Quelling hepatitis

State public safety and health officials are working with community advocates to educate and support Hawaii prisoners with hepatitis B and C to prevent the disease from spreading.

Symposium on a 'Silent Epidemic' The Hepatitis Support Network will hold a symposium on "Hepatitis in Hawaii -- unique perspectives and problem solving" from 8 a.m. to 4 p.m. Oct. 27 at the Queen's Conference Center, 510 S. Beretania St. » The free event will address problems Hawaii medical professionals are facing with the "silent epidemics" of hepatitis B and C, the network said. » National and Hawaii specialists will discuss epidemiology, screening, diagnosis, liver disease, therapies, research, reimbursement, vaccines and what to expect in the future. Hawaii has the highest rate of liver cancer in the United States, and complications from end-stage liver disease are expected to increase by 60 to 200 percent in the next few years, according to the network. » Up to 10 percent of Hawaii residents born in Asian and Pacific island countries could have chronic viral hepatitis B and not know it because most people do not feel any symptoms until it might be too late for successful treatment, the network said. » To register for the symposium, fax your name, contact information and degree and/or title by today to 585-0206. Attendance is limited to 100 people.

"We're doing education so prisoners inside know how not to spread it and how not to get it," said Heather Lusk, state Health Department coordinator for hepatitis C. "It's a big public health issue to help people transitioning out of prison to not increase transmission of hepatitis C."

The Hepatitis Support Network of Hawaii initiated the Hepatitis Prison and Outreach Ministries project, directed by Eddie Ochoa with collaborators Lusk and Dr. Kay Bauman, Public Safety Department medical director.

Lusk said she created the curriculum based on the federal correctional health care curriculum with feedback from hepatitis support volunteers, Bauman and other public safety officials.

The program will begin at Halawa Correctional Facility and eventually expand to other prisons, Lusk said. She will train some peer educators in the prisons to help with the workshops. Hepatitis is a viral liver disease, and hepatitis B can sometimes be fatal.

When she joined the Public Safety Department five years ago, Bauman said her major task was to get a hepatitis treatment program going.

"We try to treat them during their incarceration so we don't have to worry about them continuing when released."

Guidelines are updated regularly, Bauman said. "We're very careful to watch what's going on in the country and St. Francis Liver Center."

Hawaii has the highest rate of liver cancer in the nation because of high rates of hepatitis B and C, a liver disease.

Bauman works with infectious-disease specialist Alan Tice on treatments offered at all prison facilities, including the women's correctional center and mainland prisons housing Hawaii inmates.

"Our cure rate is just a little better than nationally published cure rates," she said. "It's just a challenging treatment program because patients require a lot of monitoring and support."

All inmates entering the corrections system are offered a hepatitis C test at intake, and all prisoners within the system are offered hepatitis B immunizations. (There is no vaccine for hepatitis C.)

Inmates were offered HIV/AIDS testing through the Health Department for years, but hepatitis C testing has been offered only since last January, Bauman said.

She said she is trying to get a current picture of the hepatitis infection rate among isle prisoners. Based on her testing, she believes the rate is lower than the national rate of 30 percent to 40 percent of inmates. But even if it is as low as 20 percent, it is still one out of five inmates, she pointed out.

"We think numbers are going down with a younger population," she said, explaining the hepatitis C epidemic started in the 1980s with intravenous drug use.

Hawaii's needle exchange program, one of the first in the country, "was a wise public health decision," she said. "It protects drug users from the need to share needles and get a needle-transmitted diseases. That has protected many younger patients from getting hepatitis C."

Also, the street drug of choice now is crystal methamphetamine, or "ice," which can be injected but is generally smoked, she said.

The inmate population totals about 6,000, with one-third in mainland facilities, which she visits regularly to ensure standards are met, Bauman said.

Newly released prisoners and the homeless are offered free screenings, vaccinations for hepatitis B and other services at the Prison and Outreach Ministry office in the River of Life Mission.

For more information or to volunteer to help with the project, call Ochoa, 845-9944.

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Tattoos cited in study but experts want more proof

Tattoos get blamed for the spread of hepatitis C in prisons, but the issue needs more study, officials say.

"Everyone wants to blame them because they use funny equipment ... guitar strings or whatever they can find," said Dr. Kay Bauman, state Public Safety Department medical director.

Heather Lusk, state Health Department coordinator for hepatitis C, said a study is needed where people are tested when they enter the prison and when they leave to see what is happening.

"Are they coming in with it because we're incarcerating drug users or because they're sharing razors or tattooing inside the prison? A lot of this unfortunately is speculation," she said, adding that the best evidence is a study reported in the Hawaii Medical Journal in November 2005.

"A Case Control Investigation of Hepatitis C Risk Factors in Hawaii" was done by a state Health Department and John A. Burns School of Medicine team including Paul Effler, state epidemiologist.

Tattoos administered by nonprofessionals were cited as a risk for hepatitis.

Because tattooing is a strong cultural tradition in Hawaii and the Pacific and the process has a ceremonial nature, they "may be more likely to be done at home by a friend," the authors said.

"Tattooing could be a risk for hepatitis C virus transmission if the tattooing instruments were used on more than one person and not sterilized between uses," they said.