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Week Ending: October 15th, 2005
Alan Franciscus
Editor-in-Chief
To download pdf version click here
This Issue:
• Medicinal Cannabis Gets Popular Thumbs Up
• Hepatitis B Vaccination of Men Who Have Sex With Men: Experience With an Accelerated Course of Vaccination in a Genitourinary Medicine Clinic
• How to Help Patients Face Up to Hepatitis C
• AB 547 Removes Section of State Law Regarding Emergency Declarations
• Digging Up the Truth
• Giving Up Anonymity to Fight Hep C
• Crucell N.V.: Merck and Co., Inc. Exercises Option on PER.C6 License for Adenovirus-based Vaccine Against Hepatitis C
• Stem Cell Breakthrough to Treat Liver Damage
• Genital Tract a 'Sanctuary Site' for Hepatitis C Virus in Coinfected HIV-Positive Women
• Liver Cancer Rates Rising
• Jury Awards $685K In Hepatitis Suit
• China Develops Reagent for Testing Drug Resistance of Hepatitis B
• Punk Rock Unites for Hepatitis C Awareness
• A Missed Opportunity: Hepatitis C Screening of Prisoners
• Survey Indicates Lack of Public Awareness Hepatitis C
• Alliance Emerges as Leader in Hepatitis C Prevention and Treatment Policy
• Hep-C Victim Feels 'Un-Canadian'
• Hep B Booster Shot Unnecessary: Study
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October 5rd, 2005
Stem Cell Breakthrough to Treat Liver Damage
http://www.lse.co.uk/
Source: UK News
LIFE STYLE EXTRA (UK) - British scientists have successfully repaired patients' damaged livers by using bone marrow stem cells from their own blood.
The victim is first injected with a drug which stimulates their bone marrow to produce extra stem cells. The stem cells are then harvested from the blood and injected into a vein or artery leading directly to the liver.
Although the researchers are unsure what the cells then do they seem to help repair any liver damage, reports New Scientist.
The finding raises the prospect of regenerating diseased livers and avoid problems with current liver transplants where the patient's body rejects the foreign organ.
Stem cells are special cells which have not yet become totally specialised to one role in the body. The techniques developed to isolate these cells are regarded as being among the most important recent scientific discoveries.
To obtain the cells the patient is given an injection of a chemical called GCSF (granulocyte colony stimulating factor) which stimulates their bone marrow to produce extra stem cells.
After five days on the drug the patient's blood is screened for cells bearing the surface protein CD34 which marks them out as stem cells.
These are then extracted from the blood, concentrated and injected into the patient's portal vein or hepatic artery - both of which feed blood directly to the liver.
No one is sure exactly where these cells go or what they do - but they appear to home in on and help repair any liver damage.
The liver function and general health of three out of five patients given the treatment improved significantly within two months of treatment, according to liver surgeon Nagy Habib of Imperial College London, who heads the team conducting the trial.
He presented the findings at a seminar in London hosted by the London Regenerative Medicine Network. The two patients whose health did not improve showed no ill effects from the treatment.
One patient in his early 60s had a chronic condition called primary sclerosing cholangitis which progressively damages the liver's bile ducts.
"At the outset he had jaundice, was vomiting blood and had ascites - swelling caused by fluid around the liver," says Mr Habib.
Two months later his jaundice had disappeared while levels of albumin - a marker of healthy liver function - rose to normal. Magnetic resonance scans showed the swelling had also gone down.
Mr Habib's team are hopeful they will gain approval to conduct a follow-up trial on 18 more people with liver disease.
This time Mr Habib hopes to refine the technique by isolating specialised stem cells he calls "livercytes" and multiplying them outside the body for about two weeks before re-injecting them.
An added benefit of the treatment is the stem cells can be harvested from the blood rather than from bone marrow - which is a painful procedure.
Other researchers in Japan are close to publishing the results of a similar study on 10 patients using stem cells to treat liver failure - but their technique involves extracting the cells directly from the bone marrow.
Adult stem cells offer great promise in medicine as they may generate the full spectrum of cell types needed to repair a damaged organ.
Using adult stem cells will also avoid the ethical problems associated with even earlier cell types. Embryonic stem cells can be made to develop into any cell type in the body - they would offer the ultimate flexibility.
But their only source is from aborted tissue or discarded test-tube embryos - and several campaign groups have vowed to fight any law change permitting the widespread harvesting of stem cells in these areas.
About 5,000 people in the UK are awaiting organ transplants - and for many an organ will almost certainly not be found in time. Patients will inevitably die waiting for a suitable donor.
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October 8th, 2005
Medicinal Cannabis Gets Popular Thumbs Up
Source: Ireland on-line
http://breakingnews.iol.ie/
Research carried out by the National Advisory Committee on Drugs (NACD) found the majority of people in Ireland would approve of using cannabis for medicinal reasons.
A synthetic product, containing cannabis, has been developed and is being trialled at the moment to fully understand and appreciate its benefits and effects.
Head of the NACD, Mairead Lyons says the trial is in its early stages but if it proves successful it could be licesnsed here.
The Irish Medicines Board has responsibility for approving all prescription drugs sold here.
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October 9th, 2005
Hepatitis B Vaccination of Men Who Have Sex With Men: Experience With an Accelerated Course of Vaccination in a Genitourinary Medicine Clinic
SourceURL:http://www.rednova.com
By A McMillan
Summary: An accelerated course of hepatitis B vaccination was offered to men who had sex with men attending a genitourinary medicine clinic. The uptake and completion rates of the vaccine between 1 November 2002 and 28 February 2004 were compared with data for 1994. The uptake of vaccine was significantly higher during the former audit period than the latter (310 [98%] of 315 versus 146 [74%]). There was, however, no significant difference in completion rates between the two audit periods: 220 (73%) of the 302 men who initiated the accelerated schedule, compared with 118 (81%) of the 146 men who completed the standard course in 1994. Innovative means of ensuring completion of vaccination are needed.
Introduction
Although vaccination is effective in reducing the risk of hepatitis B virus (HBV) infection among men who have sex with men (MSM),1 most studies have shown that fewer than 75% (in some studies only about one-fifth) complete the standard course of three injections given over a six-month period.2-6 The rather protracted nature of the vaccination schedule might be a factor in determining whether or not an individual will complete the course of vaccine, although this hypothesis has not been fully explored in reported studies. An accelerated vaccination schedule for rapid protection against hepatitis A and B has been described.7 Doses of combined hepatitis A and B vaccine (Twinrix, Glaxo SmithKline, Belgium) are given on days 0, 7 and 21, with a booster dose administered 12 months later. About 95% of vaccinees develop protection against hepatitis B within three months of completion of the primary vaccination schedule.7
The accelerated course of vaccination against hepatitis A and B was introduced into the Edinburgh clinic protocol in November 2002. The aim of this paper is to describe the acceptance of this vaccination schedule among MSM, and to compare the results with those of the standard schedule as shown in a previous unpublished audit.
Methods
The two audit periods were (1) between 1 January 1994 and 31 December 1994, and (2) between 1 November 2002 and 28 February 2004. MSM who attended the Department of Genitourinary Medicine, Edinburgh Royal Infirmary, were identified from the clinic database for these periods, and their case-notes were retrieved manually. Note was made of the patient's age, postcode (2002-2004 only), the number of injections of hepatitis vaccine administered, and the results of serological testing for current or past infection with HBV.
The Amerlite system (Ortho Diagnostic Systems, Germany) was used for the detection of hepatitis B surface antigen (HBsAg) and of core antibody (anti-HBc).
During the first audit period, the clinic policy was to offer vaccination against hepatitis B to MSM who had not been vaccinated previously and who had no pre-existing immunity to HBV (anti-HBc negative). The serological status was determined from a blood sample obtained at the patients' initial attendance. An appointment was given to re-attend the clinic about 14 days later and the first dose of monovalent hepatitis B vaccine (Engerix B) was given to eligible patients. The second and third were given one and six months after the first dose.
During the second audit period, a combined hepatitis A and B vaccine (Twinrix) was offered to all MSM who had not been vaccinated previously. The first dose, which was given before the results of serological testing were available, was given at the patient's first clinic visit, and appointments were made for attendance seven and 21 days later for the second and third doses. When there was pre- existing immunity to hepatitis A, only monovalent hepatitis B vaccine was used in the second and subsequent dosing. The nurses who administered the vaccine emphasized the importance of completion of the course.
