Sunday, 23 September 2018 04:25

Why me? Why do I have Hepatitis C?

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The stigma and stereotype associated with Hepatitis C says "you only get that from IV drug use". While you certainly can get it from IV drug use, the majority of my Baby Boomer patients didn't. How do I know? Well, of course, I can't know for sure how anybody caught any communicable disease, but when talking to the 3000+ patients I've helped access affordable generic medication there is a recurrent theme. That theme is "Hey doc, I never did drugs, I don't have any tattoos, and I've never had a blood transfusion, so how did I get HCV?" That led me to look for the answer. The real answer, not the stereotype.

The short answer is the medical or dental profession probably gave it to you, but how do I know that?

Well, for a start, we know the disease requires blood-blood contact for transmission and, outside of IVDU, tattoos and blood transfusions most of us don't share our blood with friends. So for people who have the disease, but don't have these risk factors, what other blood-blood exposures did they have? The answer to that is clear, they had two distinct exposure risks:

  • Doctors giving vaccinations using reusable glass syringes, reusable needles, and multi-dose vials and jet guns for vaccinations.
  • Dentists drilling and scraping away at damaged teeth using reusable tools.

Nowadays with disposable everything, it's easy to forget what medicine looked like in the 50s, 60s, 70s, 80s and (believe it or not) the early 90s.

As a young child in the 60s I followed my father around. He worked in Intensive care and I got to play with all sorts of cool stuff. Glass syringes, reusable needles, liquid mercury from the blood pressure machines (shudder). My father and the other staff routinely got blood all over their neatly pressed white lab coats with barely a glove or facemask to be seen. Surgeons used that stuff, but not the doctors and nurses in the rest of the medical world.

I was immunized several times in a gymnasium line up with all my school friends. It was a wham bam thank you ma'am type thing. I thought the jet gun was nifty as there was no needle but discovered it hurt more.  As a medical student in the 80s I was aware of HIV but the notion of universal precautions was still a decade in the future. If we got blood on our hands we just washed it off. The world was very different and the acronym OH&S barely existed. 

Here are some timelines:

400 B.C. Campaign Jaundice: Hippocrates (yes, the Hippocratic oath guy) described a condition he called “epidemic jaundice.”

8th century A.D.: Pope Zacharias quarantined men and horses with jaundice. This was meant to control the spread of the disease.

1861-1865: More than 40,000 cases of jaundice were recorded in the Union Army during the Civil War.

1942-1945 Hepatitis and World War II: Approximately 182,383 US service members were hospitalized for hepatitis during World War II. The disease was contracted in two different ways. An epidemic of hepatitis broke out among many service members who were vaccinated against yellow fever. The source of the infection was traced to the serum that was used in the vaccine. A different form of hepatitis, acute hepatitis, was found among soldiers who had received blood transfusions.

1951: Rothauser produced the first injection-molded syringes made of polypropylene, a plastic that can be heat-sterilized. 

1956: New Zealand inventor Colin Murdoch was granted New Zealand and Australian patents for a disposable plastic syringe, it will catch on but will take time.

1964: Ansell manufactures the first disposable latex medical glove based on the production technique for making condoms, but universal use (as part of universal precautions) will take close to 3 decades to catch on.

1965: The hepatitis B virus was discovered by Dr. Baruch Blumberg.

1973: The hepatitis A virus was discovered at the National Institutes of Health by a team led by Steven Feinstone.

1973: Cases of hepatitis not caused by either hepatitis A or hepatitis B come to be called "non A, non B hepatitis".

1989: Hepatitis C virus (previously known as non A, non B) is discovered by scientists at a California biotechnology company called Chiron.

1991: A test for Hepatitis C in the blood supply becomes available.

1992: The Occupational Health and Safety Administration (OHSA) published its Bloodborne Pathogens Standard. Around this time, there was increased awareness regarding HIV, and OHSA implemented the rule to protect workers who would come in contact with bodily fluids. OSHA’s standard required employers to provide personal protective equipment, including disposable gloves, to these workers.

So, we know that Baby Boomers are more at risk of Hepatitis C than any other group? Why? It's actually pretty simple.

Some of the soldiers that returned to the USA from WWII came back with Hepatitis C. Poor medical hygiene spread it, and this spread was almost certainly by vaccination in the 1950s, NOT by IVDU in the 1960s and 1970s. Nice theory, but how can we be sure? One word - genomics. Here is the study, published in the most prestigious journal in the world "The Lancet".

Abstract here: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2816%2900124-9/fulltext

Full text here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245154/

Here it is in plain English, thanks to Sheryl Ubelacker from The Canadian Press.

Canadian researchers have determined the peak of the hepatitis C epidemic in North America occurred about 15 years earlier than previously believed, suggesting it wasn’t youthful indiscretions that put baby boomers at a high risk for the disease.

It was long thought that boomers who were infected with the blood-borne virus likely contracted the disease in their late teens or early 20s, due to such risky behaviours as IV drug use or sexual experimentation.

But a study by B.C. researchers found the peak of the hepatitis C epidemic occurred about 1950, when many baby boomers were young children and had plateaued by 1960 — well before the zenith of injection drug use at the end of that decade.

The oldest of the baby boomers were just 5 years old at the peak of the epidemic, the researchers say.

“The spread of hepatitis C in North America occurred at least 15 years earlier than it was suspected before, and if that is the case, the baby boomer epidemic ... cannot be explained by behavioral indiscretions on the part of the baby boomers,” said co-investigator Dr. Julio Montaner, director of the BC Centre of Excellence in HIV/AIDS.

“We suspect that this is more likely attributable to medical practices at the time,” said Montaner, explaining that hepatitis C hadn’t yet been identified and injections and blood transfusions were given employing reusable glass-tube syringes and metal needles, which were subject to contamination despite boiling.

“The baby boomers in North America ought to be offered hepatitis C screening,” he said, “not because they did anything wrong but because they are baby boomers, and so they were alive at a time in which the standard of care was such that we are all potentially at risk of having contracted hepatitis C.”

If you or a loved one have Hepatitis C, but can't get access to insurance-funded treatment, then maybe getting cured with generic HCV medication is worth a thought. Visit our home page to learn more about generic hepatitis C treatment.

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