Back to News Review
Week Ending: March 31st , 2007
Alan Franciscus
Editor-in-Chief
To download pdf version click
here
This Issue:
Back to top
March 25th , 2007
Hepatitis C Called a Looming Crisis: Disease Affects Many Inmates but Treatment Is Hard to Get
http://www.contracostatimes.com/
By Martha Mendoza
ASSOCIATED PRESS
VACAVILLE - The most dangerous thing coming out of prison these days may be something most convicts don't even know they have: hepatitis C.
Nobody knows how many inmates have the disease; by some estimates, around 40 percent of the 2.2 million in jail and prison are infected, compared with just 2 percent of the general population.
Eventually, when they are released, medical experts predict they will be a crushing burden on the health care system, perhaps killing as many people as AIDS in years to come. At the same time, they will be carriers, spreading the disease.
Hepatitis C can be treated, but many prisons do not test for it. Among the reasons: Budgets are tight and treatment is expensive. So prison officials close their eyes to the gathering emergency and pass it along to the outside world.
"Right now, there's a golden opportunity to bring solutions to this problem before it hits," said Dr. John Ward, director of viral hepatitis at the National Center for HIV/AIDS at the Centers for Disease Control and Prevention in Atlanta.
Hepatitis C is already the most common disease of its sort in the United States -- a chronic, life-threatening, blood-borne infection. It is most commonly linked to infected needles used for drugs, though prison tattoos and body piercing with nonsterile equipment are also risky.
What makes this virus particularly insidious is that as many as half of the people who have hepatitis C don't even know they have it. The "silent killer," already considered epidemic by the World Health Organization, often remains dormant for decades.
Some of the infected are lucky: One in five people who get hepatitis C will clear it out of their system naturally. But without treatment, one in four will suffer liver failure or develop liver cancer. Last year, liver cancer was the only one of the top 10 fatal cancers in this country to increase, in large part because of hepatitis C.
More than $1 billion is already spent each year on hepatitis C, and those costs are expected to soar unless prevention and treatment are expanded.
Without those changes, researchers project that liver-related deaths will triple from around 13,000 in 2000 to 39,000 by 2030. It's also estimated that 375,000 Americans with hepatitis C will develop cirrhosis by the year 2015.
'I didn't know'
Anita Taylor, 48, is already there, in end-stage liver disease. Taylor speaks very slowly and moves with care. She often finds that she can't say the words she wants to -- they just won't come out. Her body hurts most of the time. Her nose bleeds a lot.
A mother of two and former heroin addict, Taylor said she learned she had hepatitis C when she was jailed in Nevada in 1991 for being under the influence of drugs.
"They tested me and told me I had hepatitis C. They didn't tell me there was a treatment and a cure," she said. "And I didn't know to ask."
Taylor's experience is not unusual.
"The doctor gave me a death sentence," recalls Leslie Czirr, a 36-year-old parolee. "He told me, 'There's no cure for this and you will die from it unless you are hit by a truck first.'"
Czirr learned she had hepatitis C during a prenatal examination in 1996, at a time when she wasn't in prison. Czirr has been arrested 10 times for drug possession and served almost eight years in prison on various drug possession and dealing charges.
She has started to suffer exhaustion, brain fog and aches. She recently enrolled in a county program to be treated -- treatment, she said, she was denied at California's Norco State Prison.
"I asked and asked, but they barely want to give you a Motrin," she said. "I really want to get well, not just for myself, but so I'm not putting anyone else at risk."
Limited studies indicate that fewer than 10 percent of prisoners who have contracted hepatitis C are treated. The reasons vary. Medical staff have other priorities, and not all are well-informed about the disease. Prisoners with short sentences are often excluded because they won't be able to complete treatment, and drug addicts who are inclined to return to risky behavior are often turned away because it is assumed they will simply reinfect themselves.
Usually, though, it comes down to money. Prison officials say that even if they wanted to provide the treatment, it is extremely expensive -- about $9,500 per patient per year -- and no federal funds have been earmarked to pay for it.
"It's a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren't incarcerated who don't have adequate health care," said Dr. Joseph Bick, chief medical officer at the California Medical Facility at Vacaville.
Many of the inmates in Vacaville's hospice unit -- reserved for those given six months or less to live -- are dying from hepatitis C-related ailments. Bick said half of the prison's 3,200 inmates have a history of having been infected with hepatitis C, and at any given time, about 40 of those men are receiving the intensive drug treatment to cure it.
"I'm pretty sure this is how I got it," said Anthony Harris, an inmate at Vacaville. He rubbed his forearm hard, as if trying to remove the prison tattoo bearing his children's names.
Harris, 51, is a former barber serving a life sentence for second-degree murder. In 2003, a doctor at another prison told him he had hepatitis C; he researched the disease in the prison library and has sought treatment ever since.
"They gave me shots for hep A and B, got rid of them. I'd like to get rid of the C, too," he said. "I'm entitled to that. But some docs will give you the treatment and others won't. I keep making appointments. I keep asking."
The course of treatment can take a year and involves taking pills twice a day and weekly injections. Side effects are like those associated with chemotherapy -- nausea, exhaustion, depression, debilitating aches and pains -- and the cure only works about half the time.
But Bick said the high cost of treating prisoners for hepatitis C is a bargain compared to the bill that would come due if these cases are left untreated. "It's a tremendous opportunity for us to have an impact on the larger health of the community," he said.
No rules
Dr. Lynn Taylor, an assistant professor of medicine at Brown University's medical school, agrees that prison is "perhaps one of the best settings for treatment of high-risk individuals."
"Prison can be a window of opportunity to reduce the reservoir of infection," she said.
But there are no federal rules about testing and treating hepatitis C. Federal guidelines, issued by the CDC in 2003, said correctional facilities should "become part of prevention and control efforts in the broader community." But they don't recommend screening for all inmates.
Instead, the CDC urged medical staff to ask new inmates about their risk factors, and only those prisoners who seem likely to be exposed should undergo screening, which costs $5 to $10.
The CDC guidelines fell short, said Dr. Josiah Rich, a professor at Brown who directs the university's Center for Prisoner and Human Rights. Rich's studies confirm that convicted criminals are almost always willing to be tested for hepatitis C but will often lie to prison authorities about their past drug use.