The X2 test with Yates' correction and the Mann- Whitney U-tests were used in the analysis of the categorical and numerical data, respectively.
Only hepatitis B vaccination is considered in the current audit.
Results
During the first audit period, 500 MSM attended the Department; 197 (39%) were eligible for vaccine. Of the 197 men, 51 (26%) declined vaccination, were not offered vaccine, or defaulted from the first follow-up visit.
During the second audit period, 921 MSM attended the Department; 315 (33%) were initially considered eligible for hepatitis B vaccination; three men declined vaccination, two men were not offered vaccine, and eight men were subsequently shown to be anti- HBc positive. The uptake of vaccination was significantly greater during the second audit period than the first (X2 = 71.0; P < 0.0001).
There was no significant difference between the two audit periods in the median ages of men who initiated vaccination (median ages [interquartile range - IQR] in 1994 and second audit period 27.0 [9.0] years and 25.0 [13.0] years, respectively; P>0.05).
Men who did not attend for the second dose of the accelerated course of vaccine were significantly younger than those who did attend (median age 23.0 years [IQR 7.0 years] versus 25.5 [IQR 13.0 years]; P = 0.01). There was no significant difference in the median ages between those who attended for the third dose and those who defaulted (26.0 years [IQR 11.0 years] and 24.0 years [IQR 13.0 years], respectively; P>0.05).
There was no difference in the proportions of men who received all three doses of the accelerated vaccine between those who had an address in the City of Edinburgh (EH01-EH17) and those who did not (177 of 240 versus 43 of 62 men; X2 = 0.28, P>0.05). Four men did not supply an address. Similarly, there was no difference in these parameters among men who received or did not receive the second dose of vaccine (209 of 240 versus 55 of 62; X2 = 0.02, P>0.05).
Discussion
This study has shown that among MSM attending the Edinburgh clinic, the uptake of hepatitis B vaccination has improved dramatically. The completion rate, however, has not changed significantly with the introduction of the accelerated vaccination schedule.
Several studies have shown significant correlates of uptake of hepatitis B vaccination among MSM. These include younger age, living in an urban setting, educational level, knowledge about HBV vaccine, sexual openness, and a limited number of lifetime sexual partners.8 Negative correlates of vaccination have included more than 20 lifetime sexual partners, injection drug use, and a perception of being at low risk for HBV infection. In one of the few studies on lack of completion of hepatitis B vaccination among MSM, having unprotected sexual intercourse, multiple sexual partners and accepting money, drugs or gifts for sex were identified as factors.9 In the present study, men who defaulted from the second dose of vaccine were significantly younger than those who received this dose. None of the patients had a history of injecting drug use. As the number of lifetime sexual partners was not always recorded, it is impossible to correlate lack of completion of vaccination with this parameter. Similarly, an association with the acceptance of gifts for sex cannot be determined.
As the clinic is centrally situated in the City of Edinburgh, and as there was no significant difference in completion rates between those men living centrally and those who lived further from the clinic, lack of completion of the course of vaccine cannot be attributed to the geographical location of the unit.
It is clear that further research into the reasons for failure of completion of hepatitis B vaccination is required, and that innovative means of ensuring complete vaccination are needed.
References
1 Szmuness W, Stevens CE, Zang EA, Harley EJ, Kellner A. A controlled clinical trial of the efficacy of the hepatitis B vaccine (Heptavax B): a final report. Hepatology 1981;1:377-85
2 Bhatti N, Gilson RJC, Beecham M, et al. Failure to deliver hepatitis B vaccine: confessions from a genitourinary medicine clinic. BMJ 1991;303:97-101
3 Yuan L, Robinson G. Hepatitis B vaccination and screening for markers at a sexually transmitted disease clinic for men. Can J Public Health 1994;85:338-11
4 Weinstock HS, Bolan G, Moran JS, Peterman TA, Polish L, Reingold AL. Routine hepatitis B vaccination in a clinic for sexually transmitted diseases. Am J Public Health 1995;85:846-9
5 Neighbors K, Oraka C, Shih L, Lurie P. Awareness and utilization of the hepatitis B vaccine among young men in the Ann Arbor area who have sex with men. J Am Coll Health 1999;47:173-8
6 Sansom S, Rudy E, Strine T, Douglas W. Hepatitis A and B vaccination in a sexually transmitted disease clinic for men who have sex with men. Sex Transm Dis 2003;30:685-8
7 Nothdurft HD, Dietrich M, Zuckerman JN, e\t al. A new accelerated vaccination schedule for rapid protection against hepatitis A and B. Vaccine 2002;20:1157-62
8 Yee LJ, Rhodes SD. Understanding correlates of hepatitis B virus vaccination in men who have sex with men: what have we learned? Sex Transm Infect 2002;78:374-7
9 Dufour A, Remis RS, Alary M, et al. Factors associated with hepatitis B vaccination among men having sexual relations with men in Montreal, Quebec, Canada. Sex Transm Dis 1999;26:317-24
(Accepted 29 July 2004)
A McMillan MD FRCP
Department of Genitourinary Medicine, NHS Lothian, University Hospitals Division, Lauriston Building, 39 Lauriston Place, Edinburgh EH3 9HA, UK
Email: a.amcmm@btopenworld.com
Source: International Journal of STD & AIDS
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How to Help Patients Face Up to Hepatitis C
SourceURL:http://www.rednova.com
Dr Rob Hicks
THE BASICS
A pro-active approach is vital if the spread of hepatitis C is to be halted, says Dr Rob Hicks
There are an estimated 200,000 people in England who are chronically infected with the hepatitis C virus (HCV). The current FaCe It campaign aims to encourage those who may have been exposed to hepatitis C to seek advice from their GP about being tested for the virus.
NICE has issued guidance on treatment of hepatitis C that clearly sets out when it is appropriate for secondary care to offer and provide drug treatment to those with hepatitis C and what this treatment should be, since effective options are now available.
Pre-test counselling
People who request screening in response to the campaign because they are worried they may have been exposed to hepatitis C should be offered pretest counselling. This should include information about the nature of the condition, its mode of transmission, a person's exposure risk and formal antibody testing.
A positive antibody test, confirmed with a second test, however, does not distinguish between previously resolved or current infection and should prompt further testing to establish whether the virus is still present.
Further testing may be done in primary or secondary care depending on local policy, so it is a good idea to know what the policy is in your area.
Many patients who are known to be in a high-risk group may not be aware of hepatitis C and so it will be their GP who will need to raise the subject of screening.
Since hepatitis C is usually asymptomatic, or causes only non- specific symptoms, GPs should have a low index of suspicion for hepatitis C when seeing patients with vague symptoms of 'feeling under the weather', tiredness, or poor appetite, for example, and to ask whether they may have been exposed to hepatitis C and are therefore in a high-risk group.
It is also possible to be proactive and to contact patients at greater risk who should be offered testing.
It is estimated that about four patients in 1,000 are chronically infected with hepatitis C. The majority of these will be current or past IV drug users. Such patients are at the greatest risk of hepatitis C and identifying them will go a long way to establishing who has chronic infection and may need treatment.
Screening offers the opportunity for treatment to reduce the risk of long-term complications of chronic infection and the opportunity to reduce the risk of the infection being transmitted to others. In fact, many of those in high-risk groups, for example, recipients of transfused blood in the UK before September 1991, will have already been tested.
Ongoing support
For those who are confirmed to have current infection, referral to local specialist liver services should be accompanied by appropriate ongoing support and re-enforcement of the steps to take to reduce the risk of transmitting the infection to others.
GPs, in association with their primary care organisations, should try to ensure that these secondary care services, and the resources for treatment, are available in their area.
Between 60-80 per cent of those who acquire hepatitis C become chronically infected, with the remainder clearing the infection spontaneously.
The majority of those with chronic infection will have a normal lifespan without symptoms. Others may develop symptoms of chronic liver disease many years after infection, while between 5 and 20 per cent will develop liver cirrhosis after 20 years. Some will go on to develop primary liver cancer.
For these reasons, detecting and treating hepatitis C is important.
Current recommendations are that patients with moderate to severe chronic hepatitis C are treated with a combination of daily oral ribavirin and weekly subcutaneous peginterferon alfa. This regimen has been shown to be successful in clearing the infection in up to 55 per cent of patients.
