Prisons Lack Plan for Hepatitis C Epidemic

Under questioning by lawmakers Tuesday, state officials said there is no quick-fix plan for addressing the spread of the potentially fatal hepatitis C virus in California’s prisons.

After a legislative oversight hearing on the disease, Sen. Richard Polanco (D-Los Angeles) called the virus a “silent killer” that could be as deadly as the AIDS epidemic unless it is contained.

“It is very, very prevalent in high-risk groups such as the inmate population,” said Polanco, chairman of the Senate Public Safety Subcommittee on Prison Construction and Operations.

Although exact figures are not known, studies by the state estimate that 54% of incoming female inmates and 39% of incoming male inmates are infected with hepatitis C.

One random state study in 1994 found that 41.4% of male and female prisoners in the sample group had the hepatitis C virus. California houses about 155,000 prisoners.

Nationally, public health experts report that 40% or more of U.S. prison inmates may be infected.

During the hearing, Polanco grilled officials from the state health and corrections departments about why there is no plan in place for widespread screening and treatment for hepatitis C, particularly in state prisons.

Health department officials said they are awaiting development of a national plan for tackling the virus, to be introduced by the federal Centers for Disease Control and Prevention within the next six months.

California will follow the federal recommendations, said health department epidemiologist John Rosenberg, because it would be impossible for state officials to develop their own strategy for screening and treating the virus any sooner.

An estimated 4 million people nationwide and half a million Californians are carriers of hepatitis C, which can infect people for 20 or more years before symptoms appear.

The disease attacks the liver, and the virus is spread through contact with mucus and blood, especially from the sharing of drug needles and cocaine paraphernalia, tattoos, body piercing and, in extremely rare instances, blood transfusions.

Unlike its better-known cousin, hepatitis B, there is no known vaccine against hepatitis C.

Medical experts are at odds over how best to tackle the virus, which changes and develops differently in different people. It is especially pernicious in prisons, where many inmates have used drugs intravenously or nasally, or have been tattooed with unsanitary instruments.

“This is obviously a very complex situation, and there are no clear answers,” said Susann Steinberg, deputy director of health care operations for the Department of Corrections, at Tuesday’s hearing.

The department was criticized by lawmakers after it returned to the state’s general fund all but $240,000 of $2 million it requested in last year’s budget for screening and treating hepatitis in prisons.

In an interview, Polanco questioned the department’s response, saying, “I’m appalled. . . . We’ve got to make sure [inmates] are screened and treated.”

Steinberg said the money wasn’t spent because not enough information was available from the medical community to enable the department to determine exactly how to use the funds.

She said the department has no does not have a program in place to screen all incoming inmates specifically for hepatitis C.

She said department health officers are confident that routine blood testing of inmates reveals most cases of the virus. Inmates may also request a test.

But there is uncertainty among medical specialists both inside and out of the prison system over what, if anything, should be done when it is learned an inmate has hepatitis C.

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Hepatitis C

As many as 4.5 million Americans are infected with hepatitis C, which is a leading cause of liver failure and liver cancer.

* Symptoms: Mild, flu-like symptoms at early stage of infection, then no further symptoms until liver fails, which can take up to 20 years.

* Treatment: Interferon, which reduces viral replication but is not a cure.

* Transmission: Like AIDS, hepatitis C is passed by unprotected sex, blood transfusions, intravenous drug use and tattooing.

Source: New York University Medical Center