That’s one of the questions posed by Wyoming Department of Health Viral Hepatitis Prevention Coordinator Ashley Grajczyk as she describes an unexpected surge in local reports of the disease.
In 2012, there were 56 new reports of hepatitis C infections in the county — roughly double from the year before, putting the county’s rate of new infections substantially above the state average, according to Department of Health data. Around 39 percent of the 2012 reports came from the Powell area, with the remaining 61 percent coming from Cody, Grajczyk said.
Department of Health data shows the spike is generally attributable to newly reported infections among younger people between the ages of 20 and 34.
Hepatitis C is transmitted by blood, and the department’s data suggests the disease is generally being picked up by individuals sharing equipment while using drugs. It’s possible a part of the new reports are from out-of-area residents who come to Park County for substance abuse treatment, but it’s not known how much that has contributed. The county’s rate has been rising since 2008, Grajczyk said.
“We’re talking about hepatitis C here, but in reality it is at-risk kids, 15 to 30, who are doing all kinds of things that maybe we don’t want to acknowledge, or we know about but don’t know what to do about,” said Park County Public Health Nurse Manager Bill Crampton.
Crampton and Grajczyk spoke at a Nov. 7 meeting of the Park County Health Coalition in Powell, looking for ideas on how to stop the continued spread of the disease and how to help those already infected.
The Department of Health and Public Health spearheaded a campaign in May to raise awareness of the problem by hanging posters around the county. The poster’s message, as Grajczyk describes it, was “if you’re injecting drugs, you may be at risk for communicable diseases and hepatitis.”
But cases continued to crop up and “we’re seeing that we need to make further efforts,” Crampton said.
“Hepatitis C is for life. You can put it into remission. You can live with it. You can live a full and healthy life,” Crampton said later on in the meeting. “But you may need treatment for some of these folks that will bear hepatitis C badly and how do we assist them?”
Once contracted through a contaminated needle, blood transfusion, a non-professional tattoo needle or other blood-to-blood contact, hepatitis C begins to attack the liver. In the initial stages, an infected individual is unlikely to display any symptoms. However, the infection typically progresses over a course of years from that “acute” stage to a “chronic” one, where the patient may have elevated liver enzymes and feel joint pain, fatigue and chronic abdominal pain.
Liver damage or cancer can result from the disease.
“Some people can live with it for 40 to 50 years and live a full life, but then again, there are individuals who can actually die from this infection,” Grajczyk said.
Hepatitis C is treatable, but the treatment is expensive. Those high costs loom large given that, according to Grajczyk, many of the people infected are under- or un-insured.
Finding a way to provide treatment to those individuals — whether through telemedicine or a local medical provider — was one of the ideas for which Grajczyk sought input.
Increasing awareness and screening for the disease are other prongs of the plan. That may include finding health-care providers to donate resources such as testing supplies to check for hepatitis C infections.
But prevention of new infections altogether is the ultimate goal.
Crampton and Grajczyk said the effort needs to include more organizations, finding others to further the work of groups such as Northwest Wyoming Family Planning.
“We have realized that it is much bigger than these few organizations. It really is going to be a community effort when we talk about prevention activities,” Grajczyk said.
Crampton suggested education efforts though Park County Youth Services, Northwest College, local schools and substance abuse treatment providers.
In addition to warning of the dangers of using illegal drugs and sharing needles, part of the messaging may include advice on how to clean drug-injecting equipment and avoid disease.
“We may not be able to modify them and get them to stop injecting, but if they clean their equipment with bleach, you know, at least we’re making another step,” Crampton said. “Does that mean we’re promoting the idea? No, we’re not promoting the idea, but there’s just some folks that aren’t going to listen to us. We can at least break the chain at some point.”
Tai Wright, a field epidemiologist at the Wyoming Department of Health, said it’s a model of harm reduction. While health officials ultimately want individuals to stop injecting drugs, there is education that can be provided on ways to make the use more safe, Wright said.
“It’d be a wonderful world to think that they can go into a treatment program for 30 days or even a year and they come out and it’s never going to happen again, but harm reduction ... you’re going to have to go there at some point because that’s the reality,” said another woman at the meeting who’s worked with drug addicts locally. “Because it’s a sad, sad state of affairs for a lot of people.”
West Park Hospital prevention specialist Helena De Fina added that receiving education about safety could one day lead to a person quitting.
“You never know,” said Crampton. “It’s astonishing what saying one thing to one person affects somebody two people down the chain — and you never realize you had that effect.”
Powell Police Chief Roy Eckerdt asked whether it would help for the state to start regulating tattoo parlors, but Wright responded that “there’s no data to support that these diseases are coming from store-front tattoo parlors.”