A pre-filled pen-delivery system is also available. It enables patients to administer their pegylated interferon alfa therapy, offering the opportunity to improve treatment convenience, compliance and acceptability, and of reducing the risk of relapse in former injecting drug users.
Public awareness
Raising awareness of hepatitis C needs to be approached from different directions if those with undetected chronic hepatitis C are to be diagnosed and managed appropriately.
In primary care it is not only GPs who should have up-to-date knowledge to offer patients about hepatitis C and the possible need for testing. Other healthcare professionals, for example, practice nurses, also need to be well informed.
Displaying leaflets and posters about hepatitis C within the practice will support the public campaign and help to ensure that the target audience is reached.
Only then can those with undetected chronic hepatitis C can receive the care that is available for them.
Groups to whom hepatitis C testing should be offered
* People who have ever injected drugs in the past or who are currently injecting drug users.
* People who have received transfused blood in the UK prior to September 1991 or blood products prior to 1986.
* Recipients of organ and tissue transplants in the UK before 1992 or abroad in countries where hepatitis C is common and donors may not have been screened.
* Babies born to mothers known to be infected with hepatitis C virus (HCV).
* Children of mothers found to be infected with HCV.
* Regular sexual partners of patients infected with HCV.
* Healthcare workers accidentally exposed to blood where there is a risk of transmission of HCV.
* Anyone who has received medical or dental treatment in countries where HCV is common and infection control may be poor (this will include blood transfusions and blood products where donations are not screened for HCV).
* People who have tattoos, body piercing and other forms of skin piercing where infection control procedures are poor.
Identifying current or past IV drug users will go a long way to establishing who has chronic hepatitis C infection
More information
FaCe It Hepatitis C Awareness: www.hepc.nhs.uk
The Hepatitis C Trust: www.hepcuk.info
The British Liver Trust: www.britishlivertrust.org.uk
Hepatitis C testing should be offered to those who are currently injecting drug users or those who have ever injected drugs in the past
Dr Hicks is a part-time GP and a clinical assistant in sexual health medicine in London.
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AB 547 Removes Section of State Law Regarding Emergency Declarations
http://www.eurekareporter.com
10/8/2005 Gov. Arnold Schwarzenegger has signed a bill by Assemblywoman Patty Berg that makes it easier for cities and counties to maintain needle-exchange programs that fight the spread of AIDS and hepatitis-C.
"This bill very simply saves lives," said Berg (D-Eureka). "I'm very happy that it has been signed into law."
Assembly Bill 547 will eliminate a section of state law that requires cities and counties to declare a health emergency every two weeks in order to continue operating a needle-exchange program.
Several county health officers throughout the state have said they would be more likely to initiate needle-exchange programs if Berg's bill becomes law.
Needle-exchange programs fight the spread of blood-borne diseases that threaten not just intravenous drug users, but also people whose lives are knowingly or unknowingly linked to them.
"This is a great moment for public health," said Humboldt County Public Health Officer Ann Lindsay. "This bill will allow at least six more counties to conduct needle-exchange programs and protect not only injection drug users, but their families from infectious disease."
Last year, the governor vetoed a similar bill by Berg. But this year, Berg and her supporters managed to garner the support of key law enforcement groups.
In addition to sponsorship by California's public health officers, the bill had backing from the California Peace Officers' Association and the California Narcotic Officers' Association.
In California, more than 1,800 people die of AIDS every year, and 1,500 new infections occur through syringe sharing among intravenous drug users. Another 5,000 people become infected with Hepatitis C in the same manner, according to Berg's office.
The following cities and counties operate needle-exchange programs: the counties of Alameda, Contra Costa, Humboldt, Marin, Mendocino, Monterey, San Francisco, San Mateo, Santa Clara, Santa Cruz, Sonoma and Ventura, and the cities of Berkeley and Los Angeles.
Injection drug users are the second-largest group at risk of HIV infection, and are the primary source of heterosexual, female and perinatal transmission, according to Berg's office.
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Digging Up the Truth
SourceURL:http://www.nydailynews.com
By WILLIAM SHERMAN
DAILY NEWS STAFF WRITER
More than 30 bodies will have to be exhumed in an expanding probe into the trafficking of bones and tissue illegally harvested from corpses in funeral homes throughout the city, the Daily News has learned.
The exhumation will be done to determine how bodies were carved up, without relatives' permission, by a team of alleged body snatchers who sold body parts into the lucrative market for transplants.
Those transplants include bones for dental implants and orthopedic procedures; ligaments and tendons for those with tears, and skin and fatty tissue for burn victims and cosmetic procedures.
The exhumation also is expected to resolve allegations that the traffickers forged documents on corpses' medical condition and cause of death.
It is alleged that the traffickers' forgery was designed to make their product acceptable to tissue processing companies that finally prepare material for transplantation into the living.
U.S. Food and Drug Administration regulations require full documentation on corpses used for transplant material in order to prevent the transmission into the living of tissue contaminated by disease, including HIV and hepatitis.
The FDA also is investigating body parts trafficking in New York City.
The gruesome allegations were first disclosed by The News on Friday.
The Brooklyn district attorney's probe centers around a Fort Lee, N.J., company, Biomedical Tissues Services Ltd., and funeral homes in the city.
The company is run by Michael Mastromarino, who personally performed the harvesting procedures on corpses.
His former partner, Joseph Nicelli, a former funeral home owner, is also under investigation, according to sources.
After Mastromarino surgically removed bone and tissue, the corpses were roughly sewn up with plumber's PVC pipe, inserted to fill out clothed bodies in open coffins, sources said.
No such efforts were taken in cases of cremation under investigation.
Jerry Schmetterer, a spokesman for the Brooklyn district attorney's office, declined comment.
Julie Zawisza, an FDA spokesperson, confirmed her agency's probe, and it was also learned that the NYPD's major case squad has launched a separate investigation into the trafficking allegations.
Many of the corpses were dissected at the Daniel George and Son funeral home, 1852 Bath Ave., Brooklyn. Nicelli owned the home until about 18 months ago.
The body parts probe began after Nicelli sold Daniel George & Son to Robert Nelms and Debora Johnson, a now estranged couple, who own a chain of funeral homes.
Johnson and Nelms became suspicious about Mastromarino's operation and reported it and other problems at the Daniel George home to authorities.
Since then, Johnson and Nelms have "turned over cartons of documents to the DA's office," according to their lawyer, Eric Franz of Manhattan.
"Nelms and Johnson had nothing to do with any illegal operation by Biomedical Tissues," Franz added. "They are cooperating with the DA's office, and they are not involved in any criminal activity."
Nelms, who also is chairman of the Waitt-Nelms funeral home in Morganville, N.J., declined comment.
The Daniel George home, purchased by Nelms and Johnson for $1.5 million, is now closed.
Meanwhile, executives of two of the tissue processing companies that bought body parts from Mastromarino's company for eventual transplantation into the living said that so far, recipients have not experienced any adverse reactions.
The companies are able to track which recipients received material from Biomedical Tissue Services.
The two companies are cooperating with the investigation.
"In light of these events, we have suspended our relationship with Mastromarino and Biomedical Tissue Services," George Lombardi, chief financial officer of Tutogen Medical Inc., of West Paterson, N.J., told The News.
"It should be noted that Biomedical represents a very small percentage of our tissue recovery sources," he said.
Paul Thomas, CEO of LifeCell Corp., another Biomedical customer, said, "No adverse effects have been reported."
LifeCell, a publicly traded company, said that if Biomedical "is unable to resolve questions regarding donor documentation, [LifeCell] will not distribute the BTS inventory."
Regeneration Technologies Inc., another Biomedical customer, is also cooperating with the Brooklyn probe, according to sources.
LET US KNOW
Did this happen to your loved one?
Prosecutors are checking as many as 1,000 cases to see how many corpses may have been raided for body parts.
The center of the probe is the now-shuttered Daniel George & Son funeral home in Brooklyn.
If you suspect that someone you knew may be a victim, please call The News at (212) 210-1574, or E-mail us at: opinion@nydailynews.com, or fax us at (212)210-2963.