"We already know that more than one in three people coming through corrections has hep C, so by definition everyone coming in is high risk. It's absurd that they're not testing everyone," he said.
Rich concedes that testing every inmate will "jack up costs" for prisons.
Lawsuits are, indeed, on the rise.
The first significant case came in 1999, when officials at the Luther Luckett Correctional Complex in La Grange, Ky., refused to allow inmate Michael Paulley access to free hepatitis C treatment. Paulley, who was serving a 25-year sentence for rape and burglary, sued and won.
But the treatment came late and he died in 2004, the year he would have been eligible for parole. The litigation prompted broader testing and treatment in Kentucky, but Paulley's physician, Dr. Bennet Cecil, a Louisville, Ky.-based hepatitis C specialist, said prisoners still die "all the time" for untreated hepatitis C.
"I think it's immoral if a country, a state a society is going to incarcerate somebody and then deny them necessary medical care. I think that's an outrage," he said.
Prisons in at least a dozen states -- Alabama, California, Delaware, Florida, Georgia, Idaho, Michigan, Mississippi, Nebraska, New York, Oklahoma and Virginia -- are being sued for failure to treat hepatitis C.
But it's tough going, said Oregon civil rights attorney Michelle Burroughs. Although she's won a settlement that mandated testing for at-risk inmates and treatment for those who are eligible, five of the 10 inmates she's representing in a class-action lawsuit have died while the litigation proceeds.
"It's appalling, horrendous, horrifying. Prisoners wait five years just to be evaluated," she said.
Rep. Barbara Lee, D-Oakland, recently reintroduced legislation that would mandate prison testing and treatment of hepatitis C. Similar proposals in recent years have failed.
"The plain fact is that prisoners do not stay in prison. With more than 90 percent of incarcerated persons returning to their communities, it is clear that when a prisoner is infected, we are all affected," Lee said.
Back to top
Psychiatric History Does Not Predict Hep C Treatment Completion
www.gastrohep.com
Psychiatric comorbidity does not predict interferon treatment completion rates in Hep C seropositive veterans, reports March’s Journal of Clinical Gastroenterology
Clinical experience suggests that preexisting psychiatric conditions may adversely affect the ability to tolerate combination antiviral therapy in Hepatitis C.
Dr Adrian Dollarhide and colleagues from California evaluated the impact of common psychiatric disorders on completion of antiviral therapy in Hepatitis C virus positive US veterans.
The team performed a retrospective chart review of 130 Hepatitis C virus positive veterans treated with combination antiviral therapy from 2000 to 2004.
The combination treatment included interferon with ribavirin.
The research team examined baseline psychiatric, substance use, demographic, and comorbid medical disease variables for all patients started on treatment.
The researchers found that 13% of patients required treatment discontinuation for neuropsychiatric adverse effects.
A body weight of 100kg or more predicted the likelihood of treatment completion -- Journal of Clinical Gastroenterology
There was no association between treatment completion, and any specific psychiatric diagnosis, or combined psychiatric and substance use diagnoses.
The team noted that there was no association between treatment completion, baseline use of antidepressants, and history of substance abuse/dependence.
The researchers observed no association between completing treatment and patients receiving either standard or pegylated interferon plus ribavirin therapies.
Psychiatric and substance use disorders were not associated with dropout due to neuropsychiatric adverse effects.
The team noted that baseline comorbid medical disorders also did not predict treatment completion.
However, higher body weight did predict likelihood of treatment completion.
The researchers observed this association especially for those weighing 100 kg or more compared with subjects weighing less than that.
Dr Dollarhide‘s team commented, “In this cohort of veterans, prior psychiatric or substance use history did not predict completion of recommended interferon with ribavirin treatment.”
“These findings suggest that a larger pool of veterans with psychiatric or substance use disorders may be considered candidates for antiviral therapy when provided with multidisciplinary support.”
J Clin Gastroenterol 2007: 41(3): 322-28
Back to top
March 26th, 2007
Charity Manager Jailed for Theft
http://news.bbc.co.uk
A manager facing credit card debts has been jailed for five years after admitting stealing more than £500,000 from two health charities.
Keith Foster, 49, of Billericay, Essex, stole £160,000 when manager of the British Association of Hand Therapists.
He then changed jobs and took £400,000 from a government compensation fund for people who had caught hepatitis C through blood transfusions.
Foster also admitted 30 other charges of deception at Basildon Crown Court.
Prosecutor David Pickersgill told Recorder Christopher Thomas QC that Foster had exploited loopholes in accounting systems and diverted charity cheques into his own account.
Abuse of trust
He had begun stealing after getting into a spiral of credit card debt, the court was told.
Foster took money from the British Association of Hand Therapists (BAHT) - a charity set up to improve the treatment of hand ailments and injuries - between 2001 and 2004.
Then, after becoming company secretary of the Skipton Fund - a charity that paid compensation to hepatitis C sufferers - he stole more funds.
Lawyers at the BAHT spotted anomalies and challenged Foster after he had left the organisation, the court was told.
Foster used money he stole from the Skipton Fund to repay them.
Richard Hampton, deputy managing director of the NHS Counter Fraud and Security Management Service, said: "Keith Foster abused his position of trust and responsibility to steal from his employers.
"He stole money meant for people with life-threatening illnesses.
"On the advice of the NHS Counter Fraud Service, the Skipton Fund has already taken action to close the loopholes that allowed this fraud to occur.
"The money Foster defrauded to repay the British Association of Hand Therapists has been returned to the Skipton Fund."
Back to top
Tech Tools Can Fight Isle Hepatitis
http://starbulletin.com/
By Robert Shikina
rshikina@starbulletin.com
A support network envisions rural clinics that use telemedicine to combat the disease
Alan Tice wants to aggressively battle what has been known as a silent epidemic in Hawaii through the Internet.
Working with the Hepatitis Support Network of Hawaii, Tice wants to open rural clinics for hepatitis treatment in Hawaii using telemedicine, visiting a patient through a Web camera and video screen with the help of a medical assistant. But first the state Legislature must approve the organization's request for a $244,000 grant over two years to launch the program.
