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Week Ending: May 7th, 2005
Alan Franciscus
Editor-in-Chief
To download pdf version click here
This Issue:
• Longer Survival with Liver Transplantation for Hepatocellular Carcinoma
• Treating Children with Chronic Hepatitis C
• Identification of Specific Genes Predicts Which Patients Will Respond to Hepatitis C Treatment
• Milk Thistle Does Not Reduce Deaths from Liver Diseases, Best Studies Find
• Hepatitis Ranges from Uncomfortable Illness to Deadly Virus
• Acetaminophen Linked to Risk of Respiratory Ills
• Hepatitis C Caring Ambassadors Program Applauds Governor Kulongoski's Proclamation of May 2005 as Hepatitis Awareness Month in Oregon
• Blee Praised for Push on Prison Hepatitis Issue
• Woman Says Doctor Infected Her with Hepatitis C
• Scalpel-Free Surgery Could Reduce Risk of HIV and Hepatitis Exposure for Health Care Workers
• Hep C Increases the Risk of Diabetes after Orthotopic Liver Transplant
• Romney Disagrees with DPH Position on Hypodermic Needles
• Hepatitis C Awareness 2005 Campaign: 100,000 Letters to Congress in May
• VA Raises Hepatitis C Awareness
• Synovate Healthcare Launches a New Hepatitis C Syndicated Patient Audit in the USA
• Patients Recalled for HIV, Hepatitis Tests
. 2nd Annual Hep C Awareness Internet Telethon
May 2nd, 2005
Longer Survival with Liver Transplantation for Hepatocellular Carcinoma
SourceURL:http://www.gastrohep.com
Research in April’s Archives of Surgery reports that liver transplantation for hepatocellular carcinoma results in long-term survival and that improvements in preoperative staging increases 5 year survival rates.
Dr Island and colleagues from Massachusetts retrospectively reviewed prospectively collected data in a cohort of 92 patients.
The patients underwent liver transplantation for hepatocellular carcinoma between 1983 and 2003 in a tertiary referral center.
The team’s main outcome measures were patient demographics, tumor stage in the explant liver, patient survival, and tumor recurrence data.
The researchers reported that the average follow-up was 1052 days.
The investigative team noted that the average tumor size was 4 cm and that 40% of tumors were multifocal and with 60% being unifocal.
Improvements in staging increase the 5 year survival rate to 69% – Archives of Surgery
The team also reported that of the 92 patients, 26% were classified as stage I, 42% as stage II, 24% as stage III, and 8% as stage IV.
The researchers found that the overall 5 year survival rate was 50%, the 10 year survival rate was 32%, and the 15 year survival rate was 27%.
The team also observed that improvements in staging in the last 5 years reduced the number of patients with stages III and IV from 39% to 19%.
In addition, improvements in staging in the last 5 years were shown to increase the 5 year survival rate to 69%.
The investigators indicated that tumor recurrence was relatively rare, however, recurrence resulted in a poor prognosis, with an average time to recurrence of 458 days.
Dr Island’s team concludes, “Liver transplantation for hepatocellular carcinoma results in excellent long-term survival for patients with stages I and II, with relatively few patients dying from tumor recurrence.”
“Improvements in preoperative staging have resulted in increased 5 year survival rates.”
“Further refinements in pre-liver transplantation staging may increase its effectiveness hepatocellular carcinoma.”
Arch Surg 2005: 140(4): 353-358
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Treating Children with Chronic Hepatitis C
SourceURL:http://www.eurekalert.org
PegInterferon-alfa-2b with ribavirin shows promise
More than half of 61 children infected with chronic hepatitis C achieved a sustained viral response after treatment with peginterferon-alfa-2b and ribavirin, report the authors of a new study published in the May 2005 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., the journal is available online via Wiley InterScience at www.interscience.wiley.com/journal/hepatology.
The combined treatment regimen is considered the best available treatment for adults with chronic hepatitis C, but until now, no published studies have examined its value of for children. To address this lack of information, researchers, led by Stefan Wirth of HELIOS Children's Hospital Wuppertal, Germany sought to evaluate the efficacy and tolerability of the therapy in infected children based on HCV genotype, liver enzyme tests, and route of disease transmission.
The researchers recruited 62 children ranging in age from 2 to 17 years, of mixed genders and races, all with chronic hepatitis C. Researchers determined their HCV genotype, mode of infection, and liver enzyme levels, then initiated the therapy that included a weekly subcutaneous dose of peginterferon-alfa-2b and a daily oral dose of ribavirin. All 62 completed the therapy according to the study protocol, save one who dropped out after developing an allergic reaction at the injection site.
Twelve months later, 39 of the 61 patients (64 percent) had undetectable levels of HCV RNA. Three of these responders relapsed during the 6-month follow-up period, but 36 (59 percent) remained HCV-free. All of the children with HCV genotype 2 or 3 achieved a persistent sustained viral response, in contrast to the fewer than half of the patients with HCV genotype 1. The study also showed that children who had been infected via needle (for example, from a blood transfusion) responded better to treatment than those who were infected by their mothers at birth. Lastly, the researchers found that patients with normal liver enzyme levels before treatment responded better than those with elevated levels.
Most of the children experienced side effects from the treatment ranging from mild flu-like symptoms to weight loss to leucopenia (a decrease in white blood cell count). One girl developed diabetes mellitus, a rare but permanent side effect associated with interferon. She continued treatment and achieved sustained viral response. All other side effects resolved when the treatment protocol ended.
"The data of this uncontrolled study confirms that treatment with recombinant peginterferon-alfa-2b plus ribavirin in children and adolescents with chronic hepatitis C was well tolerated and yielded an encouraging result with 59 percent sustained viral response," the authors report. While the response rate was not significantly higher compared to studies using non-pegylated interferon-alfa-2b plus ribavirin, "it is particularly remarkable that all patients infected by genotype 2 and 3 showed permanent response."
