Berkshires' hepatitis C rate estimated at twice national average

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PITTSFIELD — Health officials in the Berkshires are moving on several fronts to combat "sky high" rates of a potentially fatal liver disease.

This week, both the Pittsfield City Council and Board of Health are scheduled to discuss creation of a syringe-exchange program, a step North Adams is already taking.

And the Berkshire Regional Planning Commission has authorized its health staff to pursue state and federal grants to help people stricken with short-term or chronic forms of hepatitis C.

More than half of those with the viral disease don't know they have it, public health analyses show, since hepatitis C can remain asymptomatic for years.

But its presence has been a growing concern for health planners, ever since Pittsfield was listed as a hepatitis C "hot spot" in 2014.

Since 2010, more than 1,100 cases of hepatitis C have been diagnosed in Berkshire County. Factor in the number of infections not yet diagnosed, and that number may be closer to 2,000 cases, according to Jennifer Kimball, a health planner with the planning commission.

That incidence would be double the U.S. rate. This year may see 250 new cases in the county, the commission calculates.

"We were kind of shocked at the rates of hepatitis C," said Laura Kittross, public health program manager for the planning commission.

A half-day seminar the commission ran last spring on the explosion of hepatitis C cases hit its enrollment limit. Local and regional health officials who managed to get in learned the disease can turn into a long-term, chronic problem for 70 to 85 percent of those who have it. Victims become susceptible to liver cancer and liver failure.

"We had the issue gain a lot of traction with a lot of people," Kimball said of hepatitis C after last spring's seminar. "We want to do more of it."

"We have a very high need here, and it's not just us that thinks so," she said.

SYRINGE EXCHANGE

Kimball has been advising both a Pittsfield City Council committee and the Board of Health on potential benefits of a syringe-exchange program.

The health board will discuss the matter at a special meeting at 5:30 p.m. Wednesday, in City Hall Room 203.

That session follows a City Council meeting set for Tuesday at which the council's Public Health & Safety committee is expected to report on the advisability of a syringe exchange. That meeting starts at 7 p.m. in the City Council Chamber.

Gina Armstrong, the city's director of public health, said the Board of Health will review the council committee's input, then may act.

"They do feel ready to make a vote on Wednesday," Armstrong said of health board members.

However, Mayor Linda M. Tyer said Monday she plans to ask the health board to hold off on a vote until more work is done to educate the public — a delay that concerns an advocate of syringe exchange programs.

Given the rise in hepatitis C in Pittsfield, Tyer said she is inclined to support a syringe exchange "operated by experienced, professional health care providers."

But she said the public needs to understand what an exchange is — and is not. "We've started that work with the Board of Health and the City Council, but there's more to do," she said in an email in response to questions from The Eagle.

Tyer said she has asked Armstrong to reach out to the community and to other city departments about the proposal.

Liz Whynott, director of HIV health and prevention for Tapestry Health, said her group has been running education programs for years in Berkshire County. She feels an urgency, given the high number of overdose deaths, to act.

"That education will continue to happen. I just think we need to move quickly," she said. "We're in the midst of an opioid epidemic and the people we're serving are the ones that will benefit from this. That community doesn't have a very strong voice. I think it's a public health emergency."

A STATE PRIORITY

Once the health board votes to support an exchange program, as is expected, it would advise the state Department of Public Health that Pittsfield wishes to house a program.

The state would then request applications from vendors. When money becomes available, it would award a contract.

Whynott said she expects the funding to be available. "Syringe access is a priority of the DPH right now."

Armstrong said health officials in Pittsfield will continue to make the case to the public and invite their questions. The health department plans a community forum in January to provide information and take questions.

"We really want to work to help the community understand what the program is," she said.

The message to the public, Armstrong said, will be that the city is working both to reduce the transmission of disease and to help people with a drug addiction opt for treatment and recovery.

Statistics show that those who use syringe-exchange programs are five times more likely to seek treatment. Exchange programs provide information and referrals.

"It really reaches people where they're at with their addiction and recovery," Armstrong said. "There's more of a trusting relationship that develops. That's one of the most important aspects."

HEAD START

The city of North Adams is further along in the process. Tapestry has been hired by the DPH to run an exchange program there after one was approved by the city's Board of Health and backed by Mayor Richard Alcombright.

The mayor has told The Eagle he sees the program as a natural extension of work to combat opioid abuse and to improve public health.

Whynott said Monday that the North Adams project is on track and a location is expected to be announced soon.

Though Baby Boomers constitute a large part of those afflicted by hepatitis C, the numbers of new cases are growing among adolescents and young adults who are intravenous drug users, according to a 2014 DPH report.

Between 2007 and 2014, Berkshire County saw the rate of new hepatitis C cases increase by 37 percent, state figures show.

No vaccine is available, though hepatitis C can be treated with medications. It kills nearly 20,000 people a year in the U.S., according to the Centers for Disease Control.

While rates of new HIV case have been declining, the numbers are going up for hepatitis C, particularly among Baby Boomers who might have been exposed to it years ago and some are only now seeing symptoms.

Today, most people are infected with hepatitis C by sharing needles. The rapid spread of the disease stems in part from its virulence.

The virus that causes hepatitis C has been shown to survive for up to 63 days inside syringes and up to 21 days in water in a plastic container.

"It's a lot more viable than most viruses that we said," said Kimball.

"Our educated guess is that this well make a difference," Kittross said of a syringe-exchange program.

After listening to a presentation Aug. 3 by Whynott of Tapestry Health, Steve Smith of the Pittsfield Board of Health visited the syringe-exchange program that Whynott has run in Holyoke since 2012. Tapestry's Northampton needle exchange has been based in a downtown office space since 1995; it plans to open a new program in Greenfield.

Smith told fellow board members that his impressions of the Holyoke program were "very positive," according to meeting minutes.

It didn't take the 2014 report to flag the problem of hepatitis C in the Berkshires. The planning commission first determined that cases were mounting after collecting town-by-town infectious disease reports through its Berkshire Public Health Alliance.

"That's how we first recognized the hepatitis C problem, at least four years ago," Kittross said.

The disease is present across the region, but particularly in Pittsfield and North Adams.

"No community is immune," Kimball said.

OTHER EFFORTS

The planning commission is in the fourth of seven years of a grant it is using to confront opioid abuse, with many partner agencies and communities. That funding is also being used to raise awareness about hepatitis C.

Kittross and Kimball say they are waiting for word on a CDC grant they applied for in August that would expand health prevention work.

One concern is that while people with hepatitis C may receive a positive result in an initial screening, many do not obtain a second test. That may be partly due to difficulty to finding a primary-care physician.

Future grants could help the planning commission and its health alliance connect people who have hepatitis C with testing and care.

"And enable people to get the treatment they deserve," Kimball said.

"And that they need," Kittross added.


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