Hepatitis C on the rise in Berkshire County

Two-step testing important for diagnosis

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Public health officials in Berkshire County are continuing work in several efforts to reduce instances of the bloodborne disease hepatitis C, especially among the young.

With North Adams' syringe access program fully operating since February, and another one that was set to open early this month in Pittsfield, efforts are underway to support access to treatment and testing.

Berkshire Health Systems plans to open a dedicated hepatitis C clinic in Pittsfield this fall, and has implemented protocols that automatically order a confirmation test for hepatitis C when a patient tests positive in the initial phase of the process.

"The concern was, once you start identifying more people with hepatitis C, how are you going to treat them?" said Connie Flynn, a nurse practitioner at Berkshire Medical Center who is studying hepatitis C in Berkshire County as part of her doctorate in nursing.

Berkshire County had 153 confirmed and probable cases of hepatitis C in 2015 — the latest year for which official data is available. Statewide, the Department of Public Health alone fields between about 8,000 and 9,000 reports of confirmed and probable cases every year.

As of Aug. 29, Pittsfiled had 30 confirmed cases of hepatitis C. There are also 29 suspected cases so far this year, said Kayla Donnelly Winters, public health nurse manager for the city, in an email.

The rate of young people aged 15 to 29 with confirmed and probable cases of hepatitis C has been increasing statewide since 2008.

State and local officials have connected that change with growing intravenous drug use among young people.

"[These are] age groups related directly to injection drug use," said Jennifer Kimball, a senior planner with the Berkshire Regional Planning Commission and project coordinator for the Berkshire Opioid Abuse Prevention Collaborative.

The DPH recommends that anyone who has used illicit drugs — even once — be tested for the disease.

The testing is a two-step process: the first test determines if antibodies to the disease are present in the blood, and the second tests for ribonucleic acid associated with hepatitis C.

A task force emerged at Berkshire Health Systems about hepatitis C in response to Flynn's doctoral research. An examination of the testing process lead to updated testing protocols late last fall, she said.

Before, someone could come in for a hepatitis C antibody test — the first step in the process — test positive, and never have the second test to confirm the possible diagnosis, Flynn said.

"Sometimes, that was where it stopped," she said. "We only knew that they were exposed."

A positive antibody test for hepatitis C can only conclusively state that a patient was exposed to the disease — not if they contracted it.

Now, whenever a patient in Berkshire Health System's lab tests positive for hepatitis C, a the follow-up test is automatically ordered.

"We hope ... we're identifying more patients who have active disease," Flynn said.

And once patients have a confirmed diagnosis, treatment is much easier than it used to be.

Previous treatment to cure hepatitis C had significant side effects. But many cases of hepatitis C can now be cured with eight to 12 weeks of antivirals with minimal side effects.

"We want to be sure that those people who have the opportunity to be treated are identified, and they are evaluated appropriately so they can get into treatment," said Paula Aucoin, medical director of infection control at Berkshire Medical Center.

As a primarily bloodborne disease, hepatitis C is commonly passed through the sharing of contaminated needles. In that respect, it's similar to HIV.

But the safe injection practices to prevent the spread of hepatitis C are not the same as those for HIV.

"Just washing out your syringe barrel with bleach is not going to work," said Kimball of the Berkshire Regional Planning Commission.

"You're going to want to change out all your works."

This would include cottons, cookers and tie-offs, she said.

Massachusetts has begun a public health campaign surrounding hepatitis C, including high-quality informational material that the planning commission will send out as part of a targeted mailing, she said.

"We've really not had materials that dealt with hepatitis C related to injection drug use," she said. "Everything was always geared toward the [Baby] boomers."

The trouble containing hepatitis C tends to come after diagnosis, when patients have to access follow-up care to be cured.

"What trips up a lot of people — and I think this is universal — is closing those gaps with access to care," Kimball said.

A major barrier to treatment is knowledge itself.

Some people don't know about hepatitis C at all, or they might mistakenly think they had been vaccinated for it, when in fact there is no vaccine for the disease, she said.

For hepatitis C, early identification is especially important to prevent the spread of the disease, as many infected people don't show symptoms — like dark urine, abdominal pain and jaundice — for years.

If untreated, hepatitis C can cause serious liver damage, including cirrhosis, liver failure and liver cancer.

"There's a lot of undiagnosed cases out there," said Donnelly Winters, public health nurse manager for the city of Pittsfield. "With the opioid epidemic we're facing here in Berkshire County ... a lot of people will share needles. If you've ever used intravenous drugs, even once in your life, you should be tested for hepatitis C."

Donnelly Winters said she thinks the syringe access program in North Adams and the one planned for Pittsfield will help reduce the spread of hepatitis C by providing clean needles and encouraging people addicted to drugs to get treatment.

Through needle exchange programs, public health efforts and other programs, hepatitis C can be eradicated, said Flynn.

"It's something like polio — in 20 or 30 years, it shouldn't exist anymore," she said.

Reach staff writer Patricia LeBoeuf at 413-496-6247 or @BE_pleboeuf.


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