"If we had an established program where we could basically bring me or a doctor to them via a video monitor and a cell phone or video monitor and audio system, then we could have a good assessment of the patient. It's bringing health care to the community," said Tice, associate professor at the John A. Burns School of Medicine and an infectious-disease specialist.
About 23,000 people in Hawaii are carriers of the hepatitis virus, but only about 15,000 cases of the disease have been reported, said Heather Lusk, of the state Department of Health.
One of the biggest challenges facing the Department of Health is that a third of those infected do not even know it, she said, adding that early detection of the disease saves lives and money.
There are few symptoms of the hepatitis virus for 20 to 30 years until the disease progresses into liver cancer or cirrhosis of the liver. By then, treatment for the disease is greatly reduced.
It is like a silent epidemic in Hawaii, which has the highest rate of liver cancer in the nation, Lusk said. For the first time, doctors might have a cure for the virus, making early detection more powerful today, she said.
Hepatitis C can be transferred through sharing needles or razors or through open wounds. Thousands who received blood transfusions before 1992, when a test for the virus was first created, were infected and might not know it, Lusk said. Hepatitis B is transferred mother to child and can be brought from Asian populations, where there are higher rates of hepatitis, to Hawaii.
The Hepatitis Support Network of Hawaii hopes it will be able to help the battle in Hawaii's rural areas, where there are fewer doctors and possibly more carriers of the disease among homeless or immigrants. Organizers say they plan to focus on educating people about testing, help them get tested and help with treatments.
"Treatment is not easy and takes up to a year sometimes to treat people and to get rid of the virus," Tice said. "But the opposite expense is for these people to come in with liver cancer and liver failure. It's terribly expensive there, too."
Treatment can entail monthly visits to a medical aide, addressing side effects of the drugs and refrigerating the medicine. The telemedicine clinic can do all those as well as help people who are hard to reach because they might be homeless, Tice said.
Tice is already helping with hepatitis treatments at five locations on Oahu. But if the state Legislature grants the network the money, the organization will start two telemedicine sites, on the North Shore and in Hilo, and possibly on Molokai, Maui and Kauai.
"It's a way to bring medical care to the needy or the homeless or those that are reluctant to expose themselves as far having this disease," Tice said.
Back to top
Health Chief Downplays Presence of Hepatitis B
http://www.dominicantoday.com/
SANTO DOMINGO. - The Public Health Minister admitted the existence of a high incidence of hepatitis B, as the Spanish doctor Jose Maria Sanchez had indicated during the 16th International Seminar on the Liver.
However, Bautista Rojas affirmed that measures have been taken to fight the disease and cited as an example that all children born in the last 7 years have been vaccinated against meningitis and hepatitis B.
He said that in the last 10 years the cases in the child population have been controlled after the vaccine against hepatitis B was introduced and is provided free of charge.
"Since 1996 when obligatory vaccination was introduced our children don’t have those problems. We are aware of the situation of people of legal age and it’s there that the Spanish doctors see the high index, but the country has taken the corresponding measures" the Health minister said.
Rojas alerted the population to take preventive measures regarding tattooing, because they run the risk of infection with hepatitis B and C. He affirmed that also the cases of injected drugs and blood transfusions are sources of contagion.
The Spanish doctor Jose Maria Sanchez warned that the incidence of hepatitis B in the Dominican Republic is almost four times higher than the acceptable level.
Back to top
March 27th, 2007
Trends of Reduced Morbidity with Hepatocellular Carcinoma Surgery
www.gastrohep.com
April's issue of the Journal of American College of Surgeons shows that blood loss, and complications with hepatic resection for hepatocellular carcinoma have reduced.
There have been recent developments in surgery and patient management during the perioperative period.
However, critical complications still developed in a few patients who had hepatic resection for hepatocellular carcinoma.
Dr Akinobu Taketomi and colleagues from Japan reviewed 625 consecutive patients who had hepatic resection for hepatocellular carcinoma.
The investigators also assessed operative morbidity, and mortality rates.
The investigative team found there were progressive decreases in the surgical blood loss, and the rate of blood transfusion.
Occurrence of ascites and other complications dramatically decreased in the study series.
From 1997 to 2002, postoperative liver failure reduced by 1% -- Journal of AmericanCollege of Surgeons
The team found that hospital death rate, and incidence of postoperative liver failure reduced from 3% to 2% between 1985 and 1990.
Between 1991 and 1996, the incidence of postoperative liver failure was reduced from 4% to 3%.
The investigators observed that from 1997 to 2002, the incidence of postoperative liver failure reduced from 2% to 1%.
The team identified independent risk factors using multiple logistic regression.
Independent risk factors associated with postoperative complications were found to be the period of operation.
Alanine aminotransferase levels of 70 IU/L was also an independent risk factor of postoperative complications.
The investigators noted that a platelet count less than 100 × 103/mm3 was an independent risk factor.
In addition, the presence of blood transfusion during operation from 1997 to 2002 was an independent risk factor of complications.
Dr Taketomi's team concluded, “In this series, there has been a decline in surgical blood loss and rate of blood transfusion and in the number of patients with major complications.”
“These results are largely attributable to the adequate selection of surgical candidate and factors aimed at reducing surgical blood loss.”
J Am Coll Surg 2007: 204(4): 580-7
Back to top
Standard Screening Tests May Not Detect Hidden Hepatitis B Virus in HIV/HBV-Coinfected Patients
www.aidsmap.com
Liz Highleyman
A significant proportion of HIV-positive individuals may have occult hepatitis B virus (HBV) infection that is not identified through standard screening tests, according to two studies published in the March 1st issue of the Journal of Acquired Immune Deficiency Syndromes.
Occult, or hidden, hepatitis B infection refers to the presence of a low level of HBV genetic material (DNA) in the blood or the liver, without detectable hepatitis B surface antigen (HBsAg).
By contrast, patients with typical chronic hepatitis B have detectable HBsAg, as well as HBV surface and core antibodies (anti-HBs and anti-HBc, respectively). The presence of surface antibodies without surface antigen usually indicates that a person was exposed to HBV in the past but cleared the infection.
Because it is not detectable using standard antigen and antibody blood tests, estimates of the prevalence of occult hepatitis B vary widely.
