On May 19, 2008 the World learned that 1 in 12 people on this planet have some form of Hepatitis. A pretty astonishing statistic!
GET TESTED for Hepatitis C! Get Vaccinated for Hepatitis A and B!
Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). It is the most common chronic blood borne virus in the United States. It is transmitted by blood to blood contact.
You may be at risk for HCV and should contact your medical care provider for a blood test if you:
* were notified that you received blood from a donor who later tested positive for hepatitis C.
* have ever injected illegal drugs, even if you experimented a few times many years ago (or snorted any drugs)
* received a blood transfusion or solid organ transplant before July 1992
* were a recipient of clotting factor(s) made before 1987
* have ever been on long-term kidney dialysis
* have had tattoos or body piercings
* have had vaccinations administered with pneumatic jet injectors
* have shared razors, toothbrushes, nail clippers, tweezers, etc. with an infected person
* are a veteran
* have been incarcerated
* are a health care worker exposed to needle sticks
* also 5% of babies born to infected mothers will get Hepatitis C
Read about Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009 at: The Bill
For support in Tallahassee, FL and surrounding areas come to:
The Hepatitis and Liver Transplant Support Group
TMH Diabetes Center-Education Room
1981 Capital Circle Northeast
Tallahassee, FL
First Monday of every month
We DO meet on Holidays!
7:00PM to 9:00PM
Pam at figment@nettally.com or call 850-443-8029
Hepatitis A: is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.
How is hepatitis A virus transmitted?
Hepatitis A virus is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.
Most infections result from contact with a household member or sex partner who has hepatitis A. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.
Hepatitis B: is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
How great is your risk for hepatitis B?
One out of 20 people in the United States will get infected with HBV some time during their lives. Your risk is higher if you have sex with someone infected with HBV have sex with more than one partner
are a man and have sex with a man live in the same house with someone who has lifelong HBV infection have a job that involves contact with human blood, shoot drugs, are a patient or work in a home for the developmentally disabled, have hemophilia, travel to areas where hepatitis B is common.
Your risk is also higher if your parents were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands, and the Middle East.
If you are at risk for HBV infection, ask your health care provider about hepatitis B vaccine.
Hepatitis C: is a liver disease caused by the Hepatitis C virus (HCV), which is found in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person.
Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). You may be at risk for hepatitis C and should contact your medical care provider for a blood test if you:
*were notified that you received blood from a donor who later tested positive for hepatitis C.
*have ever injected illegal drugs, even if you experimented a few times many years ago
*received a blood transfusion or solid organ transplant before July, 1992
*received a blood product for clotting problems produced before 1987
*have ever been on long-term kidney dialysis
*have evidence of liver disease (e.g., persistently abnormal ALT levels)
Hepatitis D: is a defective virus that needs the hepatitis B virus to exist. Hepatitis D virus (HDV) is found in the blood of persons infected with the virus.
HDV is a defective single-stranded RNA virus that requires the helper function of HBV to replicate. HDV requires HBV for synthesis of envelope protein composed of HBsAg, which is used to encapsulate the HDV genome.
The delta agent may increase the severity of an acute hepatitis B infection, aggravate previously existing hepatitis B liver disease, or cause infection in asymptomatic hepatitis B carriers. Risk factors are history of previous hepatitis B infection, being a carrier of hepatitis B, and intravenous drug abuse. The incidence is 8 out of 1,000,000 people.
Hepatitis E: is a virus (HEV) transmitted in much the same way as hepatitis A virus. Hepatitis E, however, does not often occur in the United States.
Disease Spread
Through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.
People at Risk
International travelers; people living in areas where hepatitis E outbreaks are common; and people who live or have sex with an infected person.
Autoimmune hepatitis is a disease in which the body's immune system attacks liver cells. This causes the liver to become inflamed (hepatitis). Researchers think a genetic factor may predispose some people to autoimmune diseases. About 70 percent of those with autoimmune hepatitis are women, most between the ages of 15 and 40.
