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Hepatitis cases in Boston surge
Officials cite wider testing
By Stephen Smith, Globe Staff,
C cases soared by 300 percent in Boston during the past four years,
mirroring state and national trends, the city's Public Health Commission
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,
''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.