Study 1
In the first study, Norah Shire, MPH, and colleagues aimed to determine how often occult hepatitis B occurred amongst HIV-positive individuals seen at the University of Cincinnati Infectious Diseases Center in Ohio.
From a database of nearly 4,000 HIV-infected patients, the researchers randomly selected 909 without known HBV infection or non-viral liver disease for further analysis. Stored blood samples were pooled and a real-time polymerase chain reaction (PCR) assay was used to amplify HBV DNA. Samples with detectable HBV DNA were then tested for HBV serological markers using commercially available ELISA tests for anti-HBc, anti-HBs, and HBsAg.
The mean age of the patients was 35 years, 77% were men, and 50% were Caucasian. The mean CD4 cell count was 385 cells/mm3, 62% had detectable HIV viral load, and only 23% were taking antiretroviral regimens, about 60% of which included drugs with anti-HBV activity. About 14% had hepatitis C virus (HCV) infection.
Forty-three patients (4.7%) were found to be positive for HBV DNA. Twelve of these (1.3% of all patients) had occult hepatitis B with no detectable HBsAg. In this group, four tested positive for both HBV surface and core antibodies, two had detectable anti-HBc but not anti-HBs, and five were negative for all HBV blood markers.
Participants with detectable HBsAg had significantly higher HBV DNA titres than those with occult hepatitis B. HBsAg-positive patients also were more likely to have elevated liver enzymes (ALT and/or AST) compared with both occult hepatitis B patients and HIV-monoinfected individuals with undetectable HBV DNA.
Mean CD4 cell counts did not differ significantly among the groups, and the percentages having undetectable HIV viral load were also similar. None of the patients with detectable HBsAg had hepatitis C, compared with about 14% of both occult hepatitis B patients and HBV-negative individuals.
Importantly, none of the participants with occult hepatitis B were taking antiretroviral drugs with anti-HBV activity, such as 3TC (Epivir), emtricitabine (Emtriva), or tenofovir (Viread).
Study 2
In the second study, Vincent Lo Re, MD, and colleagues conducted a study to determine the prevalence of and risk factors for occult hepatitis B amongst HIV-positive individuals, as well as its clinical significance.
The investigators analysed data from 179 HIV-infected patients with undetectable HBsAg but detectable HBV core antibodies, randomly chosen from a database of 699 study participants at University of Pennsylvania hospitals.
In this study, the mean age was 47 years, 88% were men, and 75% were African-American. One-quarter had CD4 cell counts below 200 cells/mm3 and 40% had HIV viral loads greater than 1,000 copies/mL. Three times as many patients were on antiretroviral regimens as compared with the previous study (73%), of which about 60% contained drugs with anti-HBV activity. About half of the participants (55%) had chronic hepatitis C.
In this group, 17 patients (10%) had detectable HBV DNA using a highly sensitive transcription-mediated amplification assay, signalling occult hepatitis B. Individuals with and without occult HBV were similar with regard to demographic characteristics.
HBV surface antibodies were present in similar proportions of patients with and without occult HBV infection (41% vs 58%, respectively). In a univariate analysis, patients with occult hepatitis B had lower CD4 cell counts, but this was no longer significant after controlling for other factors.
Individuals with HIV viral loads greater than 1,000 copies/mL were almost five times more likely to have occult hepatitis B (adjusted odds ratio [OR] 4.88), whilst those with chronic hepatitis C were less likely (adjusted OR 0.26). In this study, too, use of antiretroviral agents with anti-HBV activity reduced the risk of occult hepatitis B.
In terms of clinical symptoms, patients with occult hepatitis B were slightly less likely to have elevated liver enzymes compared with HBV-uninfected individuals, but this was strongly affected by HCV status. Individuals with occult HBV infection did not have a greater likelihood of significant fibrosis, as determined by the non-invasive AST-to-platelet ratio index (APRI).
The investigators concluded that occult HBV occurred in a “sizable proportion” of HIV-infected patients, adding that it was associated with detectable HIV viral load and the absence of chronic HCV infection.
Implications for patients
Collectively, these studies do little to resolve the uncertainty about the prevalence of occult hepatitis B amongst HIV-positive individuals. Past studies have also produced disparate results, with rates ranging from 0% to 89%, depending on the patient population and the definition of occult hepatitis B.
The recent studies did concur in finding that occult hepatitis B may present with various patterns of serological markers, and is not ruled out by the presence of HBV surface antibodies.
Shire and colleagues said that their results indicate a need for better screening for HBV in “high-risk” populations.
They also recommended that HIV-positive patients who have been vaccinated against HBV should receive regular testing to ensure continued adequate antibody levels.
However, the fact that occult hepatitis B can occur in individuals with no detectable serum markers for HBV and no clinical signs of hepatitis makes it difficult to identify hidden infection using widely available tests. Universal HBV DNA testing is impractical, but it may be useful for individuals with unexplained liver enzyme elevations, even if they have no serological evidence of HBV infection.
Given the lack of liver-related symptoms amongst patients in these studies, further research is needed to clarify the clinical implications of occult hepatitis B in HIV-positive individuals, such as whether it increases the long-term risk of liver cirrhosis or hepatocellular carcinoma. Until then, both studies support the recommendation that HIV/HBV-coinfected patients should include one or more agents with anti-HBV activity in their antiretroviral regimens.
References
- Shire N et al. The prevalence and significance of occult hepatitis B virus in a prospective cohort of HIV-infected patients. J Acq Immun Defic Synd 44: 309-314, 2007.
- Lo Re V et al. Prevalence, risk factors, and outcomes for occult hepatitis B virus infection among HIV-infected patients. J Acq Immun Defic Synd 44: 315-320, 2007.
Back to top
Nearly 2,000 Haemophilia Patients Were Exposed to HIV, Hepatitis C
http://www.24dash.com
Publisher: Ian Morgan
An independent inquiry concerning the deaths of nearly 2,000 haemophilia patients who were exposed to HIV and or hepatitis C through contaminated NHS blood and blood products got under way today.
Former Solicitor General Lord Archer of Sandwell, who is heading the public inquiry, said its purpose was to investigate the circumstances surrounding the supply of contaminated NHS blood and blood products to patients, the consequences for the haemophilia community and others afflicted.
He added that the inquiry would also suggest further steps to address both the problems and needs of patients and those of the bereaved families.