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October 10th, 2005
Giving Up Anonymity to Fight Hep C
http://news.bbc.co.uk/
By Jane Elliott
BBC News health reporter
When Ron Metcalfe was first diagnosed with hepatitis C he was advised to keep it a "secret" because of the stigma linking it to injecting drug use.
But Ron was determined to do the exact opposite.
So he set up a website to provide support for others in the same position as himself, as well as to chronicle his own fight with the potentially fatal condition.
His was the first UK blog by someone living with and having treatment for hepatitis C.
Secret
"It was a total shock when I was first diagnosed. I had never heard of hepatitis C. I barely even knew where my liver was," he said.
"After being advised not to disclose my diagnosis, I kept it 'secret' for several months, but I felt uncomfortable about being dishonest when people asked 'how are you?'.
None of us, including injecting drug users, deserves to have this virus and none of us 'have only ourselves to blame' – Ron Metcalfe
"When I began to tentatively tell some people I encountered no stigma, so then became straightforward about it with people - which felt much easier and more in keeping with my nature."
As he started his arduous treatment, Ron, a family man and a professional counsellor in his 50s, from London, decided to strike a blow for the "silent majority" with hepatitis C who were too frightened to speak about their condition.
"I decided to write a blog. I thought a lot about this issue of 'keeping it quiet' and decided this feeds into the stigma and continues it.
"It will only be when people like myself straightforwardly identify themselves as having this virus that the stigma will be challenged - it is not just injecting drug user who get this virus.
"So I decided it was important to use my full name and own up that I have the virus although I am not an injecting drug user. I have never experienced any discrimination or judgement from the people I tell."
A recent report by the Hepatitis C Trust said Britain was "failing" on hepatitis C and unless urgent action was taken on tackling it, thousands of patients could die prematurely.
One of the major problems was that many people with the disease were unaware that they had it and so they did not take action, it said.
Ron is unclear when or how he contracted the virus, but suspects it could have been either from blood products used in an operation he had in Canada, an unhygienic dentist he visited, or mass inoculations he had.
Fight
But he says that the reasons for the virus are unimportant and that the important factor is beating it.
Hepatitis C
It can seriously damage the liver and its ability to function, mainly spread through infected blood or other bodily fluids.
In England the number of people infected with chronic hepatitis C is estimated to be up to 500,000.
It can take decades for the symptoms to appear
"If there is a stigma about having hep C, it is that it's the virus of injecting drug users - who by implication, have only themselves to blame for catching it.
"There are a great number of people with hep C for whom injectable drugs are not part of their lifestyle - career professionals like myself, haemophiliacs, health care professionals.
"None of us, including injecting drug users, deserves to have this virus and none of us 'have only ourselves to blame'."
Prior to diagnosis, Ron had been feeling unwell for some time. He suffered pains, fatigue and digestive problems for a number of years and doctors feared he might have irritable bowel syndrome.
"I got to the point of being exhausted and to the point of being emotionally weepy and tired. My GP thought I might be depressed and prescribed Prozac which I took. I had various skin rashes and I have still got liver spots.
My commitment to my liver goes above and beyond the medical advice – Ron Metcalfe
"I had a number of things like that and it was finally when I was feeling like I had flu and could not get out of bed that I want back to the GP and said that I was ill."
As Ron explained, the symptoms are very vague and easily missed, for which he blames no one.
He was told he would have to undertake the 48-week Pegasys, or pegylated interferon, treatment.
Before undertaking the course and during it, Ron kept himself healthy, gave up drinking, improved his diet and had complementary therapies to rid his body of toxins. He also did regular yoga.
Virus
Tests at the 12-week stage showed that Ron's hepatitis C was "undetectable" and he hopes that the drugs course, which has a 50% success rate will prove a "cure" in his case.
"They do not say though that you have been cured, if it works, they just say the virus is undetectable, because in the future they might have even more rigorous tests which might then be able to detect it."
But he is hopeful that all his careful work protecting his body will stand him in good stead.
"I think I have a good chance. My commitment to my liver goes above and beyond the medical advice."
About 200 people a day visit Ron's blog, which records his struggle with the treatment.
Trawls of his site reveal that not only is it avidly read by others with the disease, but it is also used by health professionals and specialists as it provides a grassroots account of living with hepatitis C.
Ron says blogs like his help provide a support group for others with the condition.
It is proving so popular that he has been approached by a drug company looking at funding a pilot scheme which would allow the blog to be used within the NHS for this and other conditions.
This could give bloggers protected confidentiality and might even include a professional in the role as "webmaster" to answer questions and provide support and encouragement.
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Crucell N.V.: Merck and Co., Inc. Exercises Option on PER.C6 License for Adenovirus-based Vaccine Against Hepatitis C
SourceURL:http://biz.yahoo.com
LEIDEN, Netherlands, Oct. 10, 2005 (PRIMEZONE) -- Dutch biotechnology company Crucell N.V. (Euronext:CRXL) (NasdaqNM:CRXL - News) announced today that Merck & Co., Inc. (NYSE:MRK - News) has exercised its option to use Crucell's PER.C6(r) production technology to develop an adenovirus-based vaccine against hepatitis C (HCV). Crucell will receive a US$ 1 million (0.8 million) exercise fee with the prospect of annual fees and milestone payments, plus royalties on net sales.
Merck already uses PER.C6(r) technology for its adenovirus-based HIV vaccine, currently in proof-of-concept Phase II trials.
“It is extremely satisfying to see that PER.C6(r) can play a role in the fight against such a widespread and serious infection as hepatitis C,'' said Dr. Ronald Brus, Crucell's Chief Executive Officer. ``There is no question that the world needs a vaccine against HCV.''
Under the terms of the agreement, Crucell has retained 'co-exclusive' rights which provide the Company with the option of developing or co-developing its own HCV vaccine. “Crucell believes that, as with diseases like HIV/AIDS, malaria and TB, adenovirus-based vaccines may prove to be a fruitful approach for HCV because of their ability to induce both cellular and humoral immunity and the scalability that our PER.C6(r) technology can provide,'' explained the Company's Chief Scientific Officer Dr. Jaap Goudsmit.
About HCV
Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). HCV is spread primarily by direct contact with human blood, with intravenous drug use employing contaminated needles being among the causes of transmission. The World Health Organization (WHO) estimates that approximately 200 million people, 3% of the world's population, are infected with HCV, with 3-4 million people newly infected each year. About 85% of infected people become chronically infected and 70% develop chronic hepatitis, putting them at risk of developing cirrhosis of the liver or liver cancer. WHO estimates that hepatitis C is an epidemic disease in 131 countries around the world, and is responsible for 50-76% of all liver cancer cases and two-thirds of all liver transplants in the developed world. No vaccine currently exists for the prevention of HCV infection.
About Crucell
Crucell N.V. is a biotechnology company focused on developing vaccines and antibodies that prevent and treat infectious diseases, including Ebola, influenza, malaria, West Nile virus and rabies. The company's development programs include collaborations with: Sanofi Pasteur for influenza vaccines; the U.S. National Institutes of Health for Ebola and malaria vaccines; and GlaxoSmithKline (GSK), Walter Reed Army Institute of Research and New York University for a malaria vaccine. Crucell's products are based on its PER.C6(r) production technology. The company also licenses its PER.C6(r) technology to the biopharmaceutical industry. Licensees and partners include DSM Biologics, GSK, Centocor/J&J and Merck & Co., Inc. Crucell is headquartered in Leiden, The Netherlands, and is listed on the Euronext and NASDAQ stock exchanges (ticker symbol CRXL). For more information, please visit http://www.crucell.com.
Crucell's Licensing Program Disclosure Policy
Crucell believes it has a duty to inform (potential) investors and other stakeholders about every licensing agreement it reaches with third parties -- regardless of the significance of current or future revenue or royalties generated by the agreement. Crucell fulfils this duty by issuing a press release that invariably consists of the name of the contract party, the nature of the license and an indication of the relevant technology or therapeutic area. This ensures that every potential investor or interested party can be fully up-to-date with all licensing agreements made by Crucell with third parties. An overview of all Crucell's licensees and partners can be found on the Company's website, including an overview of each relevant product's phase of development.
Forward-looking statements
This press release contains forward-looking statements that involve inherent risks and uncertainties. We have identified certain important factors that may cause actual results to differ materially from those contained in such forward-looking statements. For information relating to these factors please refer to our Form 20-F, as filed with the U.S. Securities and Exchange Commission on April 14, 2005, and the section entitled ``Risk Factors''. The company prepares its financial statements under generally accepted accounting principles in the United States (U.S. GAAP).
