TOPIC:

Many people believe that if you have hepatitis C then it automatically means that you fall into one of the four following categories

(a) you are/were an intravenous drug user
(b) you got it from a blood transfusion
(c) you got it from violent unprotected sex
(d) you are a liar

Here is a story about "baby-boomers" and hepatitis C:

www.theglobeandmail.com/news/british-col...ind/article29488842/

Here is the original article in the Lancet:

www.thelancet.com/journals/laninf/articl...6%2900124-9/abstract

I remember when I was a kid at junior school (late 1960s), the whole class was lined up to go to the clinic just next to the school for BCG jabs. What I do not remember is whether in those days the nurse used a disposable syringe or not because the nurse always turned out heads away before the jab... And anyway, this is not the kind of thing a 10-year-old kid would think to ask

Does anyone know when disposable one-shot syringes were first used by the NHS or elsewhere?

Please note, I am not trying to blame the NHS for anything here. The hepatitis C virus was only discovered in 1989, and so anyone (or any institution) who re-used syringes before that date should not be blamed for something that was not medically known at the time.

But if there really is a proven link between vaccinations and the spread of the virus, it could help to remove a lot of the stigma that exists today...

Hi Vororo,

The fully disposable syringe was invented by Colin Murdoch, a New Zealand pharmacist, in the year I was born (1956). Obviously it took a while after that to come into common let alone universal use. I have early childhood memories of GP inoculations being given by syringes that were shiny and "clinked" when returned to the little metal tray they used and just the fact that they put it back on the tray would indicate it probably wasn't disposable. This occurred prior to migrating from UK to Aust so very early sixties when I was maybe 3-6 yr old?

Having said that and while it doesn't matter much anyway, I can state that I'm a gentle soul and with conviction that it isn't possible that I contracted HCV from method (b), which leaves (a) unless (d) applies.

There are also some interesting studies of how it appears to have spread outwards into the community from Glasgow hospitals post WW2.

So while I suspect us BBs have caused some interesting patterns and swirls in the dissemination of HCV, the research does seem to indicate that the greatest spread has occurred due to knowledge/technology/military issues rather than allegedly "moral" ones.

Yeah Gaj and V,
A lot of blood flowing during the first half of the 20th century all over the world. Given the unsanitary conditions, both on the battlefield and off, its no surprise that a blood borne disease went "viral". Add Korea and Vietnam, factor in the mass smallpox and polio vaccinations and you have a perfect setting for an epidemic.

mgalbrai wrote: A lot of blood flowing during the first half of the 20th century all over the world. Given the unsanitary conditions, both on the battlefield and off, its no surprise that a blood borne disease went "viral". Add Korea and Vietnam, factor in the mass smallpox and polio vaccinations and you have a perfect setting for an epidemic.

Good deduction there Mike, so how did the various genotypes come about? Just asking cause that area always confuses me.

fretboard wrote:

mgalbrai wrote: A lot of blood flowing during the first half of the 20th century all over the world. Given the unsanitary conditions, both on the battlefield and off, its no surprise that a blood borne disease went "viral". Add Korea and Vietnam, factor in the mass smallpox and polio vaccinations and you have a perfect setting for an epidemic.

Good deduction there Mike, so how did the various genotypes come about? Just asking cause that area always confuses me.

Yeah, no doubt technology and bloody wars contributed a lot to the spread. But the fact that there are 6 genotypes or more must mean that the virus has been in the human population for a very long time.

Until modern medicine came along, human life expectancy was only about 30 years. So back in ancient times the chances are pretty high that anyone with the virus would die of something else long before it would cause any problems...

en.wikipedia.org/wiki/Life_expectancy

fretboard wrote: .........so how did the various genotypes come about? Just asking cause that area always confuses me.

Okay, so I'll try and give this a go from an evolutionary genetics perspective:

As Vororo says HCV has been around for a long time. Basically we probably started out with either one (or possibly a very few) strain of HCV which crossed the barrier from some other host into the human population. Viruses don't breed though so they basically replicate themselves with each generation being the same as the previous one.

The exception to this rule is when they mutate into something different but in almost all cases the mutation will be weaker than the original strain and won't be as successful at replicating so will die out or be killed off by its hosts immune system ending that new strain before it has a chance to spread into other hosts. But very, very occasionally the mutation will be successful. It will be good at replicating itself accurately and may have an advantage over the original in how it manages to evade our immune system. So it will continue to thrive and may get lucky enough to spread into other peoples bloodstreams. If it does that often enough then that strain will likely continue into the future as a new genotype or subtype. Now, the chances of genotype 1b mutating into 3a are so infinitesimally small that basically "it ain't gonna happen!". But what will happen is that 1a will become 1ax or 1ay or if it is different enough it will create a new genotype, say GT8 or whatever we decide to call it.

Here you have to remember that because HCV is only spread by blood to blood contact it has a linear transmission path so in ancient times you would find that all the people infected in an area would have the same or similar genotypes/subtypes. Until you throw in population movement, migration and now modern jet travel, etc. then we start to get a mix of types across the world.

