LAKE COUNTY, Calif. – Public health officials at every level of government are encouraging Americans – especially the baby boomer generation – to proactively pursue screening for hepatitis C, a measure that’s estimated to save hundreds of thousands of lives in the decades to come.
In August, the Centers for Disease Control and Prevention in Atlanta released final recommendations urging all U.S. baby boomers – born from 1945 to 1965 – to get a one-time test for the hepatitis C virus, in an effort to protect that generation’s health and save lives.
The reason: one in 30 baby boomers has been infected with hepatitis C – often decades ago, specifically, the 1970s and 1980s, when infection rates were highest – and are not aware of it, don’t perceive themselves to be at risk and haven’t been screened, the federal health agency said.
The CDC estimated that more than 2 million baby boomers are infected by the disease, which accounts for more than 75 percent of all American adults living with hepatitis C.
It’s expected that the recommended one-time tests for all baby boomers – not just testing based on risk factors, as the CDC previously had recommended – could identify more than 800,000 additional people with hepatitis C, saving 120,000 lives or more.
Hepatitis C causes serious liver diseases, including liver cancer – the fastest-rising cause of cancer-related deaths – and is the leading cause of liver transplants in the United States, the CDC said.
According to the agency’s statistics, more than 15,000 Americans – most of them baby boomers – die each year from hepatitis C-related illnesses.
Identifying those infected with the disease can lead to successful treatment – including therapies that can cure an estimated 75 percent of infections, the CDC said.
The CDC estimated that incidences of the disease occurring in the United States are far higher than what are actually reported.
As an example, it cited data from 2007, during which 849 acute cases of hepatitis C were reported nationwide. However, the CDC estimated that the number was far higher – in the range of 17,000 cases.
The California Department of Public Health supports the new recommendations and encourages baby boomers to talk to their doctors about getting tested for hepatitis C, said agency spokesman Ralph Montano.
Montano said the California Department of Public Health is currently working on a report summarizing data on reported cases of hepatitis C from 2007-2011.
Detailed information will be available in the viral hepatitis surveillance report for 2007-2011, which will be available for public distribution by the end of 2012, Montano said.
Data challenges for public health officials
Lake County Public Health Officer Dr. Karen Tait said CDC’s screening recommended is a good idea. Otherwise, she said cases can go undetected even if liver function tests are measured, because those tests can appear normal. “Damage to the liver can occur slowly and insidiously,” she said.
One of the challenges for public health has been having accurate data on how many Americans have hepatitis C, said Tait, who suggested that one of the additional benefits of having baby boomers tested could be having a more accurate picture of the nation’s active caseload.
Tait said it’s just as hard to get a handle on Lake County’s hepatitis C numbers. She said there were 112 chronic hepatitis C cases reported in Lake County in 2010, which reflects the cases of people who lived in Lake County at the time of initial diagnosis of their infection.
However, Tait cautioned that such data has its limitations, and it’s hard to translate those numbers into the case load that lives in the county because some of the people may have moved away or died.
“Although we receive regular reports enough to say that there is a lot of hepatitis C that has been diagnosed and is being followed here in Lake County, the data is very inaccurate,” Tait said. “I've discussed this with the state and they agree that the data is inaccurate at all levels. This is the result of changing testing methodologies over the years and changing criteria for calling someone a ‘case.’”
She said she discovered the inaccuracies in data in the course of trying to understand how the disease’s numbers used to be reported.
“I think the reporting issues are probably nationwide because they’ve been the same for everybody over the years,” she said.
One of the unknowns for Lake County is how hepatitis C is related to the high rate of liver disease reported in the county over the past decade.
The 2011 Lake County Health Needs Assessment pointed out that in 2003, a key sample year, Lake County’s rate of death due to cirrhosis of the liver was five times higher than the statewide rate, and noted that hepatitis C could be a major cause of cirrhosis.
Tait said the health needs assessment’s statement about hepatitis C’s possible impact on local cirrhosis cases was “speculative.”
“We have issues of substance abuse that we know contribute to liver disease,” including both drugs and alcohol, Tait said.
Alcohol use on top of having hepatitis C, Tait added, worsens the disease’s progression.
Education remains crucial
Tait said the information about how hepatitis C is transmitted is far better now and more complete than what was available to baby boomers.
Public health also has developed better measures for cutting off transmission. Blood bank screening has helped interrupt what Tait called “a major mode of transmission in the past.”
While the disease can be sexually transmitted, such transmission isn’t efficient, Tait said.
The CDC said injection drug use currently is the most common means of hepatitis C transmission in the United States.
As such, Tait said ongoing educational efforts about risks are critical, particularly for the injection drug-using population – including athletes who use steroids and other performance enhancing substances – as well as those who take part in other practices that result in exposure to infectious blood.
Just one time using a dirty needle is sufficient to transmit the infection. “One slip up can be all that matters,” Tait said. As such, syringe exchange programs attempt to mitigate that risk.
Tait explained that there also is a population where it can’t be determined how they got hepatitis C.
In addition to the danger it poses to individuals, Tait said there is another concern.
“Hepatitis C is the ‘elephant in the room’ when it comes to costs and demands on the health care system down the road, not unlike the consequences we're now beginning to appreciate about obesity and its health impacts on diabetes, diabetic eye and kidney disease, cardiovascular disease and degenerative joint disease,” she said.
For additional information about hepatitis C, visit www.cdc.gov/hepatitis , www.cdc.gov/hepatitis/HCV/HCVfaq.htm or www.cdph.ca.gov/programs/Pages/ViralHepatitisResources.aspx .
Email Elizabeth Larson at [email protected] . Follow her on Twitter, @ERLarson, or Lake County News, @LakeCoNews.