Contact:
Crucell N.V.
Harry Suykerbuyk
Director Investor Relations and Corporate Communications
Tel. +31-(0)71-524 8718
h.suykerbuyk@crucell.com
For Crucell in the U.S.:
Redington, Inc.
Thomas Redington
Tel. (212) 926-1733
tredington@redingtoninc.com
Source: Crucell N.V.
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October 11th, 2005
Genital Tract a 'Sanctuary Site' for Hepatitis C Virus in Coinfected HIV-Positive Women
SourceURL:http://www.aidsmap.com
Edwin J. Bernard
Hepatitis C virus (HCV) appears to be compartmentalised in the genital tract of women coinfected with HIV, and may replicate independently, according to a study from the United States and Poland published in the November 1st issue of The Journal of Infectious Diseases, now available online. The study, which also found that HIV interacts with HCV in the genital tract, may help to explain why mother-to-child transmission of HCV occurs at a comparatively higher rate in coinfected women than in women who are monoinfected with HCV, and suggests that the risk of female-to-male sexually transmitted HCV infection may be increased in coinfected women.
Despite growing evidence suggesting that female-to-male and mother-to-child transmission of HCV is on the increase, little is known about vaginal and cervical shedding of HCV in HIV-positive women. Consequently, researchers from the University of California Los Angeles, the Mayo Clinic in Scottsdale, Arizona and the Medical Academy in Warsaw, Poland, sought to examine factors that correlated with HCV genital shedding as well as examine HCV quasispecies composition in a group of HCV/HIV-coinfected women.
They undertook a cross-sectional study of 71 women that was nested within the Women's Interagency HIV Study (WIHS); a prospective, multicentre study that has been examining the impact of HIV infection on women since 1993.
This study included 58 of the 113 HCV/HIV-coinfected women enrolled at the Los Angeles WIHS site, as well as thirteen of the 23 women monoinfected with HCV. HCV was measured in the genital tract by cervicovaginal lavage (CVL). This is a method of "washing" the vaginal cavity to test the resulting fluid in order to determine HCV viral load in a woman's genital tract secretions.
Most (65.5%) of the coinfected women were aged 35 or older, 40% were black, 31% Hispanic, and 15% white, and 79% reported a history of injection drug use. Seventy percent had received highly active antiretroviral therapy (HAART) within the previous six months, but the researchers provide no further information on HAART or on the anti-HCV therapy, if any, undertaken by the women.
HCV RNA (viral load, with limit of detection of 600 copies/mL in plasma) was detected in plasma from 67% (39/58) of the coinfected women, compared with 46% (6/13) of the monoinfected women. The coinfected women also had higher HCV plasma viral loads than the monoinfected women (data not shown).
HCV RNA (viral load, with limit of detection of 60 copies/mL in CVL) was detected in CVL fluid from 31% (18/58) of the coinfected women, although the researchers note that the viral loads were relatively low (median 1500 copies/mL; range, undetectable to 4000 copies/mL); 16 of the 58 women had CVL HCV viral loads below 800 copies/mL. The only significant difference between the coinfected women with and without detectable HCV shedding was that the women with HCV shedding had higher plasma HCV viral loads (p=0.04). None of the monoinfected women had detectable HCV viral load in CVL (p=0.03).
Univariate analysis showed that there was no correlation between HCV viral load in CVL fluid and HIV viral load in plasma, the number of white blood cells in CVL fluid, or anti-HIV therapy. There were, however, possible associations between the presence of HCV viral load in CVL fluid and CD4 cell count, the presence of HCV viral load in plasma, the presence of HIV viral load in CVL fluid, and blood contamination.
However, in multivariate analysis that adjusted for plasma HCV viral load, CVL HIV viral load, plasma HIV viral load and CD4 cell count, the only statistically significant predictors of HCV shedding in CVL fluid were the presence of HCV viral load in plasma (OR, 16.81; 95% CI, 1.53-185.31) and the presence of HIV viral load in CVL fluid (OR 19.87; 95% CI, 1.70-231.65).
Nine women (six coinfected women and three monoinfected women) were randomly selected for intense molecular evaluations in order to assess whether compartmentalisation of HCV led to genetic diversity between blood and genital HCV. HCV viral load was detected by a highly sensitive RT-PCR method in both plasma and CVL fluid from five women (three coinfected and two monoinfected women). In the three coinfected women, HCV from CVL contained unique sequences that were not seen in HCV derived from their plasma or PBMCs. This suggests, say the study's authors, "that a local HCV genital tract reservoir may exist and that this may be the source of infection for those suspected to have been infected sexually, a possibility further supported by the analysis of HCV quasispecies isolated from plasma, PBMCs, and CVL fluid."
This is the first study to demonstrate that HCV is compartmentalised in the genital tract of HCV/HIV coinfected women. In addition, it is also the first to suggest the possibility that HCV replicates in the genital tract independently of plasma. "These findings have important implications for both sexual and perinatal transmission of HCV," comment the study's authors, adding that "increased mother-to-infant and sexual HCV transmission in HCV/HIV-1-coinfected women makes it especially urgent to study and understand the dynamics of HCV in this subset of patients."
The add that "our study also suggests that, among HIV- 1-infected women who are HCV viremic, there is an association between shedding of both viruses and that local control of both viruses may be impaired in those found to be shedding. This may explain the increased rate of perinatal HCV transmission to HIV-1-infected newborns and the observation that sexual transmission may be increased in coinfected patients."
Currently it is unclear exactly how HIV and HCV may interact in the genital tract resulting in increased shedding. The authors suggest two plausible explanations: HIV and HCV may be infecting the same cells, resulting in increased HCV turnover; or local immune dysfunction allows both viruses to replicate.
The authors conclude: "we have found that HCV RNA can be detected in almost 30% of HCV/HIV-1-coinfected women and that viral diversity does exist between local HCV and plasma HCV extracted from HCV/HIV-1-coinfected women. Our findings may explain a comparatively higher rate of HCV vertical transmission by HIV-1-coinfected women reported in several studies. The relationship between HIV-1 and HCV shedding is intriguing and suggests a unique local interaction between these two viruses in the genital tract."
Reference
Nowicki MJ et al. Presence of hepatitis C virus (HCV) RNA in the genital tracts of HCV/HIV-1-coinfected women. JID 192: 1557-1565, 2005.
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October 12th, 2005
Liver Cancer Rates Rising
SourceURL:http://www.ncpa.org
Daily Policy Digest
Overall, Americans' death rates from cancer have dropped 1.1 percent a year since 1993, a trend that continued in 2002, the year with the most recent figures available, according to the Journal of the National Cancer Institute (JNCI).
Rates of new cases are holding steady for men. But a small and stubborn increase in female diagnoses continues at 0.3 percent a year since 1987, fueled mostly by steadily rising rates of breast and thyroid cancer, melanoma and lymphoma.
One concern is ensuring that patients receive care based on the latest expert guidelines. The report shows growing numbers of patients do, which is considered a significant reason why deaths are dropping. But there are gaps, including:
More breast cancer patients are getting just the tumor removed instead of the entire breast, but a significant number skip the follow-up radiation recommended to kill any leftover cancer cells.
Patients 65 or older are less likely to receive recommended chemotherapy after surgery for advanced colorectal cancer.
Only 34 percent of female Medicare beneficiaries had their ovarian cancer removed by a gynecologist oncologist, a specialist considered to have better outcomes than more general surgeons.
While there is a dispute over what is the most appropriate prostate cancer treatment, in general, black men receive less aggressive care than white men.
Surprisingly, another fairly rare malignancy is becoming more common: liver cancer. The report found annual increases of 3 percent among white men, 4.5 percent among black men, 3.7 percent among white women and 5 percent among Hispanic women.
It's not clear what's spurring the rise; one factor may be hepatitis infections, say researchers.
Source: Associated Press, "Cancer death rate falling, but liver malignancies climbing," Dallas Morning News, October 5, 2005; based upon: Brenda K. Edwards et al., "Annual Report to the Nation on the Status of Cancer, 1975-2002, Featuring Population-Based Trends in Cancer Treatment," Journal of the National Cancer Institute, October 5, 2005.