The authors also emphasized the importance of the high viral response rate of children whose liver enzyme tests were normal before treatment began, which suggests that such children should not be excluded from treatment. The lower response rates among children with genotype 1 and in those who were infected by their mothers implies a need for additional research.
"Further studies with larger numbers of patients have to elucidate whether there is a different response rate in relation to mode of transmission," the authors conclude. Other studies "should focus on treatment duration for genotype 2 and 3 patients and particularly on vertically infected children with genotype 1."
Article: "Peginterferon-alfa-2b Plus Ribavirin Treatment in Children and Adolescents With Chronic Hepatitis C." Stefan Wirth, Heidrun Pieper-Boustani, Thomas Lang, Antje Ballauff, Ulrike Kullmar, Patrick Gerner, Philip Wintermeyer, and Andreas Jenke, Hepatology; May 2005; Volume 41, Issue 5.
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May 3rd, 2005
Identification of Specific Genes Predicts Which Patients Will Respond to Hepatitis C Treatment
SourceURL:http://www.medicalnewstoday.com
For the first time, physicians at University Health Network and University of Toronto have identified a small subset of genes that can predict whether a patient with chronic Hepatitis C will be able to respond to current treatments.
These genes could also become the basis of a simple new test in the future to predict which patients will respond to therapy.
The study, published in the May issue of the American Gastroenterological Association's Gastroenterology, found that the difference between those patients who responded to treatment and those who did not was the level of expression - whether the genes were turned on or turned off - of 18 genes.
"Our results demonstrate that a relatively small number of genes can predict response to therapy. These genes may be important to the ability of the patient to eliminate the virus, so studying these genes in more detail will hopefully lead to novel antiviral treatments," said Dr. Ian McGilvray, the senior author of the study. Dr. McGilvray is a transplant surgeon at Toronto General Hospital, University Health Network and an Assistant Professor of Surgery at the University of Toronto. "By manipulating the products of these genes we might be able to improve treatment responses to this chronic disease."
"This information is helpful for patients because it's one more piece of evidence that we hope will encourage 'responder' patients to start and continue treatment for Hepatitis C, despite it's many side effects," said Dr. Jenny Heathcote, a hepatologist at Toronto Western Hospital, University Health Network and Professor of Medicine at University of Toronto, who contributed to the study and treats many of the patients in the study. "We want to be able to give patients as much information as we can, so that they can make the best decisions about their treatment options."
Tony Angelini, 42, was one of the patients in the study who responded to treatment. He is now clear of the virus. "Knowing that you are a responder gives you the courage and the fight to go on. It was devastating, but having the support of my friends and hospital staff really helped me through the treatment. And I wanted to participate in this study so that the research could help others in the future."
The study followed 31 patients with chronic Hepatitis C who were treated at Toronto Western Hospital from October 2001 until May 2004. Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). About 230,000 Canadians are infected with it, and about 170 million people worldwide. Over time the viral infection leads to liver damage, cirrhosis and/or liver cancer. It is currently the leading indication for liver transplants.
Liver biopsies were performed on the 31 chronic HCV patients before treatment, and were compared to 20 biopsies from healthy, uninfected livers. 16 patients did not respond to subsequent treatment, while 15 did; both groups were well matched with respect to age, HCV viral load (number of viral particles circulating in the blood), and liver disease activity.
In order to define which genes discriminate between those patients who respond to therapy to those who do not, microarray technology, based in a Banting and Best Department of Medical Research laboratory at University of Toronto, was used to analyze the pattern of genes in all participants. This technology allows scientists to compare levels of expression for tens of thousands of genes on a glass slide - these "gene chips" are the size of a postage stamp. The technology is able to quickly scan the expression of those genes and differentiate between genes which are "turned on" or "turned off". Comparing "genetic fingerprints" allows researchers to rapidly and effectively identify sensitive genetic changes associated with various stages of disease, and hopefully identify the most suitable candidates for specific therapies.
"We went into this experiment without any hypothesis about what to look for," said Aled Edwards, a Professor in the Banting and Best Department of Medical Research at University of Toronto with cross appointments in the Departments of Medical Biophysics and Medical Genetics and Microbiology. He is also a senior scientist at the Clinical Genomics Centre at the University Health Network and Director and CEO of the Structural Genomics Consortium. "We cast a very wide net, looking at 19,000 genes of each of the patients."
The researchers found that the difference between those patients who did not respond to therapy to those who did was a subset of 18 genes. In the non-responders to treatment, 16 genes were turned on and two were turned off. Many of the 16 genes which were turned on are stimulated by interferon, one of the key antiviral agents that the body produces in response to viral infection and a medication that patients currently receive as part of their therapy. "Paradoxically, in the non-responders, the liver is revved up and the genes are responding like mad, but there is something about the response that just does not work," said Dr. McGilvray.
In the near future, determining the levels of a small subset of genes in patients' liver biopsies, with perhaps a simple blood test, may be helpful in deciding who will respond to treatment of chronic Hepatitis C with the current combination therapy using the synthetic antiviral agent ribavirin and interferon. This treatment can currently get rid of the virus in only roughly 50% of persons infected with genotype 1, the most common genotype in North America and world-wide.
The study was supported by grants from the PSI Foundation and the Canadian Institute of Health Research.
University Health Network consists of Toronto General, Toronto Western and Princess Margaret Hospitals. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has one of the largest hospital-based research programs in Canada, with major research projects in transplantation, cardiology, neurosciences, oncology, surgical innovation, infectious diseases, and genomic medicine. University Health Network is a teaching hospital affiliated with the University of Toronto.
Contact:
Alex Radkewycz
alexandra.radkewycz@uhn.on.ca
416-340-3895
University of Toronto
http://www.utoronto.ca
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Milk Thistle Does Not Reduce Deaths from Liver Diseases, Best Studies Find
SourceURL:http://www.medicalnewstoday.com
By Lise Stevens, Contributing Writer
Health Behavior News Service
Milk thistle, a widely used alternative medicine, is not proven effective in lowering mortality in alcoholic or hepatitis B or C liver disease, according to a systematic review of current evidence.