The hearings concern the deaths of 1,757 haemophilia patients who were exposed to HIV and/or hepatitis C by contaminated NHS blood and blood products. Many more are said to be terminally ill.
"The purpose of the inquiry is to unravel the facts, so far as we are able, and to point to the lessons that may be learnt," he said in his opening statement.
"As in the case of any public inquiry, the consequences of its report cannot be foreseen.
"Its impact will, however, depend crucially on the public perception of its value and we shall endeavour to make it a report worthy of high regard.
"Hopefully our findings may help to restore public confidence in the future treatment of patients.
"We trust it will also help those afflicted and bereaved to come to terms with the tragedy - knowing much more of how it came about."
The tragic events, which took place between the early 1970s and the mid 1980s, have been described by fertility expert Lord Winston as "the worst treatment disaster in the history of the National Health Service".
The campaign on their behalf has been led by Labour peer Lord Morris of Manchester who was Britain's first minister for disabled people and who is president of the all-party Parliamentary Group on Haemophilia.
He said of the 4,670 haemophiliac patients exposed to hepatitis C, 1,243 were also exposed to HIV and despite improvements in treatment for both viruses, only 2,552 patients with hepatitis C and just 361 with HIV are still alive.
Lord Morris said that successive governments had resolutely resisted a public inquiry since 1988, preferring in-house inquiries at the Department of Health.
Lord Archer of Sandwell said today that the inquiry was not statutory. He said it was of "primary importance" to establish and maintain its independence.
Already a number of former ministers in the Department of Health and others able to give information have made contact, he said.
"There is no hidden agenda, he said. "Neither I nor either of my colleagues will receive any remuneration."
He added that expenses would be funded privately and it was for the donors to decide whether they wished their support to remain confidential.
The inquiry will begin hearing oral evidence on April 18.
The inquiry website address is: www.archercbbp.com
Back to top
Stem Cells Speed Growth of Healthy Liver Tissue
http://www.docguide.com
Science Daily — For the first time, researchers have used adult bone marrow stem cells to regenerate healthy human liver tissue, according to a study published in the April issue of the journal Radiology.
When large, fast-growing cancers invade the liver, some patients are unable to undergo surgery, because removing the cancerous tissue would leave too little liver to support the body.
Researchers at Heinrich-Heine-University in Düsseldorf, Germany, used adult bone marrow stem cells to help quickly regenerate healthy liver tissue, enabling patients to eventually undergo a surgical resection.
"Our study suggests that liver stem cells harvested from the patient's own bone marrow can further augment and accelerate the liver's natural capacity to regenerate itself," said Günther Fürst, M.D., co-author and professor of radiology.
In the study, researchers compared the results of portal vein embolization (PVE), a technique currently used to help regenerate liver tissue, to a combination of PVE and an injection of bone marrow stem cells into the liver.
PVE blocks blood flow to the diseased portion of the liver and diverts blood to the organ's healthy tissue, promoting liver growth. Bone marrow stem cells extracted from the patient's hip bone and injected into the liver also help the liver regenerate.
The study included 13 patients with large central liver malignancies who were unable to undergo surgery because resection would leave less than 25 percent of their total liver volume.
Six of the patients underwent both PVE and injection of bone marrow stem cells. Seven patients underwent only PVE. Computed tomography (CT) scans were performed before and up to five weeks after PVE to determine the degree of liver growth.
Patients who received the combination of PVE and stem cell injection had double the liver growth rate and gain in liver volume, compared with those who underwent PVE alone. As a result, the patients who received the combined treatment were able to undergo surgery an average of 18 days sooner than patients who received PVE only.
"Our research demonstrates that stem cells are a powerful adjunct to PVE for patients undergoing surgical resection," said Jan Schulte am Esch, M.D., co-author and surgery staff member. "Based on our results, we also believe that adult stem cell administration may be a promising therapy for regenerating livers damaged by other chronic and acute diseases."
The researchers are currently embarking on a randomized controlled trial of the therapy.
"Embolization and CD133+ Bone Marrow Stem Cells for Liver Regeneration." Collaborating with Prof. Fürst and Dr. Schulte am Esch on this paper were L. Benjamin Fritz, M.D., Ludger W. Poll, M.D., Stefan B. Hosch, M.D., Michael Klein, M.D., Erhard Godehardt, M.D., Andreas Krieg, M.D., Britta Wecker, Volker Stoldt, M.D., Marcus Stockschläder, Claus F. Eisenberger, M.D., Ulrich Mödder, M.D., and Wolfram R. Knoefel, M.D.
Note: This story has been adapted from a news release issued by Radiological Society of North America.
Back to top
March 28th, 2007
Couple Focus on Happier Days
http://www.nwherald.com
By JOCELYN ALLISON - jallison@nwherald.com
McHENRY – Barbara Kinsala is waiting to get her life back.
She’s waiting for the day when she can visit her 14 grandchildren with ease, when she and her husband, Don, can retire to Pigeon Forge, Tenn., and live out their days amid the Smoky Mountains enjoying a marriage that still is young.
Barbara Kinsala, who has hepatitis C, is waiting for the day when she won’t feel sick anymore, when a successful liver transplant will reverse the effects of a disease that for years lay dormant inside her.
“The days are kind of different for me,” said Kinsala, who speaks slowly and with visible effort. “I’d like to get better and enjoy my grandkids. I wish I could have a long time ago.”
Kinsala, 53, of McHenry is among a growing number of people across the country in the past five to 10 years who have started to experience the symptoms of hepatitis C, a viral hepatitis that is transmitted through blood and can lead to liver disease.
In McHenry County, the health department recorded 124 cases of hepatitis C in 2006, making it among the most frequently reported illnesses to the department’s communicable disease program, said Debra Quackenbush, community information coordinator with the health department.
First diagnosed 10 years ago, Kinsala’s condition has worsened over the years to the point where she rarely leaves the house, and then only to visit the doctor or go to the lab for bimonthly blood tests, Don Kinsala said.
For the Kinsalas, who once took every opportunity to travel since they were married in October 1995, every day is the same.
“Saturday, weekday, it’s pretty much the same,” said Don Kinsala, 72, who cares for his wife full time.