The disease is usually quite serious and, if not treated, gets worse over time. It's usually chronic, meaning it can last for years, and can lead to cirrhosis (scarring and hardening) of the liver and eventually liver failure.
Autoimmune hepatitis is classified as either type I or II. Type I is the most common form in North America. It occurs at any age and is more common among women than men. About half of those with type I have other autoimmune disorders, such as thyroidosis, Graves' disease, Sjögren's syndrome, autoimmune anemia, and ulcerative colitis. Type II autoimmune hepatitis is less common, typically affecting girls ages 2 to 14, although adults can have it too.
CDC HIV/STD/TB Prevention News Update
Tuesday, October 07, 2003
"Those with Hepatitis C Still Face Long Odds"
New York Times (10.07.03)::Jane E. Brody
There is finally some good news to report about hepatitis C,
the debilitating liver disease that has infected 4 million
Americans and 170 million people worldwide. New cases of HCV have
declined 80 percent since the virus was identified in 1988 and
blood banks began screening for contaminated donations four years
later.
But, the annual death toll from the long-term consequences
of HCV is 10,000 a year in the United States, and scientists
project it will triple by 2010 unless new treatments are
developed to eliminate the virus or postpone its complications
indefinitely.
HCV's primary route to a new bloodstream has been through
contaminated needles shared by drug users and by blood
transfusions. Unlike HIV, HCV is rarely transmitted through
sexual contact - although people who engage in high-risk sex with
multiple partners and people with STDs face increased risk of
transmission. Low rates of transmission also affect health care
workers through needle-stick accidents, men who have sex with
men, and babies born to infected women.
Not everyone infected with HCV becomes ill. In most cases,
however, the virus can linger in the body for years - even
decades - before liver damage appears. Severe cirrhosis, liver
failure and liver cancer make HCV the leading reason for liver
transplants.
With at least six major genetic types and more than 50
subtypes of HCV, prospects for a vaccine are not promising. And a
vaccine for HCV, which changes rapidly, depends on finding an
exposed part of the virus that remains stable even as its protein
coat mutates.
The two main HCV therapies are lengthy, expensive and can
cause devastating side effects. They are most effective in
patients with Genotypes 2 and 3, which represent about 25 percent
of US patients. The most common ones, Genotypes 1a and 1b, are
the most difficult to treat and affect about 75 percent of
patients.
Therapy is most successful when the treatments - weekly
injections of interferon, usually long-acting pegylated
interferon, and the oral antiviral drug ribavirin - are used
simultaneously. The combination therapy is effective in slightly
more than half the cases - in 42 percent of those with Type 1 and
80 percent for those with Types 2 or 3.
http://archive.mail-list.com/pkids/msg03031.html
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Posted on Sun, Nov. 09, 2003
HEPATITIS C: SILENT ALARM
By KAREN DILLON and MIKE McGRAW
2003 The Kansas City Star
Michael Douglas, a Kansas City truckdriver, got it during an
operation. South Carolina technician Dale Muir got it while
inspecting used catheters. Teresa Cox, who works for a Kansas City
radio station, got it from a transfusion while giving birth.
These Americans, and at least 4 million more, have been infected with
the hepatitis C virus. Ten thousand or more of them will die from it
this year -- about 35 times the toll from last year's much-publicized
outbreak of the West Nile virus.
In fact, the annual number of hepatitis C deaths in the United States
now approaches those from AIDS. And although the Centers for Disease
Control and Prevention have launched aggressive battles against AIDS
and West Nile, they give hepatitis C much less money and attention.
Despite warnings from two U.S. surgeons general, the federal
government has failed to follow through almost every time it has
announced massive campaigns to educate citizens about hepatitis C,
The Kansas City Star has found.
Even today, a 3-year-old information kit still sits at the CDC
waiting to be produced and distributed to 250,000 doctors and their
patients. CDC officials say they're doing the best they can with
little money.
But the CDC collects only limited information about Americans with
hepatitis C. It relies partly on states to report infections, a
process that has been woefully unreliable. Kansas, for example,
reported more cases of leprosy -- one -- than hepatitis C in 1999.