While some studies found that liver-related mortality may be significantly reduced in patients treated with milk thistle, these findings were not duplicated in the higher quality clinical trials.
However, milk thistle was found safe to us with no serious side effects and with participants perceiving improvement in symptoms -- although no more than with placebo.
Dr. Andrea Rambaldi, visiting researcher at the of the Centre for Clinical Intervention Research at Copenhagen University Hospital, led a team that reviewed 13 randomized clinical trials involving 915 patients who were treated with milk thistle or its extracts.
Participants had acute or chronic alcoholic liver cirrhosis, liver fibrosis, hepatitis and/or steatosis, and viral-induced liver disease (hepatitis B and/or hepatitis C). Patients with rarer specific forms of liver disease were excluded.
All the trials compared the efficacy of milk thistle or any milk thistle constituent versus placebo or no intervention in patients with liver disease. "There is no evidence supporting or refuting milk thistle for alcoholic and/or hepatitis B or C virus liver diseases," the authors found.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
According to the Centers for Disease Control and Prevention, 170 million people worldwide are infected with hepatitis C, and 2 billion are infected with hepatitis B.
While a vaccine exists to prevent hepatitis B, there is no vaccine for hepatitis C.
Although the virus can be cleared in a handful of patients, many strains are resistant to treatment. Drug therapies that focus on long-term suppression of the virus are expensive, and many patients develop a resistance. The current gold standard treatment, which combines injections of interferon and ribavirin, has serious side effects and is hard for patients to tolerate.
With lack of effective treatment for liver disease, researchers have been looking for alternative therapies that curb symptoms with minimum adverse effects on patients. Milk thistle and its extracts have been used since the time of ancient Greece for medicinal purposes, are currently widely used in Europe for liver disease, and are readily available in the United States at alternative medicine outlets and outdoor markets.
G. Thomas Strickland, M.D., Ph.D., professor at the University of Maryland School of Medicine, has been studying the role of silymarin, an extract of milk thistle, in preventing complications of chronic hepatitis virus infection. Strickland says that the exact mechanism of action of silymarin is unclear.
A problem with current trials, according to Dr. Strickland, is that the dose of silymarin administered, typically 140 mg three times daily, is too low. "I would certainly double it," he says, "especially since at the current dose we're not seeing any improvement in acute viral or chronic hepatitis, and we've shown that silymarin is totally safe."
"The problem is, there is no cure for viral hepatitis except bed rest and diet, and treatments like silymarin are worth pursuing," Strickland says, calling for more research funding.
"We should consider doing randomized clinical trials with higher doses of silymarin," Dr. Rambaldi concurs.
According to the National Center for Complementary and Alternative Medicine , a part of the National Institutes of Health, studies in laboratory animals suggest that silymarin may benefit the liver by promoting the growth of certain types of liver cells, demonstrating a protective effect, fighting oxidation (a chemical process that damages cells) and inhibiting inflammation.
In their review, Dr. Rambaldi and colleagues conclude, "Milk thistle could potentially affect alcoholic and/or hepatitis B or C virus liver diseases. Therefore, large-scale randomized clinical trials on milk thistle for alcoholic and/or hepatitis B or C liver diseases versus placebo may be needed."
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Interviews: Andrea Rambaldi at +39 3394215382 or arambaldi@hotmail.com.
Rambaldi A, Jacobs BP, Iaquinto G, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. The Cochrane Database of Systematic Reviews 2005, Issue 2.
The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
Contact:
Andrea Rambaldi
arambaldi@hotmail.com
Center for the Advancement of Health
http://www.cfah.org
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Hepatitis Ranges from Uncomfortable Illness to Deadly Virus
SourceURL:http://cgi.ozarksgateway.com
By Juliana Goodwin
News-Leader
Word just means inflammation of liver; disease is caused by different viruses, known as A, B and C.
The outbreak led to panic: Hundreds of people lined up in 1997 at the Springfield-Greene County Health Department for inoculations against hepatitis A after the condition popped up at a local restaurant.
It's been years since there has been such an outbreak locally, and Ron Lawson, a public health investigator for the department, credits a 2001 health ordinance that requires restaurant workers to wear gloves when handling ready-to-eat foods.
Even so, the threat of hepatitis can stoke fear among health officials and the public.
The word hepatitis simply means inflammation of the liver. Alcoholism and an overdose of pills can cause it, but hepatitis A, B and C are all viruses with distinct differences. Hepatitis D and E also exist, but are extremely rare.
There are vaccinations for hepatitis A and B, but not C – which may make it more of a concern.
Here's more on the most common types of hepatitis, what causes them and how they can be avoided.
Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV).
What sets A apart from B and C: It's a fecal-oral virus, which means that fecal matter containing the virus somehow enters the mouth. It is often spread through poor hygiene, such as bad hand-washing habits. According to the Centers for Disease Control in Atlanta, outbreaks can occur in restaurants, child-care centers with many children in diapers, and it can potentially be spread through sexual contact, especially between two men.
While hepatitis A is the most common type of hepatitis nationwide – accounting for 30 percent of cases – it's also the least serious, said Dr. Georgeanne Freeman. Freeman is a family practice physician at Dade County Family Medical Center in Greenfield who also has a master's in public health.
Dr. Jonathan Thornsberry with Cox Family Medicine Residency said hepatitis A is acute, not chronic.
"Usually symptoms are gastrointestinal (such as) vomiting and diarrhea," he said. "It usually runs its course. You don't have it for life."
In fact, most people get over it in a few weeks.
Also, a vaccine exists for this type of hepatitis.
The Ozarks is not following the nationwide trend: Linda DeGraffenreid, epidemiologist with the Springfield-Greene County Health Department, said HAV is the least common version locally.
"Currently we're seeing an increase in hepatitis C. Here and there we see B, and then rarely we see hepatitis A," DeGraffenreid said.
