Hepatitis C's silence is its threat

Experts say it can take decades for symptoms of the virus to surface, with no vaccine available

BY DELTHIA RICKS.delthia.ricks@newsday.com

November 18, 2007

Among viral infections that have reached epidemic proportions worldwide, hepatitis C ranks high on the list of public health threats because it lacks a protective vaccine, such as the one that has helped limit infections with its microbial cousin, hepatitis B.

The alphabet of viruses - A, B, C, D and E - comprises a highly infectious family of pathogens that have made the most-wanted list of federal virus hunters, who are tracking their incidence in the population - and in health care and food service settings, sites where outbreaks have been spawned.

While hepatitis A is a gourmand's nightmare, transmitted through fecal matter that contaminates food, B and C remain worrisome for a variety of reasons. They are transmitted through blood-to-blood contact, and in rare instances, have been communicated through contaminated medical equipment.

Analyses have shown hepatitis B to be 100 times more infectious than HIV, and numerous studies have characterized hepatitis C as a tidal wave expected to crest in only a few years.

By 2015, the Centers for Disease Control and Prevention predicts a 279 percent nationwide increase in the incidence of liver damage due to hepatitis C; a 528 percent increase in the need for liver transplants; and a 223 percent increase in the liver-related death rate.

"Hepatitis C is typically a silent disease," said Dr. Melissa Palmer, a Plainview liver specialist who has tested new treatments for various forms of hepatitis. "But it is also the only form of hepatitis that can be cured."

Treatments involving injections of the immune booster pegylated interferon, plus doses of the antiviral Ribavirin, have been known to force the infection into retreat.

Both hepatitis C and B can lead to liver cirrhosis, Palmer said, and eventually, liver cancer and the need for a transplant.

For some people, however, the power of a healthy immune system can trigger a hepatitis C infection to resolve on its own. "This is the only form of hepatitis for which this occurs," Palmer said.

Yet hepatitis C remains an international public health issue of breathtaking magnitude because not every patient can be cured. The infection sometimes smolders for two decades before symptoms are recognized.

The World Health Organization estimates 170 million people around the globe carry the virus, 4 million of them in the United States.

"The actual lab work to identify whether hepatitis B or C is present in the blood does not take that long and can be turned around very quickly," said Joseph Perz, a health care epidemiologist at the CDC. He, like other experts, worries about hepatitis C's growing impact.

In 2005, the state convened a meeting in Manhattan about the rise in hepatitis C infections statewide. Of chief concern was the growing problem of dual infections involving HIV and hepatitis C, which have reached epidemic proportions in New York City. Public health officials from Long Island also cited an upward trend in hepatitis C infections.

Earlier this month at the annual meeting of the American Public Health Association, experts emphasized the need for impeccable infection control measures in health care settings, particularly in light of the prevalence of blood-borne viruses in the population.

Sloppy techniques have stirred health authorities and instilled fear in patients who've been notified of possible exposure.

Transmission in health care settings, though said to be rare, is not new. A 2003 study highlighted a spate of infections involving hepatitis B and C in outpatient settings nationwide, two of them in New York City.

One centered on a Manhattan physician's colonoscopy practice, where 12 patients contracted the hepatitis C virus. The second involved a Manhattan pain treatment center where 38 patients were infected with hepatitis B. Both outbreaks involved medication drawn from multiuse vials. More than 2,000 patients received letters about possible exposure in the two cases.

In 2004, a scare rippled across Long Island when the North Shore-Long Island Jewish Health System notified 177 patients that endoscopic tubes inserted through patients' mouths, allowing doctors to view the upper gastrointestinal tract, had not been properly disinfected.

North Shore spokesman Terry Lynam said last week that letters were sent to patients as a precaution and there were no infections. But as health care institutions work to refine methods of infection control, scientists are still seeking to better understand the genetics of the viruses that cause hepatitis.

Hepatitis C remains an area of intense research because for decades it had been among the most elusive. Until 1989, it had escaped detection, making it a looming - and potentially deadly - presence in the blood supply. Scientists at Chiron Corp. first identified it, paving the way for blood-supply screening and patient diagnosis.