Below is a great picture that shows the main genotypes by their place of origin/greatest commonality. The interesting thing to note is that while there are 7 main genotypes there are many, many more subtypes. Some of these subtypes have or will die out, other new ones will be created. This is a bit like human genetics in that there are people who are blue eyed, and of these some will have blonde hair. So we have blue eyed/blondes but even within this grouping there will be some with straight hair, some with wavy hair, some with curly hair and some with frizzy hair. Each of the Geno-subtypes is a bit like that. But to keep things simple and because all the genotype 1a subtypes are very similar, we just say they are 1a. (Or blue eyed/blondes).







Hopefully all that makes sense as a very simplistic explanation. Please discuss amongst yourselves and there will be a test in the morning.

1970s dentists (and in fact dentists 2015) School vaccinations, medical procedures and .... contact with the blood of others, particularly partners and those who are alcoholics, self-abuse and bleed often. Home done tattoos.

I was never taught to avoid the blood of others. We even used to do that pin-prick blood brothers / sisters thing way back when. I think medical procedures especially in the 60s/70s have helped the virus spread, no doubt about that in my mind

Thanks Gaj for the nice explanation and graphic.

Thanks Londongirl, also. There is probably a good evolutionary reason for our fear of dentists

But the thing that still bothers me is how it was transmitted before battle-axes, syringes, and dentists were invented?

Current medical opinion says it was not by insect bites, even though insects are the main vector for the other flaviviruses (en.wikipedia.org/wiki/Flaviviridae).

... Dog-bites?

Big birthday coming up for Gaj. Hope you are going to have a big festival of Gaj (I did last year and it was epic)

Gaj wrote:

fretboard wrote: .........so how did the various genotypes come about? Just asking cause that area always confuses me.

Here you have to remember that because HCV is only spread by blood to blood contact it has a linear transmission path so in ancient times you would find that all the people infected in an area would have the same or similar genotypes/subtypes. Until you throw in population movement, migration and now modern jet travel, etc. then we start to get a mix of types across the world.

Very good analogy of how things came about. So if its been around since ancient times, how has that been determined? Have mummys been found to have HepC?

... Dog-bites?

Probably that or horses is how it got into the human population in the first place but dogs haven't been domesticated long enough for it to have been a common vector within our species. On the other hand, injuries during hunting or just the scratches and cuts of general living plus huddling together for warmth at night pre-fire? Scarification? And all baby boomers will have seen the opening sequence to 2001: A Space Odyssey so will realise that even before battle axes, blood stuck to the nearest available branch/club.

So if its been around since ancient times, how has that been determined? Have mummys been found to have HepC?

I don't believe so. Basically it's figured it out from the RNA sequence evidence that was used to draw up the graphic I posted. If you know what Genotypes/subtypes are around now and their relationship to each other genetically plus how often the virus successfully mutates on average, you can work backwards to determine at what points the branches in the genetic tree occurred and how long it has been around.

Thanks beaches, this year the festivities fall just after EOT so there will be much (low carb) feasting but rather limited sacraments.

I understand HCV has been around a long time. Also, that different genotypes exist and are prevalent in different geographic locations.
The point I was trying to make was the world has gotten much smaller. Huge, bloody wars between groups of people halfway around the worlds from each other came along with the second industrial revolution.
So, there was a lot of opportunity for exposure to genotypes not common in certain areas, like between the Japanese and the Allied forces fighting in the Pacific. Vietnam, Korea...a lot of blood...
I teach U.S. history. I could fill a whole year talking about nothing but wars. We just don't seem to be content living in peace.
m

Vororo wrote:
But if there really is a proven link between vaccinations and the spread of the virus, it could help to remove a lot of the stigma that exists today...

Yes V, I remember lining up for TB vaccinations at school. Australia in the 1960s.

As for stigma, I had an ugly experience yesterday at the chemist. I was there with my elderly mother who was filling a script. It’s a busy pharmacy adjacent to a busy bulk-billing (ie free) medical clinic on the border of Queensland and NSW.

While waiting I heard the senior pharmacist complaining to another elderly customer about the new Hep C medications. How they cost her $22,000 for each 12 week treatment. How she refuses to stock them. How ‘they’ don’t deserve to get medication on the PBS when ‘they’ are responsible for getting Hep C in the first place.

I was dumbstruck. I didn’t expect to hear such malicious misinformation from a health professional, or in such a public way.

So I took her aside and let her know I strongly disagreed with her views. How for a start not everyone with Hep C got it from using drugs (the faces of Lynne and Tina helped me along here, as I tried to shove my own guilt aside). How the new meds are saving lives.

Her response was about how much her husband’s cancer and chemo treatment are costing, while ‘those drug addicts at Mirikai’ (a Gold Coast rehab) pay only $6.20. I didn’t think to say sorry about your husband. Maybe that would have softened this stressed out, angry and intolerant person. Or not...

Instead I pointed out that her attitude is discriminatory, and exited with ‘someone in your position should know better than to mouth off like that’. My blood was boiling.

Do I take this further? Name and shame? Complain to the Health Care Complaints Commission? Or let it go as another sad example of human ignorance?

To remove the stigma of Hep C, perhaps we need to remove Hep C.