Hepatitis C is on the rise in northern Alaska
In many parts of the state, rates of Hepatitis C infection have more than doubled over the last several years.
That's according to an August epidemiology bulletin sent out by the state's Division of Public Health which showed increases in infection across all regions of the state ranging from a 45 percent rise along the Gulf Coast to a nearly 500 percent rise in Southeast.
Southwest Alaska saw a dramatic increase of 270 percent since 2011 and the northern region, including the Nome and Bering Strait region, Northwest Arctic Borough, and North Slope Borough, was just behind with a 267 percent rise.
"I think [the numbers are] going along with the trend we're seeing not just statewide but nationally in regards to the increase in IV (intravenous) drug use," said Doreen Leavitt, a public health nurse and director of Health Administration with the North Slope Borough Department of Health and Social Services. "Once you have the injectable drug use, you're going to see increases in Hepatitis C and HIV (human immunodeficiency virus). As a state and a nation, we're raising more awareness about IV drug use and prevention but yet we're still seeing the use continue."
IV drug use, especially heroin and opioid use, has been going up around Alaska over the last several years, according to the state.
"Here locally in our region, we're not seeing so much heroin as we are seeing an increase in methamphetamine and injectable meth use in that younger age range," said Leavitt.
Hepatitis C is a liver disease caused by a viral infection contracted most commonly from blood contact with an infected person. Sharing dirty needles, syringes, and other equipment to inject drugs is one of the leading ways Hep C is spread.
"We encourage people not to share anything like needles, or razors or shaving equipment, or even toothbrushes because if somebody is infected, you can get it that way," said Josephine Oke, a community health nurse in Kotzebue.
One of the ways drug users can avoid sharing needles is through access to a needle exchange program, in which they are able to dispose of used needles and obtain sterile hypodermic needles at little to no cost.
There are not currently any needle exchange programs in either the North Slope Borough or Northwest Arctic Borough, though health officials say they are effective.
"It is something, I think, we need to seriously take a look at as a region with our leadership and decision-makers and our partners in health care because we are seeing an increase in injectable drug use and although it can be a controversial public health method, it is an intervention to help decrease the spread [of infectious diseases]," said Leavitt.
"In years back, condoms weren't readily available or on countertops in health care facilities because people would interpret it as giving permission to have sex. Now, it's a common public health method to prevent the spread of sexually transmitted infections and pregnancy," she explained. "Now, especially in more rural regions or more conservative regions, you won't see needle exchange programs as much because it may be perceived as condoning the use of it. But, studies have shown that needle exchange programs work."
The overarching goal is to prevent IV drug use altogether, but Leavitt said it's not possible to completely stop use.
"Of course that's the goal but if people are going to choose to use, then they can do it safely to not harm others," she said.
Oke said although there are no needle exchanges in the Arctic, people who travel to hubs like Anchorage and Fairbanks may find and use them there.
While public health officials believe the increase in Hepatitis C is linked to drug use, there is no tracking program in place to determine the exact source of an infection on a community level.
"Right now, statewide it's not done because there's no [federal] funding," said Oke. "Right now for HIV, if we have a case, we have to investigate and find out how they got it and who their partners are and try to connect them to treatment or screening. But, with Hep C there's no infrastructure for it."
That leaves care providers without the tools necessary to track down each person who might be infected surrounding each confirmed case they receive.
"You hear it through the grapevine when you are talking to some of the people in that [high-risk] age group from 20-29, but because we don't do investigation, we really can't say definitely this is how a person gets it," Oke said. "But, we can assume it's because of an increase in IV drug use."
In addition, there are two types of Hepatitis C, acute and chronic, and an infected person may take months or even years to show signs of infection, making track-back hard.
According to the Centers for Disease Control and Prevention, acute Hep C is a short-term illness that typically manifests itself within the first six months after exposure.
Chronic Hep C is a long-term illness that happens when the virus remains in a person's body. Extended effects of chronic Hep C can include cirrhosis of the liver and liver cancer.
"Hepatitis can be asymptomatic, [meaning] they might not show any symptoms at all. They can live with the infection for a long time without feeling sick but it's affecting their liver," said Oke. "Some people don't show symptoms until it's the very end stage in which their liver is already damaged."
That's why it's important to educate about and screen at-risk populations for Hepatitis C and ensure they have access to appropriate care if they are diagnosed, she said.
However, because Hep C has risk factors that include substance abuse and drug use, which are other public health issues, the approach to education and prevention can extend past the realm of just Hep C.
Both the North Slope and Northwest Arctic have prevention teams whose job it is to get the word out about healthy living and to tackle the interconnected nature of public health problems.
On the Slope, the team looks at drug and alcohol abuse in youth and does positive promotion activities like sports events and health fairs, Leavitt said. Public health nurses speak in schools and at community events about prevention and the behavioral health department has an outpatient drug and alcohol treatment program in which they can do one-on-one screenings and risk assessments for infectious diseases.
"It's not just Hepatitis C, it's this huge public health picture that has long-term impacts. It's not just the drug use, it's not just the substance abuse, it's not just the child neglect and abuse, it's not just homelessness. They all have huge impacts to our community and they all tie together," Leavitt said. "Approaching it in a public health way addressing it as prevention, education, health promotion, promoting the positive health aspects like culture and youth development and leadership development, all lead to improved health in a community. The long-term impacts of Hepatitis or HIV include not just the health network but public safety, health care costs, suicide, so many things. It's a bigger public health picture."
More information about Hepatitis C can be found at the Centers for Disease Control and Prevention website, www.cdc.gov/hepatitis/.
The Alaska Native Tribal Health Consortium runs a Liver Disease and Hepatitis Program and information can be found at anthctoday.org/community/hep/.
To schedule an appointment for a screening in the Northwest Arctic, contact either your local village clinic or Maniilaq Association's public health nursing program in Kotzebue at 442-7144.
To schedule an appointment for a screening on the North Slope, contact either your local village clinic or public health nursing in Barrow at 852-0270.
For substance abuse treatment and services in Barrow, contact the behavioral health department at 852-0366.