CALIF. OFFICIALS STEP UP THE FIGHT AGAINST HEPATITIS

STOCKTON - With a new strategic plan in place, California public
health officials hope to break the silence about hepatitis.

"It's important to recognize that viral hepatitis is a significant
and costly public health problem. Most people who are infected have
no symptoms and are completely unaware of their status. We have been
silent too long about the problem," said Dr. Gail Bolan, chief of the
Sexually Transmitted Diseases Control Branch of the state Department
of Public Health.

Dr. Karen Furst, health officer with San Joaquin County's Public
Health Services, said, "The ultimate control is prevention. We still
have a lot of folks out there who don't know they are infected. So
it's important to identify those people at high risk."

Hepatitis - inflammation of the liver caused by a viral infection -
can lead to liver disease such as cirrhosis and liver cancer. The
three most common viruses are hepatitis A, hepatitis B and hepatitis C.

According to the federal Centers for Disease Control and Prevention,
viral hepatitis is the leading cause of liver cancer and the most
common reason for liver transplants. In the United States, an
estimated 1.2 million Americans are living with chronic hepatitis B
and 3.2 million are living with chronic hepatitis C.

Earlier this month, Bolan's agency released a comprehensive planning
document. Among key findings:

. The need for awareness of what hepatitis is, how it is transmitted,
the availability of simple screening tests and effective vaccination
(except for hepatitis C, for which there is no vaccine).

. In 2007, state hospitalizations for hepatitis B and C cost $2 billion.

. The incidence of liver cancer over the next 20 years is expected to
increase 59 percent and be highest among Latinos, Asian Americans and
Pacific Islanders.

People with hepatitis A have symptoms ranging from a mild illness
lasting a few weeks to severe health problems lasting months. It is
usually spread when a person ingests fecal matter from contact with
contaminated objects, food or drinks. It can be prevented through vaccination.

As a reportable disease, there were 10 cases of hepatitis A in San
Joaquin County during 2008, the last year for available data.
Statistics show the disease steadily in decline the past 10 years
except for outbreaks in 2001 and 2005.

Hepatitis B, on the other hand, is usually spread when blood, semen
or another body fluid from an infected person enters the body of
someone who is not infected. This can happen through sexual contact,
sharing drug needles or from an infected mother to her baby at birth.

Acute hepatitis B is a short-term illness that usually occurs within
six months of exposure and can - but does not always - lead to
chronic infection. Chronic hepatitis B remains in the body long term,
leading to serious health problems and even death. An effective
vaccine preventing hepatitis B has been available since 1982.

In 2008, there were eight new cases of acute hepatitis B reported in
San Joaquin County. There was a high of 49 cases in 2002. There were
220 cases in the county of chronic hepatitis B in 2008, showing
little change over the previous two years.

The county's efforts to break the cycle of transmission between
infected mother and baby are working exceptionally well, according to
Furst. Doctors are required to test pregnant women for hepatitis B.

"They have very good efficacy for preventing the baby from getting
chronic hepatitis B," Furst said. In addition, "we evaluate the whole
family. If there are no (hepatitis) infections, we vaccinate," Furst said.

Most people at risk today for hepatitis B are in their 30s or older,
since most young people have been vaccinated.

Hepatitis C is the nation's most common chronic blood-borne
infection. During 2008, there were 1,819 cases reported in the
county. That's almost double the 931 cases reported in 2007, but the
reporting pool grew when clinical laboratories were first required to
report cases in addition to physicians.

Furst also noted that county numbers are skewed higher because of the
presence of Deuel Vocational Institution near Tracy, a large state
prison. According to the state report, approximately 55,000 of the
more than 150,000 people incarcerated in California prisons have hepatitis C.

Hepatitis C is primarily transmitted through dirty syringes commonly
shared among intravenous drug users.

Dr. Aziz Khambati, an internal medicine physician who has been with
downtown Stockton's Channel Medical Center for 14 years, sees about
25 patients with hepatitis C. Most acquired the disease because they
were sharing needles.

"I see a need for a clean needle-exchange program along with a strong
educational element. I would advocate for education," Khambati said.

Stockton and San Joaquin County are among the largest jurisdictions
in the state without an authorized needle-exchange program. Advocates
say it is the simplest way to prevent the spread of hepatitis C.

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TO LEARN MORE

California Hepatitis Alliance: www.calhep.org

California Department of Public Health:
www.cdph.ca.gov/programs/Pages/ovhp.aspx

Federal Centers for Disease Control and Prevention: www.cdc.gov/hepatitis