Hepatitis C is the most common chronic blood-borne virus in this
country. Yet the CDC keeps better figures about people crushed to
death by hay bales.
Without an alarm from the government, many people who don't know
they're infected with hepatitis C won't get treated and will
unknowingly spread it.
"They (federal officials) basically failed to do what they needed to
do to stay on top of the challenge of hepatitis," said Arthur Caplan,
one of the nation's most prominent bioethicists and former chairman
of a federal blood safety committee.
"They've not really come to grips with the fact that this is a
serious disease."
The head of the CDC said in a statement that the government has tried
to address HCV, as hepatitis C is called.
"CDC has been working with numerous partners to better understand the
extent of the infection in the United States as well as educating the
public about how HCV is transmitted, what they can do to protect
themselves, and the need for testing and counseling for those at
risk," said Julie Gerberding, CDC director.
But most Americans with hepatitis C still do not know they have it,
CDC officials believe.
Indeed, many hepatitis C myths persist.
An estimated 60 percent of infected people got the virus from
injection drug use. That has led many to believe that hepatitis C
affects only drug addicts and prisoners.
But almost a half million people are living with hepatitis C because
of blood transfusions before 1992, according to a CDC estimate,
including many women who had Caesarean sections. Despite calls from
Congress, the government never followed through on a plan to notify
thousands of them. (See related story on page A-1.)
The disease also has emerged as a potentially devastating
occupational hazard for veterans, health-care workers, firefighters
and others who are exposed to blood in the workplace.
Last year's disclosure by actress Pamela Anderson that she carried
the disease prompted numerous stories, but interest in the
former "Baywatch" star hasn't yet carried over to widespread
understanding, or acceptance, of the virus.
As a result, some hepatitis C patients are reluctant to admit having
the disease.
There's too much of a stigma, says a seventh-grade teacher in Kansas
City who asked not to be named. She said she got the disease from a
medical procedure.
"I worry that my students would have the wrong idea," she
said. "Their basic knowledge is that crackheads and prostitutes and
inmates get hep C. Not their favorite teacher."
A bill filed in May in the U.S. Senate could finally help educate the
public about hepatitis C.
The legislation, introduced by Sens. Kay Bailey Hutchison and Edward
M. Kennedy, would spend up to $90 million a year on fighting the
disease.
The bill "takes a new approach to fighting this virus by establishing
a nationwide plan to provide the most effective ways of prevention,
control and medical management of Hepatitis C," Kennedy, a
Massachusetts Democrat, said in a written statement.
The Hepatitis C Epidemic Control and Prevention Act is still far from
passage and funding, however.
Dormant danger
Hepatitis C came to light in the early 1970s when scientists
determined that a virus different from hepatitis A and B was
infecting hundreds of thousands of Americans each year.
Scientists estimate that millions of people were infected in the
1960s and 1970s through blood transfusions and injection drug use.
Some said up to 10 percent of transfusion patients still were being
infected in the early 1980s, or up to 300,000 a year. Improved blood
screening beginning in 1987 helped cut the number of all new HCV
infections.
Some people clear the hepatitis C virus completely from their bodies,
and many others never get sick. Of those who do, most survive and
eventually die of another cause.
But many who contracted hepatitis C in earlier decades are now
beginning to show symptoms.
That's why it's called the Silent Epidemic.
The virus, which attacks the liver, can lie dormant for 10, 20 or 30
years before a person even notices any health problems. During those
quiet decades, the virus can slowly corrode the liver.
Eventually, some patients begin noticing fatigue, nausea and joint
pain. Some endure a lifetime of suffering from cirrhosis and other
ailments.
Dale Muir contracted HCV at his job while inspecting defective
catheters contaminated with infected blood. The virus led to a bone
marrow disorder, which required him to get transfusions more than 300
times.
"For seven years I lived on blood transfusions," said Muir, who cried
as he recalled the ordeal.
Other patients go on to liver cancer, and some to a lingering death.
In May, after spending three weeks in a coma in a hospital, Susan
Wohlert went home to Raytown to die.
