Hepatitis trends: IOM findings to aid in improved HBV/HCV awareness

The Centers for Disease Control and Prevention
(CDC) posted the key findings and recommendations from the Institute of
Medicine’s (IOM) January 11, 2010, pre-publication version of a report
on the prevention and control of viral hepatitis infections in the U.S.
The CDC, along with other partners, commissioned the IOM to examine the
topic, and the CDC Foundation has launched a Viral Hepatitis Action
Coalition to respond to the IOM report and support CDC research and
programs.

The committee’s report — entitled “Hepatitis and
Liver Cancer: A National Strategy for Prevention and Control of
Hepatitis B and C” (HBV, HCV) — found major underlying factors that
impede current efforts to prevent and control the diseases:

  • a lack of knowledge and awareness about chronic viral hepatitis
    on the part of healthcare and social-service providers, as well as
    among at-risk populations, members of the public, and policymakers;
    and
  • an insufficient about the extent and seriousness of the
    public-health problem, so inadequate public resources are being
    allocated to prevention, control, and surveillance programs.

Surveillance recommendations included a
comprehensive evaluation by the CDC of the national HBV/HCV
public-health surveillance system, as well as development by the CDC of
specific cooperative viral hepatitis agreements with all state and
territorial health departments to support core surveillance for acute
and chronic HBV/HCV. In addition the CDC is charged with supporting and
conducting targeted active surveillance (including serologic testing) to
monitor incidence and prevalence of HBV/HCV infections in populations
not fully captured by core surveillance.

The committee suggested the CDC, working with
other key stakeholders (e.g., other federal agencies, state and local
governments, professional organizations, healthcare organizations and
educational institutions), develop educational programs about HBV/HCV
for healthcare and social-service providers. Additionally, the CDC and
these stakeholders should develop, coordinate, and evaluate “innovative
and effective outreach and education programs” to target the at-risk
populations and to increase awareness among the general U.S. population
about hepatitis B and C.

Other recommendations involve immunization of
infants born to HBV surface antigen-positive women; HBV immunization as
a requirement for school attendance; increased HBV vaccination of
at-risk adults; expansion of immunization-information systems to include
adolescents and adults; expansion of private and public insurance
coverage for HBV vaccination; and ensuring an adequate, accessible, and
sustainable hepatitis vaccine supply.

Further, viral-hepatitis services recommendations
include incorporating guidelines for risk-factor screening for HBV/HCV
as a component of preventive care for at-risk and chronically-infected
patients. Recommendations also suggest providing resources for expansion
of community-based programs to provide HBV screening, testing, and
vaccination services that target foreign-born populations and
injection-drug users to reduce the spread of hepatitis C virus
infection.

More details about the IOM report and other information about the
prevention and control of viral hepatitis infections are available at

www.cdc.gov/hepatitis/IOMnews.htm
.

Effective, cost-effective QC in an ever-changing environment
“Serology tests (for infectious-disease antibodies and antigens) are showing up more and more on large automated systems that used to be just for chemistry tests. Tests for pathogen nucleic acids (called NAT in blood banks) have their own automated systems; and before too long, systems will likely be developed that can test for small molecule, protein, and nucleic-acid analytes. Test-method and ordering-pattern changes are a constant in clinical laboratorians’ lives, making it more important than ever to be able to validate and monitor their results over time. Independent controls for hepatitis, HIV, and other infectious diseases, are carefully designed to be solid negatives or low positives for specific test methods, and we work with laboratorians to monitor test performance and spot trends. Evaluating a new method’s performance when it is implemented, and monitoring that performance over time, allows laboratorians to detect changes before they become bad results — saving time, money and, perhaps most importantly, the lab’s credibility.”

—Patricia E. Garrett,
PhD, D(ABCC)

Senior Director, Science and Technology

SeraCare Life Sciences

Milford, MA

Maker of ACCURUN Controls and BBI Panels


Thousands exposed to HCV by hospital tech

Reminiscent of other news stories in recent years
is the case in Denver, CO, of Kristen D. Parker, 27, a former employee
of Rose Medical Center there. Parker admitted to police on videotape
that while she worked at the facility in 2008 and 2009, she stole
pain-medication syringes from operating room trays, replacing them at
times with needles she had already used to inject herself.