Doctors believe that Barbara Kinsala’s hepatitis C might have resulted from a blood transfusion she received in the late 1970s, before blood tests included a screening for the disease.
Although many people with hepatitis C never experience the symptoms, about 30 percent go on to develop cirrhosis, a chronic liver disease that can lead to liver failure, said Dr. Steven Flamm, hepatologist at Northwestern Memorial Hospital.
Barbara Kinsala has been on the national organ transplant list since February 1999, but until her condition worsens, she won’t receive the liver she needs, Flamm said. And because her blood type, Type O, is the most common, her wait time is longer, he said.
Estimates show that about 2 percent of the U.S. population, or about 4 million people, have hepatitis C, and more than half of them don’t know that they have it, Flamm said.
Many who are beginning to show symptoms now contracted it during the late 1960s to early 1980s during a period of high drug use, before HIV/AIDS awareness prompted people to use clean needles, he said.
And because the disease can remain undetected for 20 to 30 years, many just now are starting to experience the symptoms, said Flamm, who estimated that he saw close to 300 new hepatitis C patients a year.
“If even a fraction of the patients with hepatitis C who developed cirrhosis ended up on the [transplant] list, if the patients started to present, it would just cripple the system and a lot of people are fearful of that,” Flamm said.
If caught early enough, there are medications to treat, and even cure hepatitis C, he said.
But for Barbara Kinsala, whose advanced condition prevents her from benefiting from such medications, the only option now is to wait.
And while she does, she finds strength in her faith and comfort in the memories she made during the first five years of her marriage, before the disease started to take hold, she and her husband said.
“Times when she’s really feeling down or we’re sitting alone at night, we’ll go back to those years and the fun we had together,” Don Kinsala said.
“Had, back then, we’d said, ‘No, wait until next year [to take that trip],’ we wouldn’t even have that,” he said. “Live your life to the fullest, because you just don’t know.”
Did you know?
April is National Donate Life Month. In 2006, nearly 300 people died while waiting for organ transplants at Illinois transplant centers. Nationally, more than 5,000 people died while waiting for transplants.
Source: Gift of Hope Organ & Tissue Donor Network, www.giftofhope.org
Area cases
Number of new hepatitis C cases reported in McHenry County over the last five years:
- 2002: 77 cases
- 2003: 70 cases
- 2004: 106 cases
- 2005: 88 cases
- 2006: 124 cases
Source: McHenry County Department of Health
Back to top
Health Scare Raises Questions in Lloydminster
www.cbc.ca
CBC News
Lloydminster residents say they are shocked by Alberta's latest health scare, caused by improperly sterilized medical equipment at a local doctor's office.
The College of Physicians and Surgeons of Alberta investigated two obstetricians at the Lloyd Women's Clinic in the small Saskatchewan border city two years ago for allegedly not sterilizing instruments properly.
The investigation only recently came to light, after a hospital in Vegreville was all but shut down when officials found problems with its sterilization procedures, along with a superbug outbreak.
In both cases, patients are being told to get tested for HIV and hepatitis B and C.
Residents of Lloydminster told CBC News that they are shocked by the news and concerned it wasn't made public until Monday, after the college informed Alberta's health minister.
"There's all kinds of things that are being hidden, that we're not finding out about, until it's almost too late," Diana Mapletoft said.
"We pay a lot into Alberta health care and whatnot and I'd like to know where the money is going if they don't the proper equipment to sterilize and everything," added Debbie Short.
Both the hospital and the doctors' office are in the East Central Health region, which concerns Rosemary Ash.
"Should we maybe be looking at all the hospitals in this area? Should we maybe be reviewing sterilization techniques in east central region? I have a lot of questions, so I am very concerned."
No one got sick, Lloydminster doctor says
Dr. Musbah Abouhamra, who works at the clinic, confirmed to CBC News Tuesday that he and his wife, named in the Edmonton Journal as Turia Elghdewi, were the subjects of a complaint to the college. But he maintains there was no problem with his equipment and no one has become sick as a result.
However, on the advice of the college, he recently sent out letters to 261 patients advising them to get tested for HIV and hepatitis.
Dr. Trevor Theman, the registrar of the college, said the Lloydminster case is the first one he has dealt with in his eight years with the college.
Physicians are responsible for the cleanliness of their equipment and the college will only investigate if there is a complaint, Theman said.
Hancock meets with Vegreville residents
Also on Tuesday, Health Minister Dave Hancock tried to calm fears in Vegreville, about 150 kilometres west of Lloydminster.
A team from the Health Quality Council of Alberta was in Vegreville last week to look into an MRSA outbreak at St. Joseph's hospital and shortcomings in the hospital's sterilization room, which is now closed.
At Chin's Restaurant, Hancock not only got coffee Tuesday, but also an earful from concerned residents.
"My wife had surgery three years ago and I had a grandson that had surgery," said one man. "Neither one of them has been contact to see whether they got any concern about their health."
"This hospital was ordered to cut a million dollars from its budget. Why? We are already behind, we are already suffering," said another.
Some asked Hancock to hold a public inquiry into what happened at the hospital, but he responded that it was not necessary at this time.
Sterilization room was supposed to be closed
The St. Joseph's sterilization room was supposed to be closed on Feb. 13 after a routine surgical audit uncovered problems.
But when the region's medical health officer went to the hospital on March 16 to investigate a superbug outbreak — seven patients in the 25-bed hospital contracted the infection over a one-month period beginning in mid-January — the room was still in operation, so he ordered it shut down.
The emergency room is open at the hospital, but it's not taking in-patients.
Health officials are checking records of hospital patients back to April 2003. Although they say the risk to patients is low, they are contacting those who were exposed to surgical equipment that had been inadequately sterilized, advising them to get tested for HIV and hepatitis B and C.
The first to be contacted will be those who had their tonsils removed, health officials say.
Back to top
March 29th, 2007
GPs Armed with New Hepatitis C Resource
http://www.healthcarerepublic.com
The Department of Health's FaCe It campaign has launched this week a new guide for primary care professionals providing essential information on the virus.
The Department of Health's FaCe It campaign has launched this week a new guide for primary care professionals providing essential information on the virus. With epidemiological surveillance suggesting that the majority of people in England with hepatitis C may not be diagnosed, the leaflet aims to support GPs in identifying and testing patients at risk of infection.