Hepatitis A can occur in isolated cases or widespread epidemics, such as an outbreak that originates in a restaurant. Lawson said the city health department urges restaurant workers to get vaccinated, and more are volunteering to do so. The department offers discounts on hepatitis A shots for those in the restaurant industry.
Hepatitis A vaccinations are not standard for the public, but people who dine out a lot or who are traveling overseas to an area where there are more cases may want to consider being vaccinated, DeGraffenreid said. The CDC also suggests that men who have sex with men should be vaccinated.
The good news is that once someone has had hepatitis A, according to the CDC, they can never get it again.
The best way to prevent the spread of hepatitis A is by frequent hand-washing, DeGraffenreid said.
Hepatitis B
Hepatitis B is a serious disease caused by the hepatitis B virus (HBV), which attacks the liver. It can cause lifelong infections, cirrhosis of the liver, liver cancer, liver failure and death.
According to the CDC, it occurs when blood or body fluids from an infected person enter the body of a person who is not immune.
"Hepatitis B and C are what we call blood-borne pathogens," DeGraffenreid said. "They can be transmitted through the blood."
There are an estimated 1.25 million Americans chronically infected with hepatitis B, the CDC says.
Ann Erving, a registered nurse with Skaggs Community Hospital in Branson who is certified in infection control, said the virus is virile.
"Hepatitis B is very concentrated in the bloodstream and can live a long time outside the bloodstream," Erving said. In fact, she continued, studies have shown that the virus can be alive even in blood that has been dried for seven days.
Nationwide, cases of HBV have declined significantly in the past two decades, especially among children: There has been a hepatitis B vaccine since 1982, and inoculation is now required before a child can attend school.
The virus is sometimes contracted by sharing needles and through blood transfusions, though all donated blood is tested for hepatitis B and C. It can also be spread from an infected mother to her baby during birth.
But it is most commonly spread through sexual intercourse, Freeman said, and has a higher occurrence in people in their 20s.
In Greene County, the number of hepatitis B cases rose from just fewer than 20 in 1998 to just fewer than 60 in 2003.
Erving said about 30 percent of those with hepatitis B do not display symptoms. And the severity is different for each person, Freeman said -- hepatitis B can be an acute or chronic infection. Chronic carriers are infectious and account for about 20 percent of those infected, according to the CDC.
As with any case of hepatitis, alcohol and some over-the-counter medications can make HBV worse.
There is treatment for hepatitis B, and some people get over it without any drugs.
People can protect themselves from the virus by getting vaccinated, not sharing drug or tattoo needles and practicing safe sex.
Hepatitis C
"Hepatitis C scares me," Freeman, the public health expert, said.
The virus, which has no vaccine, is the leading cause of liver transplants in America, the CDC says.
There are an estimated 3.9 million Americans infected with the hepatitis C virus (HCV), and 2.7 million of those are chronically infected, the organization says.
Like B, hepatitis C is spread when blood or other fluids from an infected person enter the body of a person who is not infected. It can be spread through shared drug or tattoo needles, by being stuck with a needle or other sharp instrument or by an infected mother to a baby during birth. HCV can be spread by sex, but this does not occur very often.
Nationwide, the number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003, according to CDC statistics.
The number of new chronic hepatitis C cases in Greene County has fluctuated: It was 141 in 1999, peaked at 641 in 2001, and had fallen to 362 in 2003, according to figures from the Missouri Department of Health and Senior Services.
Despite the higher number of cases there is no cause for alarm, officials say: The numbers are higher because more doctors are testing for it, DeGraffenreid said.
"Recently (they) are really starting to test for it. If you look for something you will find it, so that will skew the numbers," she said.
Some health care professionals say this virus is the version of hepatitis that concerns them the most.
"To me, it's terrifying. This is what health-care workers fear the most because it's so easy to get from the blood. Back when I delivered babies it was a big fear," Freeman said.
There are several reasons for this fear; the most obvious is that there is no vaccine to protect against it.
And if someone contracts hepatitis C, it's more likely he or she will have the more serious form: 55-85 percent of those infected with HCV are chronically infected, according to the CDC.
Also, while there is medicine for hepatitis C, many people cannot tolerate the drugs.
"The problem is the drugs often make the patients sicker than the hepatitis itself," Freeman said.
Lastly, the treatment doesn't always work, Thornsberry said: "A large number of these people, after five years will (still) show evidence of hepatitis C in their blood. The problem with the treatment is it's not extremely effective."
Another major concern is that hepatitis C can incubate in the body for decades without symptoms showing up, Erving said.
"About 80 percent of people don't show signs or symptoms. During Vietnam we did a lot of blood transfusions on the field and back then we didn't even know about (hepatitis) C and so now we are seeing more of that," Erving said.
People should be tested for hepatitis C if they have ever injected illegal drugs, received a blood transfusion or a solid organ transplant before July 1992, were a recipient of clotting factors made before 1987, have ever been on long-term kidney dialysis or have evidence of liver disease.
Hepatitis is detected with a blood test. People do not need to test for hepatitis C unless they have risk factors, DeGraffenreid said.
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May 4th, 2005
Acetaminophen Linked to Risk of Respiratory Ills
SourceURL:http://www.reutershealth.com
NEW YORK (Reuters Health) - Regular use of the painkiller acetaminophen, also known as paracetamol, is associated with higher rates of asthma and chronic obstructive pulmonary disease (COPD) and reduced lung function, according to a new study.
Animal experiments have suggested that acetaminophen might lower antioxidant activity in the lungs, explain Dr. Tricia M. McKeever, at City Hospital in Nottingham, UK, and her associates in the American Journal of Respiratory and Critical Care Medicine.
Whether this experimental evidence translates to an effect on human respiratory disease has been unclear. The team therefore evaluated data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988 and 1994 in the US.
Among the 13,492 subjects in the study, 6.9 percent had asthma, 11.8 percent had COPD and 2.8 percent had both respiratory illnesses.