For study:
http://jncicancerspectrum.oxfordjournals.org
/cgi/reprint/jnci;97/19/1407.pdf
For more on Health:
http://www.ncpa.org/iss/hea/
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Jury Awards $685K In Hepatitis Suit
SourceURL:http://www.theomahachannel.com
OMAHA, Neb. -- The man who brought suit against a Fremont cancer doctor was awarded $685,000 by a Dodge County jury on Wednesday.
A Fremont man who contracted hepatitis C sued the Cancer Clinic, a nurse and the doctor at the center of the case. Robert Ridder contracted hepatitis C while undergoing treatment for cancer at the Fremont Cancer Clinic. In 2002, an investigation linked his case and 98 others to improper infection control procedures at the clinic.
Ridder's suit names Dr. Tahir Javed and his nurse, Linda Prochaska. Javed has returned to his native Pakistan and closed the clinic.
The award fell short of the amount Ridder and his wife were seeking, according to Ridder's attorney, but was five to six times what attorneys for the doctor and nurse on trial suggested was appropriate.
Ronald J. Palagi, who represented Ridder, said in a news release that his client was pleased that the jury had spoken.
"What the Ridders wanted most was an opportunity to tell their story," he said. "We want to thank the jury for their time and careful deliberations."
While Javed's Nebraska medical license has been revoked, he remains a regional minister of health in Pakistan.
About 80 cases against Javed have been settled. It's possible that the rest could go to trial.
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China Develops Reagent for Testing Drug Resistance of Hepatitis B
SourceURL:http://english.people.com.cn
The Chinese Academy of Military Medical Sciences has developed a reagent for testing the drug resistance of hepatitis B virus (HBV), according to a leading researcher with the academy on Tuesday.
Based on technology of biological chips, the reagent is easier to use and more efficient as compared to the current DNA sequencing technology, said Wang Shengqi, who led the research team.
The reagent can detect drug-resistant strains of hepatitis B patients who have been taking lamivudine, a key treatment for the disease, as well as the mutation rate of HBV in the blood, he said.
Lamivudine is an effective and popular drug for treating hepatitis B, but there has been growing concern about the tolerance of HBV to the drug.
The reagent was approved by the State Food and Drug Administration (SFDA) this month, and has been put into production by a Shenzhen-based company, he said.
HBV is one of the major sources of infection on the globe. Each year, 1 to 2 million people die of HBV infections. China now has about 40 million hepatitis B patients and approximately 140 million hepatitis B carriers, according to Wang.
Source: Xinhua
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Punk Rock Unites for Hepatitis C Awareness
SourceURL:http://www.prweb.com
As part of a national organization of musicians, punk rock bands from Orange County, CA join together to raise awareness of Hepatitis C.
(PRWEB) October 12, 2005 -- In 2004, a national coalition of musicians was formed by singer Kelly Zirbes to help raise awareness about Hepatitis C. After many years of educating others about Hep C, Kelly and her band, Kelly's Lot, decided to invite other bands to join them in their cause. This coalition of musicians distributes postcards with facts about Hep C at shows and events all over the USA. Danny Commerford and his band Boobie Trap, were one of the first to get involved by organizing a yearly concert, "Punk Rock Unites For Hepatitis C" to raise awareness in Orange County but especially in the Punk Rock Community.
This year, the 2nd annual event will take place at The Brigg located at 17208 PCH in Huntington Beach. The bands playing for the cause this year are The Hudson Drags, The Misfortunes, Shotdown, Boobie Trap and FLOCK OF GOO GOO. The event will start at 7pm on Saturday October 22 and will run until after midnight. Lots of information will be provided at the show for those wanting more info about Hepatitis C. Sponsors include Black Fly’s, 714 Clothing, Mo’s Fullerton, HoCool.com, Superheroes H.B. and The Brigg. The proceeds from the concert will go to Hepatitis C Awareness, Inc to help fund the postcard campaign.
Hepatitis C is a systemic blood borne virus that primarily attacks the liver. It is spread by blood to blood contact. One in 50 Americans have HCV - two out of three do not know it. There is no vaccine for Hepatitis C.
Have you:
- Received blood, blood products, or an organ transplant prior to 1992?
- Ever shared drug paraphernalia? Injecting or snorting?
- Ever been stuck by a used blood needle?
- Been on kidney dialysis?
- Had a tattoo or body piercing?
- Had sexual activity that involves contact with blood?
- Shared personal care items(razors, toothbrushes, etc.) with other people?
- Been incarcerated?
- Been in combat? (Veterans-especially Vietnam)
If you answered YES to any of these questions, you may have been exposed to the Hepatitis C virus. GET TESTED.
Punk Rock Unites For Hepatitis C Awareness II
Sat., Oct. 22, 7 p.m.-midnight $8 [Over 21]
At The Brigg, 17208 PCH, Huntington Beach
Featuring The Hudson Drags, The Misfortunes, Shotdown, No Solution, Boobie Trap and FLOCK OF GOO GOO
Benefiting Hepatitis C Awareness, Inc
Contact:
Kelly Zirbes
(818)769-2701
www.HepCAware.org
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A Missed Opportunity: Hepatitis C Screening of Prisoners
SourceURL:http://www.rednova.com
By Macalino, Grace E; Dhawan, Darpun; Rich, Josiah D
In 2003, the Centers for Disease Control and Prevention issued recommendations to screen all inmates with a history of injection drug use or other risk factors for hepatitis C. We compared self- reported risk factors for hepatitis C with serostatus from inmates in the Rhode Island Department of Corrections. Of the male inmates who were hepatitis C positive, 66% did not report injection drug use. Risk-based testing underestimates the hepatitis C virus (HCV) prevalence in correctional settings and limits the opportunity to diagnose and prevent hepatitis C infection. (Am J Public Health. 2005;95:1739-1740. doi:10.2105/AJPH.2004.056291)
Nearly 2% of the US population is chronically infected with hepatitis C virus (HCV).1 An estimated 29% to 43% of all people living with HCV infection in the United States are released from a correctional facility each year.1 The high prevalence of HCV infection in correctional facilities emphasizes the need for increased screening, treatment and prevention counseling within the correctional system. Recommendations for the identification of HCV infection within the correctional setting continue to evolve. In 2003, the Centers for Disease Control and Prevention (CDC) published guidelines that strongly recommend screening of inmates who report HCV infection risk factors, primarily history of injection drug use.2
Policymakers, researchers, and the public continue to debate the need to screen asymptomatic HCV infection and the adequacy of screening on the basis of risk factors.3-5 We compared self- reported injection drug use with actual serostatus among inmates to evaluate the validity of self-reports in this setting. These data can inform whether testing on the basis of self-report will impact HCV infection among prisoners.
METHODS
Data for this analysis were collected as part of a larger study investigating the prevalence and intraprison incidence of bloodborne pathogens, the methods of which are described fully elsewhere.6 Briefly, a representative sample of inmates at intake was obtained between 1998 and 2000 from the Rhode Island Department of Corrections, where 15000 male and 2500 female intakes occur each year. Serum specimens from mandatory HIV testing were tested for HIV, hepatitis B virus (HBV), and HCV and linked to demographic variables and medical intake data. Hepatitis C antibody positivity was determined from reactivity to at least 2 HCV antigen bands encoded by different parts of the HCV genome, assayed with Ortho HCV Version 3.0 ELISA (Ortho-Clinical Diagnostics, Raritan, NY).
For this analysis, we compared hepatitis C blood test results with injection drug use, self-reported to a nurse during intake in response to a question about either "drug or alcohol abuse" or "IV drug use." Because this was a blinded research survey, no additional education was given regarding HCV infection beyond informed consent Each sentenced inmate was counted once, despite potential multiple incarcerations during the 2-year study period.
RESULTS
HCV prevalence in the male inmate population was 23.1% (95% confidence interval [CI]=21.8, 24.3) among the 4263 inmates tested,6 whereas 40.5% (95% CI=36.1, 44.7) of the female inmate population had positive HCV test results (n=499). Univariate correlates of HCV infection included being White, being aged 40 to 49, reporting injection drug use, and being previously incarcerated; in the final model, increasing age (older than 30) and injection drug use remained significant.6 In our study population, self-reported data were available for 92.2% (3931 of 4263) of the men and 97.2% (485 of 499) of the women.