Developed in consultation with a professional panel, the leaflet provides GPs with a handy and concise overview of hepatitis C from diagnosis to treatment, recommending how patients with hepatitis C should be managed through testing, diagnosis and referral to a specialist.
Most patients with hepatitis C will not realise that they have the virus as it can take years or even decades for symptoms to appear. Antiviral drug therapy, however, is effective at clearing the virus in the majority of people overall and preventing progression to serious liver disease, which is why early testing is being recommended for those patients at past or current risk of infection.
The launch of the new resource is timed to coincide with the latest hepatitis C press and radio advertising campaign which encourages people to find out if they could be at risk from hepatitis C. With this in mind, the availability of this resource will help provide primary care professionals with the answers they need to cope with the increasing numbers of enquiries.
Professor Howard Thomas, Clinical Professor, Imperial College London said:
"With the Department's advertising campaign and the recent announcement by Dame Anita Roddick helping to raise awareness of hepatitis C, healthcare professionals need to be better informed about the virus. GPs need accessible information at their fingertips and the Hepatitis C quick reference guide for primary care gets essential information into the hands of GPs in a quick and straightforward manner. Because treatment is curative in the majority of cases, it has never been more important to identify those infected."
Dr Martyn Wake, GP from Wimbledon commented,
"GPs have an important role to play in identifying and offering testing to patients who might be at risk of hepatitis C infection so that they can be referred to a specialist. We hope that this leaflet will be a useful tool for GPs. Alertness in our profession will make a crucial contribution to ensuring that more patients are diagnosed and treated."
The leaflet will be distributed to all GP practice managers this week and complements a suite of hepatitis C resources including posters, patient leaflets and a guide to the hepatitis C virus produced by the FaCe It campaign. All materials can be ordered for free by contacting the Department of Health's publications line (08701 555 455) or by fax (01623 724 524) or via email to dh@prolog.uk.com
The Hepatitis C Information Line on 0800 451 451 (textphone 0800 0850859) is open from 7am-11pm, 7 days a week for confidential information and advice for both the general public and healthcare professionals.
Back to top
Parliament Adopts Written Declaration on Hepatitis C
http://www.europarl.europa.eu
Following the announcement in the minutes of 14 March (see below), the House formally adopted written declaration on Hepatitis C with some 470 MEPs signing the declaration. The declaration calls on the Commission and Council to recognise Hepatitis C as an urgent public health issue and identify priority actions in programmes of future Council presidencies.
It also calls for the adoption of a Council recommendation on Hepatitis C screening, ensuring early diagnosis and wider access to treatment and care.
The written declaration calls on the Commission and Council to respond to the recommendations of its June 2006 report on protecting European healthcare workers from blood-borne infections due to needlestick injuries and facilitate further research on treatment for Hepatitis C patients co-infected with HIV and/or Hepatitis B under the 7th Research Framework Programme.
12 millions persons in Europe are infected with the Hepatitis C virus (HCV). HCV is an urgent issue, being a disease which attacks the liver and leads to chronic hepatitis C causing cirrhosis, liver failure or liver cancer, thus increasing the need for transplantation. HCV is often seen as a 'silent killer' and 'sniper' disease, HCV is often not detected so that many patients remain undiagnosed while the diagnosed patients frequently suffer from stigmatisation.
John BOWIS (EPP-ED, UK) said: “According to the British Hepatitis C Trust, only 1 in 10 people with Hepatitis C have been diagnosed. Extended and reinforced screening efforts are therefore essential to guarantee early diagnosis and treatment, and to prevent a further spreading of the virus.”
Stephen HUGHES (PES, UK) said: “In particular for health workers, the risk of infection for Hepatitis C through needlestick injuries is enormous. I am therefore pleased that the European Parliament once more underlined the need for urgent EU action to prevent such fatal injuries.”
Frederique RIES (ALDE, BE) said: “Hepatitis C is also the first cause of liver transplant in the EU, as there is still no vaccine, screening and organ donations remain the most efficient medical practices to stop the disease. It is therefore crucial to reinforce European cooperation via the 7th Research Framework Programme and the European Registry on Organs, Cells and Tissues (EUROCET).”
Back to top
XTL Biopharma Says Phase I Study of Hepatitis C Drug XTL-6865 Safe at High Doses - Update
http://www.tradingmarkets.com
(RTTNews) - Early Thursday, XTL Biopharmaceuticals Ltd. (XTLB, XTL.L) revealed the completion of the Phase I study with XTL-6865. The trail result demonstrated that XTL-6865 could be safely administered to patients at high doses of up to 1200mg for 5 consecutive daily doses and a single dose of 2400mg. The study also enabled the company to establish the pharmacokinetic properties of XTL-6865 in patients with chronic hepatitis C. XTL Biopharma is a company engaged in the commercialization of therapeutics for the treatment of neuropathic pain and hepatitis C.
According to XTL Biopharma, the primary goal of the Phase I study was to check the safety and pharmacokinetic properties of XTL-6865 in patients with chronic hepatitis C. XTL-6865, which targets the E2 envelope protein of the hepatitis C virus, is comprised of two fully-human monoclonal antibodies and is administered intravenously. The study enrolled 32 patients into 8 cohorts, each comprised of 3 treated patients and 1 placebo patient. Of the 8 cohorts in the study, the first 7 were single administration cohorts with doses ranging from 5mg to 2400mg. The 8th cohort received 1200mg for 5 consecutive days.
The trail had shown the evidence of binding of antibody to the circulating virus and the formation of immune complexes or antibody-virus, which is meant to be vital factor for virus neutralization in the serum. But no statistically significant changes in HCV-RNA were observed. Given the short duration of administration of XTL-6865, and the fact that the patients in this study had a high rate of viral replication at baseline, no major change in viral load was to be expected, the company said.
As per XTL Biopharma, the positive results from the Phase I trial potentially pave the way for trials that would evaluate XTL-6865 in patients with hepatitis C undergoing liver transplantation, a potential target patient population for the drug. The study results also directed the way for conducting trials in chronic hepatitis C patients with low viral load. XTL said it plans to seek a collaborative partnership for the future development of this compound.