Overall, 4.3 percent of the participants reported that they used acetaminophen daily. Another 8.2 percent and 2.5 percent, respectively, reported daily use of aspirin and ibuprofen.
The use of acetaminophen was associated with an increased risk of both asthma and COPD, and the risk increased in step with the dose.
Lung function was also lower among those using acetaminophen daily.
In contrast, taking aspirin or ibuprofen was not associated with respiratory illness.
This does not necessarily mean that acetaminophen should be avoided, however. "The potential risk of acetaminophen must ultimately be estimated through a balance consideration of the positive benefit and the potential harm if these medications were substituted with others," McKeever's group advises.
SOURCE: American Journal of Respiratory and Critical Care Medicine, May 2005.
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Hepatitis C Caring Ambassadors Program Applauds Governor Kulongoski's Proclamation of May 2005 as Hepatitis Awareness Month in Oregon
SourceURL:http://home.businesswire.com
OREGON CITY, Ore.--(BUSINESS WIRE)--May 4, 2005--The Hepatitis C Caring Ambassadors Program (HCCAP) salutes Oregon Governor Ted Kulongoski for his proclamation of May 2005 as Hepatitis Awareness Month in the state. Hepatitis C is the most common chronic, blood-borne viral infection in the United States, and is the leading cause of chronic liver disease among Americans. An estimated 3.9 to 4.5 million Americans have been infected with the hepatitis C virus (HCV) including at least 64,000 Oregonians.
HCCAP's observance of Hepatitis Awareness Month will include Hepatitis C Awareness Day in the Galleria at the State Capitol building in Salem on May 23rd from 9:00 AM to 2:30 PM. Informational booths staffed with representatives from HCCAP, and other organizations and agencies concerned about the hepatitis C crisis will be on hand. Light refreshments will be served and a press conference will be held during the event.
HCCAP Managing Ambassador Lorren Sandt said of the Proclamation and the Hepatitis C Awareness observance, "Oregon is in a difficult situation, as is every state. Hepatitis C is a health care crisis without funding. We need to be creative in addressing the needs of individuals affected. The Governor's Proclamation is a great tool to raise awareness about hepatitis C and the needs of the community throughout Oregon."
Hepatitis C has been dubbed "the silent epidemic" because many Americans are unaware of this infectious disease despite the fact that it is so common. Further, many with the disease are unaware they are infected with HCV because symptoms often do not appear until serious liver damage has already occurred. The primary goal of HCCAP during Hepatitis Awareness Month is to increase public awareness of the hepatitis C epidemic. "The earlier in the course of hepatitis C that people are diagnosed, the more likely it is that we can prevent serious complications and control the spread of the disease. But the first hurdle is to get the word out so that hepatitis C becomes part of the public consciousness," said Dr. Tina M. St. John, Medical Director of the Caring Ambassadors Program. She added, "We are extremely grateful to Governor Kulongoski for his assistance in giving us a platform to increase hepatitis C awareness among Oregonians. With this proclamation, Governor Kulongoski may well end up saving the lives of hundreds of Oregonians with hepatitis C who will be tested and treated for their disease."
For additional information about Hepatitis Awareness Month in Oregon, chronic hepatitis C, or the Hepatitis C Caring Ambassadors Program, contact Lorren Sandt at 1-877-737-4372 or lorren@hepcchallenge.org, or visit HCCAP online at www.hepcchallenge.org.
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Blee Praised for Push on Prison Hepatitis Issue
SourceURL:http://www.pressofatlanticcity.com/
By PETE McALEER Statehouse Bureau, (609) 292-4935
TRENTON - Three years ago, Assemblyman Frank Blee, R-Atlantic, aimed tough questions at state Department of Corrections Commissioner Devon Brown on the handling of inmates with hepatitis C.
When Blee followed up Tuesday, Brown paid the assemblyman high praise.
"Out of your concern, we put in place major changes with regard to hepatitis C," Blee said. "You saved a lot of lives just by broaching the topic."
Brown told Blee he held several meetings on hepatitis C after the 2002 budget hearings and eventually hired more social workers and put new practices in place.
Blee had advocated for more screening for inmates, particularly those leaving prison. The department added a new screening program to identify those with the virus and treat prisoners, beginning with those closest to release.
"We knew we had a very large problem," Blee said. "It was almost so big that everybody wanted to look away."
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Woman Says Doctor Infected Her with Hepatitis C
SourceURL:http://www.arguscourier.com/
By EMILY BRADY
ARGUS-COURIER STAFF
A local woman seeking treatment for one debilitating disease was accidentally infected with another by her own physician, according to a case filed recently in Sonoma County Superior Court.
In the April 21 complaint, consumer rights law firm Hersh & Hersh alleged that a medical error at Gordon Medical Associates in Santa Rosa infected up to five of its patients with Hepatitis C on Jan. 4, 2005, including their client, Cathy Graham of Petaluma.
Graham, who was already diagnosed with Lyme Disease and being treated by Dr. Eric Gordon, was allegedly infected while receiving an IV treatment of contaminated dextrose solution, the lawsuit stated.
She was diagnosed in mid-February with Hepatitis C, a liver disease that is spread through infected blood.
During a conversation in early April with Gordon, her treating physician, the Petaluma woman learned her doctor believed she was infected while receiving the dextrose solution he gave her early January. He told her that he later learned the solution had been contaminated with Hepatitis C and had been used multiple times that day on up to five different people.
Just how the solution became infected is still unclear, the lawsuit states, but it is believed that a needle used on someone with Hepatitis C somehow came into contact with the bag.
The medical office has not released the names of the four other patients it believes to be infected with the disease.
According to Graham's attorney, the Petaluma woman decided to go public about her situation "in order to get the word out to the community in the event there are other patients who may have been infected with Hepatitis C at the careless hands of Gordon Medical Associates"
The plaintiff in the suit, Eric Gordon said in a written statement, "As a physician I work hard to take care of my patients. We are addressing the issue ... On the advice of counsel, I really cannot comment."
