government and private industry have put a lot of effort into raising awareness about hepatitis C and the need to be tested for those at high risk.''

But many of those initiatives in Massachusetts have been imperiled by state budget cuts, said John Auerbach, executive director of the Boston Public Health Commission. If the state's fractious budget negotiations don't result in the restoration of $2.75 million in prevention funding statewide, Boston will be compelled to eliminate its hepatitis initiative by July 1, Auerbach said.

Stephen Smith can be reached at stsmith@globe.com.