The 40-year-old woman, who says she never drank or did drugs,
believes she was infected by a needle stick when she was 13 and
volunteering to help clean a medical facility. Two decades later, she
was diagnosed.
Now she spends her days in bed or slumped in a chair unable to hold
up her head. "It's painful everywhere," Wohlert said.
Treatment sometimes can head off the disease if it is discovered
early enough. But treatments, which are improving, remain long and
sometimes torturous. They still have only a 50-50 success rate or
worse -- especially for African-Americans and Hispanics. There is no
vaccine.
When treatments don't work, the last chance usually is a liver
transplant -- if one is available.
Teri Gilliland didn't discover she had hepatitis C until 20 years
after a transfusion she believes was tainted. The Maryland nurse
nearly died before she received a new liver in 2001.
A diary kept by her mother, also a nurse, described her condition a
few days before the transplant: "more intense oozing of dark blood
from mouth and nose."
And Gilliland was lucky. More than 1,800 people -- a third of them
hepatitis C patients -- died in 2002 while waiting for a liver
transplant. The shortage of donated livers is expected to increase as
the disease blossoms in patients who contracted the virus years ago.
In the next two decades, hundreds of thousands will die from
hepatitis C, researchers say. One study projects the number of deaths
will top 19,000 a year by 2011.
By comparison, AIDS trends are difficult to predict, researchers say,
but deaths fell nearly 70 percent from 1995 to 2002, a year when
16,371 died.
"HIV/AIDS had a constituency, an advocacy group," said former Surgeon
General David Satcher. Such a group "had trouble developing around
hepatitis C."
When the call went out again this year for a national hepatitis C
march in Washington, D.C., 200 persons showed up.
In cascading rain, the marchers, some in wheelchairs, made their way
singing and chanting up Pennsylvania Avenue. Each marcher got a
bright yellow T-shirt, but the shirts bore no slogan.
"We couldn't afford that part," said Tricia Lupole of Hepatitis C's
Movement for Awareness.
By the time the group reached Freedom Plaza, the shirts were soaked.
Low estimates
The national cost of medical care for hepatitis C -- not counting
lost work time -- already has reached at least $10 billion each year,
according to Milliman & Robertson Inc., an actuarial firm, in a 2000
report about future health costs.
The CDC's public and much-quoted estimate of costs, including work
loss: $600 million or more.
In fact, many CDC estimates seem low.
For example, the CDC estimates the total number of HCV infections at
3.1 million to 4.8 million, based on decade-old data. As an official
figure, the CDC has settled on a number in the middle: 3.9 million.
"Obviously, it's a much bigger problem than that," said Bruce R.
Bacon, a leading HCV researcher and head of the gastroenterology and
hepatology division at St. Louis University. "It wouldn't surprise me
if it were 5 million."
Others suspect the number is higher still.
"There might be in excess of 5 or 6 million," said Willis Maddrey, a
professor at the University of Texas Southwestern Medical Center who
has written extensively about hepatitis.
CDC officials concede their estimate is conservative -- it doesn't
include the homeless, military or hundreds of thousands of infected
prison inmates, for instance -- but they continue to use 3.9 million.
Of those people, 2.7 million have chronic infections.
As for new infections each year, the CDC last year put the number at
25,000, or perhaps 40,000.
Actual numbers are important because they would tell health officials
how many people might become ill from hepatitis C in coming years.
They're also important if hepatitis C is ever to get enough funding,
said Sharon Phillips, president of Hep C Advocate Network Inc., a
Texas organization that fights for HCV awareness.
"We get frustrated every day," Phillips said.
In another official figure, which hasn't changed in a decade, the CDC
says 8,000 to 10,000 people die from hepatitis C a year. A National
Institutes of Health conference in 2002 put the death toll at 10,000
to 12,000 but said that may be an underestimate.
But Miriam Alter, the government's leading HCV epidemiologist,
defends the CDC's numbers.
"People, they like to complain and they like to cast doubt, and they
particularly like to cast doubt on the government," said Alter,
acting associate director for science in the CDC's viral hepatitis
division.