(Contact Emily Brady at ebrady@arguscourier.com)
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May 5th, 2005
Scalpel-Free Surgery Could Reduce Risk of HIV and Hepatitis Exposure for Health Care Workers
SourceURL:http://www.medicalnewstoday.com/
While the incidence of disease from HIV and hepatitis is increasing in the United States, little is known about their prevalence in patients undergoing surgery. Now, researchers have shown that nearly 40 percent of surgeries at The Johns Hopkins Hospital occur in patients who tested positive for a bloodborne germ.
"While these rates are alarming, they are not entirely unexpected. General precautions have been in effect for some time to prevent the spread of disease to health care workers in the operating room," said Martin A. Makary, M.D., assistant professor of surgery and public health at Johns Hopkins and lead author of a report in the May 2005 issue of the Annals of Surgery.
"Given the high incidence of these infections, however, we have developed new strategies such as 'sharpless' surgery-a surgical technique which uses high-technology alternatives to needles and knives. We advocate using these techniques whenever possible in high-risk settings to further protect health care workers from accidental transmission," added Makary.
Sharpless surgical techniques include laparoscopy, electrocautery to replace scalpel incisions, and skin clips or glue instead of sewing to close or repair wounds.
Previous studies have shown that health care workers are injured in about 7 percent of operations. As many as 87 percent of surgeons will receive an injury that breaks the skin -- thus allowing for possible disease transmission - at some point in their career. There are an estimated 40,000 new cases of HIV each year, and hepatitis C is increasing at an even faster rate, according to the report. The study concludes that by studying the rates of HIV and hepatitis B and C among patients presenting for surgery, a more accurate incidence of disease is measured within a community, bypassing the selection bias of traditional statistics of known infected patients presenting to primary care clinics. Furthermore, the authors report that blood-borne pathogens are associated with certain types of operations.
The researchers also found that the operations associated with the greatest risk of infection - lymph-node biopsy, soft-tissue-mass excision and abscess-drainage cases - were often assigned to the most inexperienced surgeons-in-training, placing them at greatest risk.
"Sharpless surgical techniques combined with traditional precautions and early education for surgery trainees are the most practical ways to reduce the risk of infection to health care workers," said Makary.
The researchers studied 709 consecutive adult general surgery operations performed between July 2003 and June 2004 in the community surgical service at The Johns Hopkins Hospital including inpatient, emergency department and outpatient surgical procedures. Data were collected on HIV, hepatitis B and hepatitis C test results, type of operation, age, sex and history of intravenous drug use.
The researchers found that 38 percent of all operations involved a bloodborne pathogen, and almost half (47 percent) of all men tested positive for at least one infection. HIV accounted for 26 percent of infections, hepatitis B for 4 percent, hepatitis C for 35 percent, and co-infection with HIV and hepatitis C accounted for 17 percent of infections. In addition, bloodborne pathogen infection was found in up to 65 percent of patients with a history of intravenous drug use and in as many as 71 percent of patients undergoing a soft-tissue abscess procedure or lymph-node biopsy.
While the patients in this study tend toward low socioeconomic status and increased substance use, most university hospitals in the United States are located in urban areas and serve a similar patient population, added Makary.
Other authors on the report are Eric S. Weiss, Theresa Wang, Dora Syin, Peter Pronovost, David Chang and Edward Cornwell III.
On the Web:
annalsofsurgery.com
hopkinsmedicine.org/surgery/faculty/Makary
Contact:
Trent Stockton
tstockt1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
http://www.hopkinsmedicine.org
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Hep C Increases the Risk of Diabetes after Orthotopic Liver Transplant
SourceURL:http://www.gastrohep.com/
Hepatitis C infection contributes to the development of diabetes mellitus in orthotopic liver transplant recipients, finds May's issue of the American Journal of Surgery.
Recent evidence suggests that new-onset diabetes after transplant adversely affects orthotopic liver transplant patient and graft survival.
Dr Orloff and colleagues from Oregon evaluated the effect of Hepatitis C infection on the natural history of new-onset diabetes after transplant.
The investigators conducted a retrospective review of 492 orthotopic liver transplant recipients at a single center from 1993 to 2003.
Patients were followed for a minimum of 12 months, ranging to 10 years.
The researchers reported that the study population consisted of 444 orthotopic liver transplant recipients, of which 206 were Hepatitis C positive and 238 were negative.
New-onset diabetes after transplant was defined by the need for antidiabetic medication for at least 7 days starting anytime after orthotopic liver transplant.
The overall incidence of new-onset diabetes after transplant was 33% – American Journal of Surgery
The research team performed statistical analysis by using the Student t test, Kaplan-Meier survival, and chi-square tests.
The team noted that the overall incidence of new-onset diabetes after transplant was 33 %.
The researchers also observed that there was a significant difference in the development of new-onset diabetes after transplant between the Hepatitis C-positive group at 40% and the Hepatitis C-negative group at 27%.
Other independent risk factors for development of new-onset diabetes after transplant were male gender and being more than 50 years of age.
Dr Orloff's team concluded, "Hepatitis C infection contributes to the development of diabetes mellitus in orthotopic liver transplant recipients."
"The mechanisms behind Hepatitis C infection and associated new-onset diabetes after transplant in Hepatitis C-positive orthotopic liver transplant recipients warrant further investigation."
Am J Surg 2005: 189(5): 552 – 557
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Romney Disagrees with DPH Position on Hypodermic Needles
Associated Press
Massachusetts Gov. Mitt Romney does not support the state Department of Public Health's proposed legislation to legalize over-the-counter sales of hypodermic needles as a way of preventing blood-borne diseases like HIV and hepatitis C among IV drug users, his spokesperson said Wednesday. "The position of the governor and the lieutenant governor is we don't want to do anything to that facilitates illegal drug use," said Eric Fehrnstrom. "If you allow addicts easy access to the tools of the trade, you are facilitating illegal drug use."