According to The New York Times, 17 Rose
Medical Center patients have so far been found to have a strain of
hepatitis C linked through genetic sequencing to the strain in Parker’s
blood. These results were found by the Colorado Department of Public
Health and Environment.

On January 22, 2010, the federal judge sitting on
the case, Robert E. Blackburn, rejected a plea agreement for Parker,
suggesting that 20 years in prison contained in the plea agreement was
not enough punishment for the crime; legal experts say it is unusual for
a judge to reject a plea agreement. Parker may maintain her guilty plea,
giving the judge discretion as to her sentencing next month, or she
could attempt to reach another plea agreement with prosecutors or change
her plea to not guilty and demand a jury trial.

Parker pleaded guilty to tampering with a
consumer product and obtaining a controlled substance by deceit or
subterfuge.

She admitted stealing syringes filled with
Fentanyl from operating carts while employed at Rose and at Colorado
Springs’ Audubon Surgery Center.

Parker told prosecutors she stole the syringes filled
with the narcotic and intended to replace them with saline-filled syringes
with clean needles but became careless.

Prosecutors say her scheme may have exposed nearly
6,000 patients at two hospitals to hepatitis C.

Parker said she began stealing syringes from medical
carts within days of starting at Rose, at first taking care to replace them
with clean needles, then losing track.

She came under suspicion after a syringe in her
pocket pricked a co-worker. Parker was hired a few weeks later at Audubon,
where she worked until she was arrested in June 2009 after Colorado health
officials linked her to hepatitis C cases at Rose.

Investigations were launched in Mount Kisco, NY, and
in Houston, where Parker previously worked. Parker told prosecutors she
stole no syringes at her first job in Houston.

She had started the practice at her second job at
Northern Westchester Hospital in New York, where said she filled clean,
unused syringes with saline to replace the Fentanyl-filled syringes.

About 2,800 patients at Northern Westchester were advised to get tested
for hepatitis C. In Houston, an investigation found no hepatitis cases
linked to Parker.


Hepatitis numbers

According to Centers for Disease Control and
Prevention (CDC), hepatitis C virus (HCV) infection is the most common
chronic bloodborne infection in the United States. The CDC reports the
following hepatitis statistics:

  • An estimated 1.2 million Americans are living with chronic hepatitis
    B and 3.2 million are living with chronic hepatitis C. Many do not know
    they are infected.
  • More than 100 million people worldwide are infected with HCV.
  • The incubation period from the time of exposure to the hepatitis B
    virus (HBV) to the onset of symptoms is six weeks to six months.
  • HCV RNA can be detected in blood within 1-3 weeks after exposure. The
    average time from exposure to antibody to HCV (anti-HCV) seroconversion
    is 8-9 weeks, and anti-HCV can be detected in >97% of persons by six
    months after exposure.
  • Asians and Pacific Islanders make up 4.5% of the U.S. population but
    account for more than 50% of chronic hepatitis B cases.
  • About 17,000 Americans become infected with hepatitis C each
    year.
  • In the U.S. about 12,000 people die each year from hepatitis
    C-related illnesses.
  • Chronic hepatitis B and C cause thousands of cases of liver
    cancer, liver disease, and death each year — taking the heaviest
    toll among Asians, Pacific Islanders, and blacks in the United
    States.
  • Effective treatment can eradicate the virus in about 40% of
    patients.
  • HVB and HVC infections account for nearly half of the liver
    transplantations performed annually in the U.S.
  • Although the availability of an effective vaccine against
    hepatitis B has significantly reduced its spread, some 1,000 infants
    born to infected mothers develop chronic infections each year, a
    number that has not declined over the past decade.
  • Three states — Alabama, Montana, and South Dakota — do not
    require that children be vaccinated against hepatitis B before
    entering daycare or school.
  • Each year, roughly 40,000 to 45,000 people emigrate to the
    United States from countries where hepatitis B is endemic.

Visit
www.cdc.gov
/hepatitis
.

Photo 115879330 © Karenr | Dreamstime.com
Photo 124723736 © Steveheap | Dreamstime.com
Photo 129549884 © Katarzyna Bialasiewicz | Dreamstime.com
Photo 159136554 © Alberto Masnovo | Dreamstime.com