"Why people don't have confidence in the hepatitis group
specifically, and the CDC in general, is really something I don't
understand."
Limited monitoring
The heart of the confusion: the way the CDC monitors the virus.
"I don't think CDC has any kind of active program to control this
problem," said Robert Haley, chief of epidemiology at the University
of Texas Southwestern Medical Center, whose studies found evidence
that the virus may be commonly transmitted through tattooing. (The
CDC says that still has not been proved.)
Counting hepatitis C infections is not easy because most people never
have symptoms.
The CDC tracks hepatitis C using state reporting and its own surveys.
But some of those surveys are more limited than the CDC has portrayed.
For years, the CDC conducted surveys at several sites, but they
recorded only new cases of the virus. The surveys ignored the much
more numerous chronic cases -- the people who have had the virus for
years.
In 1998, the CDC finally drew up a plan for surveys to locate chronic
cases. The plan proposed five or six survey sites where investigators
would go into the community to monitor patients and review death
certificates, hospital records and patient logs at clinics.
But five years later The Star found that only three of those sites
existed. Two of those said they weren't going outside their offices
to find patients the way the CDC plan had outlined. The third site
declined to comment.
Alter acknowledged that the CDC had backed off its plan. The way the
surveys were set up was too complex and expensive to use broadly, and
the CDC is now rethinking its approach, she said.
"We've learned a lot," Alter said. "We have done an incredible job
given the resources we have to work with."
Beyond its surveys, the CDC has asked the states for 20 years to
count cases of hepatitis C -- but only new cases. Not until last year
did it ask states to report chronic cases, too, a delay that critics
say has impaired efforts to track the disease.
And the CDC still won't accept the detailed reports that some states
complete about the chronic cases. In fact, at least two states had
just been stashing those reports in shoe boxes.
That doesn't mean the CDC is ignoring the problem of collecting data
from the states, federal officials contend.
"It's trying to figure out a system for something we just don't have
a system for," said Hal Margolis, director of the CDC's viral
hepatitis division.
Besides monitoring, the CDC has left much of the responsibility for
educating, testing and counseling the public up to the states -- but
states have done little. Most don't even have an HCV strategy.
The CDC aims to fund a hepatitis C coordinator in each state, and
indeed Missouri has a full-time position. But coordinators in some
states are far from full-time.
Kansas had to try several times for federal funding before a grant
finally came through, and then it only allows Kathleen Waters to
spend a little over a third of her time on hepatitis C.
And instead of educating the public and monitoring the virus, Waters
has had to use her hepatitis C time working to find money so the
state can continue testing adults for HCV.
Money problems were a universal complaint in January at a national
hepatitis conference in San Antonio. Coordinators from almost all the
states were reduced to sharing computer disks that would allow them
to print free hepatitis C posters.
"The unmet need on HCV is staggering, and the public awareness is
hugely unmet," said Tom Liberti of the Florida Department of
Health. "CDC is underfunded, the states are underfunded."
Education problem
Jean Schmidt has watched hepatitis C balloon in Ohio, where a friend
had to resign his job because he became so sick from the virus.
And yet so few people know about the disease that Schmidt, a
Republican state representative, pushed for state money to fund
public forums.
"Hepatitis C is going to be the number one infectious disease of the
21st century, and there has been very little public education about
it," Schmidt said.
Ignorance keeps patients from being tested and treated in time to
head off liver damage.
Michael Douglas, the Kansas City truckdriver, learned that he had the
virus soon after a car hit him 20 years ago as he crossed a street on
the way to work, sending him to a hospital where he got a transfusion.
But he didn't know he should seek treatment until three years ago,
when he began tiring quickly on the job. By then the virus had
damaged his liver.
"The public is ignorant about this disease, and so was I," said
Douglas, a father of five who worries whether he can support his
family during treatment.
Margolis of the CDC acknowledges much more public education needs to
be done but blames lack of money.
"Hepatitis C hasn't brought the same flow of resources that HIV has,"
Margolis said. "We're putting out as much as we can."