Massachusetts is one of just three states that ban the sale of hypodermic needles without a prescription. Almost 39 percent of the state's HIV cases are linked to needle sharing. Public health advocates, physicians and substance-abuse experts support the health department's proposed bill.
While many prosecutors and top police officials have long opposed the measure, resulting in its numerous defeats over the past decade, some appear to be changing their position. At hearings on Wednesday, Middlesex District Attorney Martha Coakley, Suffolk District Attorney Daniel Conley and a Boston police representative said their views have evolved from seeing needle access as unhelpful to the war on drugs to viewing it now as a way to fight HIV/AIDS.
Sen. Robert O'Leary (D-Barnstable), a sponsor of the measure, said such law enforcement support can only help the bill.
Also at the hearings, public health experts testified that research conclusively shows that needle sharing and the number of HIV cases related to IV drug use have dropped significantly in states that permit over-the-counter sales.
Fehrnstrom said it is too soon to say whether Romney would veto the bill if it crossed his desk.
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Hepatitis C Awareness 2005 Campaign: 100,000 Letters to Congress in May
Dear Community members,
Please write your letter and pass this email on to everyone.
The Hepatitis C Caring Ambassadors Program (HCCAP) enthusiastically announces the launch their Internet-based Hepatitis C Awareness Campaign (www.hepcchallenge.org) to coincide with the May observance of National Hepatitis Awareness Month. The campaign is focused on raising hepatitis C awareness in the public consciousness, and in the minds of elected officials and policy-makers. HCCAP s Hepatitis C Awareness Campaign includes a user-friendly interface that gives all interested parties the opportunity to send their Congressional representatives an e-mail message expressing concern about the hepatitis C epidemic. HCCAP has set a goal of enabling 100,000 messages about hepatitis C to be sent to Congress during the month-long Hepatitis Awareness observance. Other features of the HCCAP Hepatitis C Awareness 2005 Campaign site include daily tributes to persons who have contributed to the betterment of those with hepatitis C, daily hepatitis C facts, and a calendar of local and regional Hepatitis Awareness Month activities. Vote for your favorite hep c coordinator, advocate, outreach worker or support group leader for a special tribute.
One hundred thousand messages represent just 2.5% of the 4 million Americans living with hepatitis C. If 100,000 people sent messages about hepatitis C to their elected representatives today, it would have a tremendous impact in Washington, D.C. Our leaders would then understand this is an issue their constituents are deeply concerned about. It is time for the community to speak up and be heard. Time is running short, but working together, we can make a difference for the millions of people living with this life-threatening disease.
Thank you,
Lorren Sandt
Hepatitis C Caring Ambassadors Program
Managing Ambassador
877-737-4372 toll-free
lorren@hepcchallenge.org
Hepatitis C: Choices now on line at: www.hepcchallenge.org
"We believe strongly in the power of people working together, and that, by doing so, we will make far more significant advances than could be made by any group or discipline working on its own."
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VA Raises Hepatitis C Awareness
SourceURL:http://www.newswise.com
Source: Veterans Affairs (VA)
HEPATITIS C VETERANS SCREENING
Description
Preventative health tips from the Department of Veterans Affairs for hepatitis C in observance of National Hepatitis Awareness Month.
Newswise -- Did you know that symptoms of hepatitis C could take 20 to 30 years to appear? Hepatitis C is a disease that affects the liver and is spread through contact with infected blood or contaminated needles, tattoo tools, and other means. An estimated four million people in the U.S. are diagnosed with hepatitis C. In some cases, veterans seem to have higher rates of infection than others.
While symptoms are often very mild or non-existent, hepatitis C can be a very serious illness and, over time, cause permanent liver problems including cirrhosis and liver cancer.
The liver is one of the largest and most important organs in your body. During National Hepatitis Awareness Month, the Department of Veterans Affairs (VA) encourages those with one or more risk factors to consider getting tested. Talk with your doctor about being tested for hepatitis C if you:
*have ever used a needle to inject drugs, even if it was many years ago;
*had a blood transfusion or organ transplant before 1992;
*have been on long-term kidney dialysis;
*are a Vietnam veteran;
*have had exposure to blood on your skin;
*have had multiple sex partners;
*have tattoos or body piercings;
*have liver disease;
*have a history of drinking a lot of alcohol; or
*have had an abnormal liver function test
*wish to be tested
The test for hepatitis C is simple and only requires a blood sample.
VA is the largest single provider of medical care to people with hepatitis C infection in the U.S., and is the nation’s leader in hepatitis C screening, testing and treatment. VA has a system-wide policy for screening all enrolled veterans for hepatitis C risk factors and has identified approximately 250,000 veterans in the past 10 years who have a diagnosis of or positive blood test for hepatitis C.
In fiscal year 2003, VA spent more than $2.4 million on 16 research projects relating to hepatitis C. In addition, VA investigators received $4.1 million from non-VA sources for another 104 studies.
VA funds four Hepatitis C Resource Centers to foster innovation and disseminate best practices in prevention, care and education. They are located in Minneapolis, Minn.; San Francisco, Calif.; West Haven, Conn.; and Seattle, Wash., in collaboration with Portland, Ore.
VA research on hepatitis C includes clinical trials of treatments, epidemiological studies, investigations into the biological mechanisms of infection, and studies on improving quality of life for hepatitis C patients. Ongoing research is being conducted at VA medical centers in Bronx and New York, N.Y.; Long Beach and San Francisco, Calif.; Portland, Ore.; Seattle, Wash.; and Richmond, Va.
For more in-depth information about hepatitis, visit http://www.hepatitis.va.gov.
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May 6th, 2005
Synovate Healthcare Launches a New Hepatitis C Syndicated Patient Audit in the USA
http://www.pharmalive.com
LONDON, May 6, 2005--Synovate Healthcare, a global market research firm specialising in healthcare, has launched the Hepatitis C Monitor in the US, expanding and strengthening their anti-viral portfolio. Since 1991, Synovate Healthcare has serviced the anti-viral market through its unique expertise and knowledge gained through its’ Global HIV and Hepatitis B monitors, and is the only company which can offer clients such a breadth of data, as well as depth.
