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Mystery Hepatitis B, C
Cases Still Rising In Wyoming

From Patricia Doyle, PhD
dr_p_doyle@hotmail.com
7-12-3

Hello Jeff - I won't pretend to know what is going on with the outbreak of hepatitis in Wyoming. I simply must tell the truth, I am perplexed.
 
As you know HCV and even HBV both have long incubation periods. HCV can be as long as 10, 20 or 30+ years. When were these people infected? What caused such a massive outbreak. We normally see cases singularly, or, in some cases, clusters within a certain community. The numbers however are usually "staggered," i.e. patients became infected at different times. In other words, some may have contracted the disease 5 years ago, others newly diagnosed might have contracted it a decade or more ago etc etc.
 
The present thought is that IV drug use is the cause of the spike in cases. I have to wonder why only in the Casper/Natrona County area of Wyoming? People across the US use IV drugs, and I am sure that if increased usage took place in Wyoming, the same would hold true for New York, L.A., Chicago, etc. This outbreak does appear to be out of the ordinary and I believe that rising drug usage may not be the only culprit of spread.
 
It is quite possible that we have a deliberate infection ongoing. Whether or not the infection is being spread via IV drugs or other route, it appears that the CDC should look into a deliberate spread. The cases that have been diagnosed during the outbreak need to be surveyed personally and given assurance that their responses will be kept confidential. We need to look for a commonality among the cases.
 
The CDC prefers to publicize the risk factors for HBV and HCV as 1. IV drug use, 2. multiple sex partners and, in some cases, homosexual behaviors. They dismiss far too quickly people who have no risk factors. If people answer negatively to the above risk factors, the CDC may not test for the diseases and therefore, some people may go undiagnosed. This could cause epidemiologists to overlook cases and therefore miss a possible source for the outbreak.
 
I think that people in the Casper area need to test themselves for both HBV and HCV whether they have risk factors for the diseases or not. Something very strange is occurring and the outbreak may be far more wide then the local health department or CDC anticipated. Speaking from experience as HCV and HBV positive, contracting the diseases is quite possible without any risk factors.
 
I urge anyone in the area of outbreak to get tested, with or without risk factors. If anyone who has tested positive would like to contact me, please do so. A diagnosis of HBV/HCV is tramatic but can be made easier with help and support.
 
Patricia
 
 
Hepatitis Cases Still Rising
 
By Christine Robinson Star-Tribune Staff Writer 7-11-3
 
The number of hepatitis cases in Natrona County climbed to 72 Monday, and health officials are trying to determine which transmission routes to target their prevention efforts.
 
A nine-page confidential survey from the U.S. Centers for Disease Control and Prevention is being administered to those being tested for the liver diseases.
 
State Department of Health officials announced two weeks ago that 57 cases of hepatitis B and C had been confirmed since February. Test results take two weeks, and in the past 14 days, 15 more cases were confirmed, according to state hepatitis coordinator Clay Van Houten.
 
There have been almost as many hepatitis cases reported in Natrona County in the last five months than between 1999 and 2002, Health Department data shows.
 
Tests for HIV are being administered with the hepatitis tests, but so far no positive HIV tests have been confirmed, Van Houten said. People considered at high risk for the liver diseases are tested free of charge. Others must pay a fee, he said.
 
City of Casper-Natrona County Health Department spokesman Marty Thone said he believes the confidentiality provision in the survey will make for honest answers about possible transmission routes. But Casper infectious-disease specialist Mark Dowell, M.D., is dubious.
 
"Some people don't feel comfortable talking about it," he said Wednesday. "They think that they will be identified as someone who uses drugs. We are not out to police, though, we just want to help -- that's what we're here for.
 
"We count on people being honest, even though they might not feel comfortable, because then we can help them and it's more of a team effort."
 
The questions ask about past sexual and drug-use histories, specifically the number of sex partners, the age of first use of intravenous drugs, and whether the person being tested had injected drugs in the last month.
 
"The first three questions have to do with drug use, especially injected drug use, and with multiple sex partners," Thone said. "If people answer no to the first two questions than we don't typically test them since they wouldn't be at a high risk."
 
Those tested are also asked to list the people with whom they had sexual contact or shared needles. This list is then used by the CDC to track down potential carriers and inform them of the transmission.
 
"People are usually fairly receptive when we call them," Dowell said. "They want to know what is going on with themselves, and although it comes as more of a shock to some than others, in the end they typically want to know."
 
Officials suspect that the increase in hepatitis B and C cases is the result of a spike in IV methamphetamine use, State Epidemiologist Carl Musgrave said.
 
"They definitely feel like the recent increase in IV usage is a cause of the outbreak," Musgrave said of the officials he's consulting with. "It is not just injections, though, and the researchers want people to know that it is also transmitted by multiple sex partners.
 
"But they also said based on their experiences that meth was a cause for the outbreak."
 
Health officials continue to urge people who may be infected to undergo testing. For more information or to receive a test and/or vaccination, please contact the City of Casper-Natrona County Health Department at 235-9340.

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