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Hepatitis C rises among young people in Mass.
  Mass. officials suspect jump tied to drug use
By Stephen Smith, Boston Globe Staff | May 8, 2007
Hepatitis C infections among Massachusetts adolescents and young adults rose dramatically from 2001 to 2005, new data show, prompting health officials to warn doctors statewide to screen and educate patients about the blood-borne disease.
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Confirmed and suspected cases of hepatitis C among 15- to 25-year-olds climbed from 254 in 2001 to at least 784 in 2005, the state Department of Public Health found. In Boston, about 100 cases of the potentially painful and life-threatening liver infection were reported in 2006 -- the most this decade.
Massachusetts is better at tracking infectious diseases than many other states, making it difficult to compare state data with nationwide trends.
The spike in hepatitis C, an illness most often spread by drug needles tainted with the virus, emerges during a period of epidemic heroin use in Massachusetts.
That is almost certainly no coincidence, said John Auerbach , the state's public health commissioner. "I suspect there is a direct correlation between the increase in hepatitis C among younger people and the increase in injection drug use and heroin use, in particular," Auerbach said. "It is terribly tragic, but it is very consistent with the pattern of risk that goes along with injection-drug use."
State health authorities acknowledged that some of the rise may be attributable to more dili gent reporting of the disease by doctors.
To reverse the rising tide of both hepatitis C and heroin use, the state's Bureau of Substance Abuse Services has recently established pilot programs at community health centers and at Boston Medical Center to routinely ask every patient about possible drug use.
At the same time, the state is enlisting retired doctors and nurses to help review reports of positive hepatitis C tests, and interview adolescents and young adults to better understand the trajectory of the disease.
"We know that injecting just once with a contaminated needle can give you hepatitis C," said Dr. Alfred DeMaria , the state's director of communicable disease control.
Auerbach and other authorities said they believe that the increase in hepatitis C infections reflects a resurgence of the disease among young drug users, not among the broader population. The rise in infections, they said, demonstrates just how easily the virus can travel on the tip of a needle, or even a tube used to inhale heroin or other narcotics.
State figures show that young adults account for a growing share of all admissions to substance-abuse programs and that across age groups, heroin remains a favorite source of getting high: 50 percent of drug-treatment admissions are linked to heroin.
Dr. Maureen Jonas , a pediatric liver specialist at Children's Hospital Boston , regularly witnesses the consequences of that behavior.
"I am seeing, sadly, a fair number of 13-, 14-, 15-, 16-year-olds with IV drug use and hepatitis C," Jonas said. "A lot of them -- not all of them -- knew that the person whose needle they shared had hepatitis of some sort.
"They just have a typical adolescent frame of mind that 'it's not going to happen to me,' " said Jonas, who sits on the medical advisory board of the New England chapter of the American Liver Foundation .
The US Centers for Disease Control and Prevention estimates that about 3.2 million Americans are chronically infected with hepatitis C. In some cases, patients suffer jaundice and intense belly pains and then the disease goes away. In other patients, the virus remains latent for decades. In the worst cases, patients develop liver failure that can require a transplant.
Most of the carriers of hepatitis C in the United States are believed to be in their 40s, 50s, and 60s, having come of age during an era when drug experimentation and dirty needles were rampant, and the ramifications were not fully appreciated. That was also a period when the nation's supply of blood products was not routinely screened for the presence of the virus. The disease can also be spread during sex or by sharing toothbrushes or razors -- although it is far more difficult to contract the virus by those means.
A March report from the CDC found that rates of acute, symptomatic hepatitis C were declining in all age groups. But acute cases are a small fraction of all hepatitis C infections; in 2005, for instance, the number of newly acute patients was just 671 nationally.
The Massachusetts data, unlike the CDC's, includes everyone who tested positive for the disease, even those without symptoms.
Dr. John Ward , director of CDC's Division of Viral Hepatitis, said the agency does not have the money to do a better job of tracking hepatitis. Improving surveillance is important "both so we can actually see how many cases there are but also for patients' own care," he said.
Liver specialists typically will not begin treatment of hepatitis C until patients stop using illegal drugs and are in a setting where it is more likely that they can adhere to a regimen of powerful medications that can send the virus into remission, Jonas said.
Once adolescents successfully complete hepatitis treatment, which can take six months to a year, doctors then give them a warning, Jonas said.
"We tell them, 'You're not immune to this now. You can go out and shoot up one more time and you can get it all over again and you haven't done yourself any favors,' " the doctor said. "They look at you a little surprised when you say that."
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