Clarissa Del Pup, Manager of the Hepatitis Monitors commented ‘We are extremely excited about this launch we can offer clients an extensive portfolio of products within the anti-viral market; analysising the dynamics of this Hepatitis C market whilst gaining a helicopter view of overall brand performance and co-infection. ’ We will of course continue to offer our clients our usual outstanding level of service and therapy expertise’ The European launch of the Hepatitis C Monitor is planned for 2006.
The Synovate Healthcare Hepatitis C Monitor is based on a representative panel of physicians who regularly report on their treatment of HCV patients in the US so that changes over time can be monitored. In addition to the patient record information, the Monitor also collects physician perceptions of the market and the disease to be compared, and validated, with the “actual patient” data.
The data provided by the Monitor can help you develop viable doctor and patient segmentation models and track how the disease is perceived, managed and treated over time. The severity of hepatitis C and the limited treatment options currently available make it a key area of interest for the pharmaceutical industry. With over 20 products in the pipeline, many of which are still in early stage development, the hepatitis C market is poised to change considerably in the next few years. In anticipation of these market dynamics, the Synovate Healthcare Hepatitis C monitor is set to be a leading source of in depth market information.
For further details on Synovate Healthcare and the Hepatitis C Global Monitor visit:
www.synovate.com/healthcare
Telephone: +44 (0) 20 8246 6200
Fax: +44 (0) 20 8246 6300
Email: hepatitistm@synovate.com
Address: Synovate Healthcare, The Boathouse, The Embankment, Putney, London, SW15 1LB, UK
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Patients Recalled for HIV, Hepatitis Tests
SourceURL:http://www.expatica.com
AMSTERDAM --Nineteen patients have been recalled for HIV and Hepatitis tests after being treated with a dirty endoscope in Leyenburg hospital in The Hague.
The hospital said on Friday the endoscope was not properly disinfected because a pump malfunctioned. As a result, the disinfectant did not completely wash through the machine.
The recalled patients all underwent treatment with an endoscopy in the past two weeks at the hospital's stomach, intestinal and liver ward. The endoscope is inserted anally.
A spokeswoman for the Haga Hospital --which includes the Leyenburg unit -- said doctors have identified which patients underwent treatment and with which endoscope.
She said the patients will undergo a test for HIV and Hepatitis and that a second final test will be conducted in six months.
The chance that a patient has contracted a viral infection is slight. The risk of an HIV infection is even smaller because the endoscope first underwent a hot rinse, prior to the disinfecting wash.
The AIDS virus probably did not survive the high temperature, but the spokeswoman said the hospital wanted to test the patients for HIV infection to be 100 percent sure.
A couple of similar incidents have occurred in the Netherlands in recent years, but the hospital spokeswoman said no patient has contracted a viral infection via dirty equipment.
She said the Healthcare Inspectorate has been informed.
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2nd Annual Hep C Awareness Internet Telethon
(Los Angeles) Hepatitis C Awareness, a non-profit organization, has announced its second annual telethon to be held on the Internet on Saturday May 14 from 12 to 8pm PST. Viewers and supporters can log on to the live event at http://www.HepCaware.org.
After losing a close friend to Hepatitis C in 2001, Kelly Zirbes and her band Kelly's Lot began a four-year campaign offering Hep C information at their shows. With the desire to reach a mass level of awareness of this disease, Kelly put out a few calls to fellow musicians across the country to help raise the awareness of Hepatitis C on a national level by distributing information at various local music gigs around the nation s venues. The response and support has been astounding and led to the founding of HepatitisCAware.org in 2004.
A postcard was designed for the campaign and a grass roots movement began, which has now grown into a national coalition of musicians and street teams working together to raise awareness of this deadly disease that affects over 4 million Americans every year.
Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). The virus is present in the blood and is spread when infected blood from one person enters the body of another. It causes the liver to form tiny scars, which, over time, join together and begin to prevent blood from flowing freely through the liver. Chronic hepatitis C infection is the most common indication for liver transplantation in the United States. It affects more than four million people in the U.S. and an estimated 8,000-10,000 Americans die annually of complications related to HCV. Hepatitis C infection is a major public health problem throughout the world, yet it is largely preventable. Prevention can happen through education programs, rigorous efforts to protect blood supplies, and major intervention programs for such at-risk populations as recreational intravenous drug users. There is no vaccine for Hepatitis C.
Risk factors include receipt of blood, blood products or an organ transplant prior to 1992, sharing of drug paraphernalia (injecting or snorting), being stuck by a used blood needle, received kidney dialysis, getting tattoos or body piercing, having had sexual activity that involves contact with blood, incarceration, sharing personal care items such as toothbrushes or razors with an infected person, fought in a war (especially Vietnam). If you are in any of these categories, you may have been exposed to Hepatitis C. Get Tested.
The live telethon will feature musical performances by Gene Butler, Che Zuro, Kat Parsons, Corday, The Willies, Slim Chance, Gilli Moon, Clementine, Nina Jo, Simply Complex, Tee-M, Susan Laurenzi, Marina V, Deb Pasternak, Gwen Cardenas and Kin, Steve Pierson, Amilia Spicer, Ballentine, Throwing Toasters and Kelly's Lot. The telethon will also feature comedians such as Steve Bruner, Lord Carrett, Matt Iseman, Chris Strait, Dean Evans, Willis Turner, Pat Loborio, Kira Soltanovich and Courtney Cronin.
The telethon will conclude with the feature of the new documentary "Silence Is Deadly- Living With Hepatitis C directed by Kindra Ruocco. Hepatitis C Awareness, Inc is a non-profit 501(c)(3)
For more information on this event or to set up an interview or to receive a PSA on Hep C Aware, please contact Chip Schutzman at Miles High PR at 323-806-0400 or chip@mileshighproductions.com.
For more information please visit http://www.HepCAware.org
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