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CDC recommends considering all baby boomers at risk for Hepatitis C

Mon., June 11, 2012, 9:25 a.m.

Users of injected drugs. People exposed to contaminated blood through decades-old transfusions. Baby boomers.

That last group, the 80 million Americans born from 1945 to 1965, should be added to the populations considered at risk for hepatitis C, say officials of the Centers for Disease Control and Prevention.

They suggest every boomer be tested for the virus in a proposal some stamp as overreaching but others say is the best way to control an epidemic that kills more than 15,000 people every year.

“You don’t have to be a math wiz to figure this out,” said Dr. Tesu Lin, a Ventura digestive-tract specialist, referring to dramatic improvements in medication that increase the chance of successful treatment to about 75 percent and to the cost of liver transplants that are a best-case scenario when the disease causes liver failure. “I don’t see any downside.”

Identified by scientists less than 25 years ago, hepatitis C is the leading cause of liver cancer and the second most common reason for cirrhosis. About 3.2 million Americans are infected, according to the CDC. Because the virus can lie dormant for decades, sometimes never causing liver problems, as many as 75 percent of those afflicted don’t know it.

Hepatitis is liver inflammation that comes in different forms caused by different viruses. While hepatitis A and B have vaccines, C does not.

Hepatitis C is transmitted through blood that might have been passed by a needle, a transfusion before blood screenings in 1992, an organ transplant or the birth of a baby. Sexual contact with an infected partner can cause transmission but is less common.

The screening proposal was introduced recently in a public comment process and could be finalized later this year. Voluntary, it would recommend doctors suggest to baby boomer patients, during regularly scheduled exams, that they submit to a blood test for hepatitis C.

The current testing guidelines focus on risk groups: drug users, health care workers exposed to needle sticks and people with symptoms of liver failure. The prospect of putting every baby boomer — about 217,000 in Ventura County — into the risk pool is catching some doctors off guard.

Dr. Jack Padour, a Ventura internal-medicine physician, said he needs more information about the benefits of widespread testing that might stir up alarm and stigmas. He worries about false positives and wonders whether patients, being tested only because of their age, might have to pay for the test themselves.

“The problem is that insurance companies don’t reimburse you for it,” he said. “They don’t care what the CDC said.”

Federal officials are working with insurers to make sure the test would be covered, said Dr. John W. Ward, director of the division of viral hepatitis at the CDC. He bases his arguments for baby boomer screenings on numbers.

About 75 percent of infected adults are 46 to 66.

Baby boomers are five times more likely than other adults to be infected with hepatitis C.

Nearly 75 percent of the deaths from the disease involve boomers.

They may have been exposed through transfusions before blood screens for the virus started in 1992, Ward said. They may have been contaminated in a hospital before such facilities imposed stringent infection control standards. They may have been stuck with a needle or shared a rolled-up bill to snort cocaine.

They may be at risk even if they’re convinced they’re not.

“Is your risk of transmission as great as someone who knows they have injected drugs in the past? No,” said Ward. “Is it a risk that’s higher than someone much younger than you are? Yes.”

In Ventura County, 610 hepatitis C cases were reported in 2010, according to public health records. About 360 of the incidents involved people age 45 to 64. The rate dipped five consecutive years but is still a concern, said Dr. Robert Levin, the county’s public health officer.

“I think what the CDC really does by shining a spotlight on this is give people a choice,” he said. “A certain percentage of people who don’t think they need the test are going to be surprised by the result and find out they’re positive.”

New drugs called protease inhibitors bind themselves to the virus and destroy it, and as many as 75 percent of hepatitis C cases can be cured if caught in time, according to the CDC. Medication in the pipeline offers even more hope to people diagnosed in early stages.

“Death and transplant can be prevented,” Lin said. “All this can be prevented from a simple blood test.”

But as many as 70 percent of people who contract the virus won’t develop liver problems, said Dr. Duane Pearson, medical director for specialty services at the Ventura County Health Care Agency. Widespread testing means more people could get biopsies and expensive treatment they don’t need. They may have side effects that could have been avoided.

Other people with the virus may suffer from heart issues, immune-system deficiencies or other conditions that mean they can’t take the medication used in treatment, Pearson said.

He praised the CDC for trying to make people more aware of hepatitis C and to compel those who may be infected to get tested. But he’s not convinced every baby boomer needs to be tested.

“It would have to be on a case-to-case basis,” he said. “I just don’t want to take the decision-making out of the hands of the patients and their doctors.”

Ward’s argument is simple: Hepatitis C is an epidemic, and few people know it.

“We want to sound the alarm that we consider this an unrecognized health crisis and that something decisive and bold should be done,” he said.

The economic effect of widespread testing isn’t clear. The CDC is making $6.5 million available to expand testing efforts for hepatitis C and B. Ward said he doesn’t envision the broad screening efforts, involving gymnasiums crowded with people, that were used to vaccinate people from swine flu.

Instead, most testing would take place in doctor’s offices or at screening events already held at workplaces or health fairs, he said.

If Bill Solomon was in a risk group for hepatitis C, he didn’t know it. But about 20 years ago when he was working as a movie set painter at a filming in Arizona, a doctor delivered a bombshell.

“He told me my liver was half gone and I had six months to live,” said Solomon, 61, of Newbury Park. “It was hell going through it.”

Solomon received a new liver about two years after the diagnosis. Now he paints and sculpts and takes three-mile hikes five days a week.

If Solomon met someone who had no reason to think he was at risk besides age, he’d tell the person to see a doctor.

“I think it would be a good idea to get tested, just to cross your name off the list,” he said.

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