Our data comparing laboratory test results and self-reported data are shown in Table 1. Of those who were found to be hepatitis C positive, 65.5% of the men and 44.2% of the women did not report injection drug use at intake. Women were 2.3 times more likely (95% CI=1.7, 3.0) to report injection drug use among inmates who were HCV positive than were men.
DISCUSSION
We found that most individuals who were HCV infected would not have been tested according to the CDC guidelines for risk-based HCV testing. One factor contributing to this underestimation is that self-reporting of injection drug use requires inmates to disclose illegal and stigmatized behaviors within the correctional setting. The timing and context of the screening itself may prevent many injection drug users from discussing incriminating behaviors. Studies that used urine toxicological screening to measure drug use among recently arrested inmates estimated that 25% to 74% of those who tested positive for drug use congruently reported recent drug use.7,8 Fear of self-incrimination, mistrust of the prison system, stigma of heroin use, and lack of confidentiality all have been cited as reasons for the underreporting of injection drug use.7,9,10
The fact that women were more likely to report injection drug use may reflect gender disparities between these particular correctional facilities. The women's correctional facility processes 6 times fewer intakes per day, and all female inmates are seen by 1 physician. The intimate environment of the women's prison may allow for greater trust and disclosure of drug use.
As in many other correctional facilities, prisoners in the Rhode Island Department of Corrections may request testing, but there is no systematic access to information about HCV transmission, the availability of testing, or risk reduction practices.9 Because most of the individuals are asymptomatic, if they are identified earlier, they can be educated to abstain from alcohol, seek treatment before the development of symptoms, and prevent transmission to others.5 Because 1.3 million individuals who are infected with HCV are released from prison annually,11 these efforts would affect not only the incarcerated population but also the community at large.
Concerns about mandatory testing in the correctional setting are valid-including topics such as confidentiality, stigma, cost, and adequate follow-up. However, testing only those with reported risk behaviors reinforces the stigma of HCV infection and drug use that may have led to incarceration and serves to further marginalize these individuals. The Rhode Island model of mandatory HCV testing has shown that early identification of infected individuals can lead to adequate education end clinical care tihat can begin during incarceration and continue into the community.12 Although no formal studies have been completed to date, the cost saved by early HCV diagnosis must be considered from both a clinical standpoint and the goal of averting new infections.
Critical evaluation and creative solutions are needed to overcome the challenges of HCV testing in unique correctional subpopulations (e.g., short stay, women). These solutions should include strategies that are responsive to the needs of a particular correctional setting, such as routine, mandatory, or voluntary HCV testing at intake, in addition to universal access to education and counseling services. Our data support the argument that risk-based screening alone is not sufficient to accurately confront the magnitude of HCV infection in prisons. Screening, diagnosis, and prevention services must be incorporated into correctional health systems to reduce progression of clinical disease and stem the transmission of infection.
References
1. Hammett TM, Harmon MP, Rhodes W. The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997. Am J Public Health. 2002;92:1789-1794.
2. Weinbaum C, Lyerla R, Margolis HS. Prevention and control of infections with hepatitis viruses in correctional settings. Centers for Disease Control and Prevention [published erratum appears in MMWR Recomm Rep. 2003;52:205-214]. MMWR Recomm Rep. 2003;52(RR-1):1- 36; quiz CE1-4.
3. Butterfield F. Infections in newly released inmates are a rising concern. New York Times. January 28, 2003;sect A1:14.
4. Hammett TM. Adopting more systematic approaches to hepatitis C treatment in correctional facilities. Ann Intern Med. 2003;138:235- 236.
5. Alter MJ, Seeff LB, Bacon BR, et al. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Ann Intern Med. 2004;141:715-717.
6. Macalino GE, Vlahov D, Sanford-Colby S, et al. Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons. Am J Public Health. 2004;94:1218-1223.
7. Harrison L, Hughes A. Introduction-the validity of self- reported drug use: improving the accuracy of survey estimates. NIDA Res Monogr. 1997;167:1-16.
8. Hser YI. Self-reported drug use: results of selected empirical investigations of validity. NIDA Res Monogr. 1997;167:320-343.
9. Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51:253-263; discussion 267-268.
10. Fendrich M, Xu Y. The validity of drug use reports from juvenile arrestees. Int J Addict. 1994;29:971-985.
11. The Health Status of Soon-to-Be Released Inmates: A Report to Congress. Chicago, III: N\ational Commission on Correctional Health Care; 2002.
12. Crosland C, Phoshkus M, Rich JD. Treating prisoners with HIV/ AIDS: the importance of early identification, effective treatment, and community follow-up. AIDS Clin Care. 2002;14:67-71, 76.
Grace E. Macalino, PhD, Darpun Dhawan, BA, and Josiah D. Rich, MD, MPH
About the Authors
Grace E. Macalino is with the Institute far Clinical Research and Health Policy Studies, Tufts New England Medical Center, Boston, Mass. Darpun Dhawan is with Brown Medical School, Providence, RI. Josiah D. Rich is with the Department of Medicine and Community Health, Brown University and the Center for Prisoner Health and Human Rights at The Miriam Hospital, Providence, RI.
Requests far reprints should be sent to Grace E. Macalino, PhD, Institute for Clinical Hesearch and Health Policy Studies, Tufts New England Medical Center, 750 Washington St, Box 63, Boston, MA 02111 (e-mail: gmacalino@tufts-nemc.org).
This brief was accepted April 1, 2005.
Contributors
G. E. Macalino originated the study, supervised all aspects of its implementation, and led the writing of the brief. D. Dhawan assisted with the analyses, conceptualization, and writing of the brief. J.D. Rich established links between the study and the Rhode Island prison and provided senior guidance while writing the brief.
Acknowledgments
This research was funded by Centers for Disease Control and Prevention (grant U64/CCU119346).
The authors acknowledge all the Rhode Island Prison Study staff, whose endless hours of work and support contributed in so many ways- in particular Michael Patterson for his laboratory expertise and Michelle McKenzie for overseeing the project.
Human Participant Protection
All procedures and human participant protections related to this study were approved by the local institutional review boards of the Miriam Hospital, the Johns Hopkins Bloomberg School of Public Health, and the Centers for Disease Control and Prevention.
Source: American Journal of Public Health
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Survey Indicates Lack of Public Awareness Hepatitis C
http://www.clickpress.com
A recent survey carried out by Hoffmann-La Roche Ltd. on the level of awareness on Hepatitis C, revealed that the majority of the UAE population is unaware of the disease. The survey was conducted on the occasion of the World Hepatitis C day, 1st of October, and was meant to analyze the behavior of the UAE population with regard to the disease.
The survey, conducted by SYNOVATE research, studied the behavior of a varied group of UAE nationals and citizens. A well balanced mix of 330 Emiratis, Arab and Asian expats coming from Abu Dhabi, Dubai and Al Ain were involved. The conclusions of the survey highlight the lack of awareness on how Hepatitis C is transmitted, the consequences of the disease and possible treatment of it.
The survey revealed that only 13% of the people surveyed had been tested for Hepatitis C. UAE nationals turned out having the lowest rates, only 10% of them ever had themselves tested for the disease. Comparatively, Asians scored 17% here. In addition, only 37% of the total people surveyed believed that Hepatitis C is a serious disease.
"The results of the survey are alarming, but not unexpected as we know that there has not been a lot of awareness creation done on the Hepatitis C disease. Public awareness and knowledge are the first steps to ensuring that people are protected against the disease. Visiting your doctor on a regular basis and being tested for the disease is an important way to protect yourself. Getting tested can be done with a very simple blood test." said Rima Khadra, communications manager at Roche.
The survey also indicates the lack of information available to people about the causes and effects of the disease and the available treatment.
Only 24% of the people questioned had earlier learned about the disease, through their doctor. However, only 10% of them visited their doctor on a regular basis. The survey revealed that most people heard of the disease via word of mouth. 55% claimed word of mouth as the most common source of information. "This makes it even more important to spread awareness on Hepatitis C and provide the public with the correct information regarding, the transmission, effects and available treatment for the disease." added Rima.
The survey revealed that there are a lot of misconceptions around the modes of transmission of hepatitis C. Unlike most other serious and highly infectious diseases, people are not sure how Hepatitis C is contracted. Although people understood that the disease can be passed via blood, a very low percentage knew that contaminated personal items, like scissors or tweezers, can also cause infection.