For example, in 1999 CDC officials publicized the launch of a
nationwide poster program that would begin with a $70,000 pilot
project in Washington, D.C., and Chicago. But the pilot program never
went national.
"We just didn't have the money," Margolis said.
The CDC's spending for HCV has increased in recent years, growing
from $13 million in 2000 to $23 million in 2003.
But it still lags far behind domestic spending for AIDS, which grew
$142 million during the same period to reach $794 million.
The problem is not that AIDS receives too much money but that
hepatitis C receives too little, said Brian Klein, founding member of
the Hepatitis C Action and Advocacy Coalition in San Francisco.
"It is not a battle between AIDS and hepatitis C," said Klein, who is
co-infected with both diseases.
Margolis agreed.
"I don't know how to express my frustration," Margolis said. "We need
more resources."
But some lawmakers have questioned how the CDC has spent its HCV
money. Indeed, Caplan, the former blood safety committee chairman,
said that hepatitis C funding is a matter of priorities. The CDC
didn't need a lot more money than it already had to implement an
education campaign, he said.
"They could have pulled it off inside their budget without strain,"
Caplan said.
Congressional committees have tried to push for more aggressive
warnings to the public, but with little success.
A 1998 congressional investigation led by Rep. Christopher Shays, a
Connecticut Republican, came to this conclusion:
"Unless confronted more boldly, more directly, and more loudly by the
Department of Health and Human Services, the threat posed by
hepatitis C will only grow more ominous."
Health and Human Services Secretary Donna Shalala and Surgeon General
Satcher pledged to undertake public education campaigns. In fact, the
CDC was already putting together a 27-page strategy to detect and
prevent HCV.
But much of the plan never happened, critics say.
The CDC said it had found almost $4 million to pay for the plan but
would need $48 million the next year.
Health and Human Services never allocated the funds, though, and
never asked Congress for that additional money, according to
congressional staff members and others.
"No moneys were requested for the broad public education campaign by
Secretary Shalala," said Anne Marie Finley, who authored the 1998
congressional report and now is a health policy consultant and
lobbyist.
Shalala, now president of the University of Miami, said she could not
remember whether she made the request.
In 1999, Shalala still was reassuring a worried former Surgeon
General C. Everett Koop that Health and Human Services indeed was
alerting the public. The department had "initiated an extensive
educational effort," she wrote Koop in a letter obtained by The Star.
But the next year a department advisory committee still was pleading
with Shalala to seek funding for a "widespread means of informing the
American public."
Shalala and department officials didn't, committee members said later.
Shalala said recently she had no budget records to remind her what
the department requested.
But, she said, "None of us has ever done enough on this issue."
In fact, the lack of public education sparked a House Commerce
Committee investigation into whether the CDC was diverting money from
hepatitis C education programs.
Rep. Tom Bliley, a Virginia Republican, dropped that investigation in
July 2000. At about the same time, as Bliley looked on at a press
conference, Satcher announced he would send a "Dear Citizen" letter
to every household in America warning about the epidemic.
Satcher's office didn't have the $30 million to $40 million for
postage, so he said Congress would help mail the letter.
"It's a win for the American people," Satcher said.
But it turned out Congress had legal problems mailing a letter from
another branch of government. Apparently no lawmaker ever mailed the
letter.
That surprises Satcher, who in an interview said he assumed the
letter had been sent. He thinks it still should be.
Margolis said other HCV information has gotten out. For example, the
CDC has set up a Web site about hepatitis and sent public service
announcements to media outlets, although Margolis doesn't know how
effective they were.
Indeed, the CDC has never evaluated the success of its public
education program because there wasn't much to evaluate. "Until
recently, we thought so little had been done," Margolis said.
It's no wonder last year's National Institutes of Health nationwide
conference for doctors on hepatitis C made this its first
recommendation: "Educate the American public."
Satcher said it isn't too late to conduct the kind of public
education campaign the 1998 plan envisioned.
"I think it is sad that it hasn't been more aggressive and
implemented, but I believe that it still can be implemented," Satcher
said.
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