"Protecting your self from Hepatitis C is extremely important. However people can only do this when they are correctly informed on how they can be infected. Unfortunately this lack of knowledge also transcends to people who maybe have the disease but are unaware of the available treatment. Most importantly, although treatment is available for people infected with Hepatitis C, a third of the number of people interviewed, were not aware that the virus is curable." said Rima.
"I did not know I had the disease, up till the moment I went to the doctor for a regular check up. The blood tests revealed that I had been contaminated with Hepatitis C. When I heard this I was shocked and felt shamed. I have always considered myself to be a very neat and clean person. My doctor explained to me however, that I might have caught it unknowingly. I felt relieved when he told me that there are good treatments available for the disease now a days" Myrvat a Hepatitis C patient states.
170 million people worldwide are infected with hepatitis C virus (HCV). While the majority of chronically infected patients can now be successfully treated, approximately one third may believe they should 'watch and wait'; mistakenly believing they are so-called 'healthy carriers' of the hepatitis C virus.
For more information on Hepatitis C please call toll free 800 4038 0r log on to www.roche-arabia.com
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October 13th, 2005
Alliance Emerges as Leader in Hepatitis C Prevention and Treatment Policy
SourceURL:http://www.drugpolicy.org/
Although the words hepatitis or liver do not appear in the organization's name, the Drug Policy Alliance has emerged as one of the leading hepatitis C virus prevention and treatment advocates in the United States.
Syringe sharing is the leading cause of hepatitis C in the U.S. today, and most medical experts agree that access to clean syringes is the best deterrent against spreading debilitating liver diseases such as hepatitis C.
To this end the Drug Policy Alliance has made substantial headway in promoting liver health though litigation and legislative efforts.
This summer the Alliance, in conjunction with the ACLU, prepared and filed an amicus brief in the U.S. Court of Appeals for the Second Circuit on behalf of medical and public health experts (Morgan v. Wright). They argued that the policy of the New York State Department of Corrections, which delayed or denied hepatitis C treatment to inmates with a history of drug use, flouted both the law and accepted medical practice. The Attorney General of New York, tasked with defending the Corrections Department policy, recently decided to drop the state's appeal and is no longer trying to defend the policy.
Meanwhile, at the Drug Policy Alliance's state capitol offices in California and New Jersey, the organization has both crafted and supported legislation designed to combat hepatitis C.
In Sacramento this legislative session, the Drug Policy Alliance actively supported a bill recently signed into law by the governor to require prisons, where a large number of hepatitis C cases originate, to give information and voluntary screening to prisoners upon intake.
In Trenton, two syringe access bills have passed the New Jersey Assembly this year, and will likely be considered further this fall.
The Alliance has also worked with and been integral in forming other groups that directly deal with hepatitis C issues. Alberto Mendoza, director of the Alliance's Southern California office, has been the co-chairman of the Los Angeles County Hepatitis C Task Force since last year, and helped make HIV-hepatitis co-infection a central issue for the Southern California HIV Advocacy Coalition, which he co-chaired in 2004.
Reena Szczepanski, who heads the Drug Policy Alliance's New Mexico office, formerly worked for the New Mexico Department of Health, where she founded the nonprofit Hepatitis C Alliance last year. This is the first organized advocacy group for those infected with the disease, and the Alliance New Mexico is now actively working with the group to craft legislation related to hepatitis C prevention and care.
With the Centers for Disease Control and Prevention estimating that 80% of injection drug users across the country are infected, there is a clear need for improved syringe access and hepatitis C treatment on a national scale. The Alliance will continue to advocate for prevention and treatment using its range of strategies, from litigation to coalition-building, to meet this need.
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Hep-C Victim Feels 'Un-Canadian'
SourceURL:http://www.thenownewspaper.com
Tom Zytaruk
Tainted-blood victim Allan Blumenfeld says the federal government has made him feel like an "un-Canadian."
"My kid used to fly a flag all the time, either in his room or outside the house. He took it down because he doesn't believe a Canadian government would do this to their own people," said Blumenfeld, an anemic steelworker from Newton who contracted the Hepatitis-C virus through a blood transfusion in 1981 in Burnaby General Hospital.
Blumenfeld and other local victims wants a piece of the $217-million surplus in the federal government's current $1.1 billion Hepatitis C fund earmarked for victims of a tainted blood scandal that arose decades ago.
"I refuse to quit," he said.
Gurmant Grewal, Conservative MP for Newton-North Delta, has been trying to secure compensation for the victims since 1998.
"I think shameful is too kind a word to describe the treatment of Hepatitis-C victims," he said.
Grewal noted that a blood screening test was available in the early 1980s which was recommended by top U.S. blood experts, and that Canadian officials were briefed on this but the Red Cross and Health Canada did nothing. As a result, he added, more than 1,000 Canadians were infected with HIV and some 20,000 contracted Hepatitis-C, In 1998 the Liberal government set up a $1.1 billion compensation package but limited it to victims who contracted Hep-C between 1986 and 1990.
Facing media pressure, the federal government promised in November 2004 to help those victims outside the original compensation window and those in Ontario, Manitoba and Quebec received provincial payments of $25,000 while the B.C. government got roughly $16,000 for each victim.
Last June an actuarial report uncovered a surplus of $217 million in the fund. Earlier, in April, the House of Commons unanimously supported a motion to immediately compensate the victims, but they're still waiting.
So far nearly 5,000 victims have died.
Blumenfeld, now 60, retired and living on a $700 disability pension, struggles to make ends meet while the fund money sits in Ottawa gaining interest. He suffers from cirrhosis of the liver and is often confined to bed.
"How many more years are they going to drag it out?" he asks. "They have the money to compensate us."
Blumenfeld found out he had Hep-C after seeing a story and picture of a bag of blood in the Province newspaper, "It said if you had a blood transfusion between such and such a time, you should go get checked," he recalled. He went cold, and sure enough his doctor confirmed the bad news.
He now lives on four hours sleep a day and feels he should be compensated as the money he saved up to send his kids to college went instead to his own medical treatment.
Blumenfeld said the B.C. government forced him into a class-action lawsuit for what cash he's received. His settlement, after the law firm took $5,407.28 and the taxpayer took $598.56, is $6,434.16.
He's not alone. Lois Fraser, 60, of North Delta and carpenter Maurice Vandenberg, 46, are among those yet to be compensated.
Vandenberg contracted Hep C from a blood transfusion after undergoing emergency surgery in 1977 in Prince George Hospital following a traffic crash. Fraser got her bad blood in 1984, after undergoing surgery in Surrey Memorial Hospital. She later learned she had Hep C when she tried to donate blood and later received a call from her doctor, bearing the bad news. She's since had to quit work.
"I want to be healthy again," she said.
Grewal said they are among "our country's forgotten victims."
"This issue is not settled," he said.
"The government is so arrogant, they have no compassion for the victims."
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October 14th, 2005
Hep B Booster Shot Unnecessary: Study
SourceURL:http://news.yahoo.com
FRIDAY, Oct. 14 (HealthDay News) -- A booster shot against hepatitis B may not be necessary because infants and teens who are vaccinated against hepatitis B are protected for 10 years after the vaccination, according to Italian researchers.
Viral hepatitis B is the leading cause of acute and chronic liver disease worldwide. About 2 billion people around the world have been infected with hepatitis B, says the World Health Organization
Currently, 168 countries have universal infant or adolescent hepatitis B vaccination programs.
Until now, it wasn't clear if vaccinated children needed booster shots to sustain their immunity to hepatitis B infection.
Reporting in this week's issue of The Lancet, the researchers studied whether concentrations of antibodies against hepatitis B were still present in 1,212 children and 446 Italian Air Force recruits who received hepatitis B vaccinations as infants and adolescents, respectively.
The study found that 64 percent of the children and 89 percent of the recruits still had protective concentrations of antibodies. The results indicate that infant and adolescents immune systems can recall responding to hepatitis B more than 10 years after immunization.
"In light of our findings, the use of routine booster doses of hepatitis B vaccine does not seem necessary to maintain long-term protection in immunocompetent individuals vaccinated as infants and teenagers," researcher Alessandro Remo Zanetti of the Institute of Virology in Milan, said in a prepared statement.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about hepatitis B.
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