Ron Bentsur, CEO of XTL Biopharmaceuticals, commented, "We believe that XTL-6865 could potentially play a role in certain clinical settings, such as preventing re-infection of hepatitis C following liver transplantation or in chronic hepatitis C patients who have low viral loads following treatment with other anti-hepatitis C drugs. We believe this is now an appropriate time to seek to out-license the compound. We intend to focus our resources on commencing our clinical program for Bicifadine, for the treatment of diabetic neuropathic pain, and on completing our Phase I study for XTL-2125, our small-molecule compound for the treatment of chronic hepatitis C."
XTLB closed Wednesday's regular trading session at $3.83, down $0.19, on a volume of 21K shares.
Back to top
Meta-Analysis Confirms Hepatitis C Vertical Transmission More Likely with Coinfected Mothers
www.aidsmap.com
Derek Thaczuk
A new meta-analysis has confirmed that the mother-to-child transmission risk for hepatitis C virus (HCV) nearly doubles for mothers who are HCV/HIV coinfected. In coinfected mothers with detectable HCV viremia, the risk is nearly tripled. The results, published in the April 15th issue of Clinical Infectious Diseases, confirm those of a 2003 meta-analysis by another researcher.
Rates of vertical (mother-to-child) transmission of HCV range from 4 to 10%; mothers coinfected with HIV are more likely to transmit HCV to their child. An earlier meta-analysis (Pappalardo, 2003) determined the odds ratios for HIV-coinfected compared to HIV-negative mothers as 2.82 (95% CI, 1.78 to 4.45, p=.00001) for HCV antibody-positive women, and 1.97 (95% CI, 1.04 to 3.74, p=.04) for women with HCV viremia (detectable HCV in the blood).
Researchers from Johns Hopkins University School of Medicine have now performed a similar meta-analysis including two large studies not published at the time of the Pappalardo review. One of these – the European Pediatric Hepatitis C Virus Network (EPHN) study – is the largest such cohort to date, including 1479 babies.
The team’s conclusions were drawn from a restricted analysis that they believed provided the most reliable estimate (details below). According to this analysis, vertical transmission was 1.9 times more likely for HIV/HCV coinfected mothers than for HCV-infected mothers without HIV (95% confidence interval, 1.36–2.67). For coinfected mothers with detectable HCV viremia, the risk was 2.82-fold greater (95% CI, 1.17 to 6.81) than for HIV-negative mothers without HCV viremia.
Much of the Johns Hopkins report details the methodology of how studies were selected for the meta-analysis. The original literature review found 243 “potentially relevant” published articles (conference abstracts were not considered). From these, the team selected only results published in English which (among other criteria) presented original data, compared coinfected with HCV-monoinfected women, and included at least 20 coinfected women. This left only ten (mostly European) studies, published between 1993 and 2005 (Lam, 1993; Zanetti, 1995; Paccagnini, 1995; Zuccotti, 1995; Tovo, 1997; Zanetti, 1998; Granovsky, 1998; Resti, 2002; Rerrero, 2003; EPHN, 2005). All but one of these were prospective cohorts, yielding a total of 4424 mother/child pairs, 19.4% of which included coinfected mothers.
However, the investigators felt that the “most reliable estimate” came from an even more restricted pool – the five studies with sample sizes of at least 50. The odds ratio for coinfected mothers, calculated from the ten originally selected studies, was 2.75 (95% CI, 1.51 to 4.99). However, analysis indicated that the estimates in this group were “heterogeneous and ideally should not be pooled”. The lack of comparability was ascribed to “a lack of standardised HCV diagnostic criteria and the inability to control for known confounders” – such as selection bias, loss to follow-up, and means of delivery (Caesarean vs. live birth). The researchers therefore analysed various subgroups of the ten studies, leading to the 1.9-fold odds ratio drawn from the five studies (Paccagnini, Tovo, Granovsky, Resti, and EPHN) which “showed low heterogeneity, and were of better overall quality.”
Despite the similarity to the 2003 findings, the report concludes that more research is still required, particularly calling for “large studies that control for potential known confounders, use clear selection criteria … and employ standardized HCV testing[.]”
References
Polis CB et al. Impact of maternal HIV coinfection on the vertical transmission of hepatitis C virus: a meta-analysis. Clin Inf Dis 44:1123-1131, 2007.
Pappalardo BL. Influence of maternal human immunodeficiency virus (HIV) co-infection on vertical transmission of hepatitis C virus (HCV): a meta-analysis. Int J Epidemiol 32:727-734, 2003.
Back to top
Gene Switches On Repair in Liver
http://www.sciam.com
Hunting for a way to let the liver heal itself without causing more harm than good
Researchers may have identified a master switch that activates the liver's ability to heal itself, suggesting a route to better treatments for liver diseases such as hepatitis and cirrhosis. Mice that lacked the gene showed a marked deterioration in their livers and lived shorter lives than normal mice.
Damage to the liver activates a group of specialized wound-healers called hepatic stellate cells (HSCs), which churn out scaffoldlike collagen fibers that support the growth of new liver cells. "You want the cells to get activated but you don't want them to stay activated for too long," says neurobiologist Katerina Akassoglou of the University of California, San Diego, because the fibers begin substituting for healthy liver tissue, leading to liver failure in people with chronic cirrhosis, for example. But researchers do not know which genes control the process.
Akassoglou and her colleagues thought they had a good candidate in the gene for the p75 neurotrophin receptor (p75NTR), a regulator of cell death in the brain that also switches on soon after liver injuries. Using mice that had a propensity for liver disease, her team created a strain of rodents that lacked the p75NTR gene. The livers of the engineered mice were covered in lesions after 10 weeks, and only half of the animals lived longer than that, compared with more than six months for the unmodified rodents.
The p75NTR protein sits on the surface of HSCs. The group believes that when activated by a still-unknown agent after liver damage, it stimulates a cascade of signals inside the cells that trigger them to begin the healing process, according to results presented in this week's Science. The next step, Akassoglou says, is to determine the role p75NTR plays in later stages of liver disease, to see if shutting it down will stop the harmful production of collagen.
"If you know what the switch is," she says, "and if you know how these cells become quiescent again … then you can start interfering with this process."
Back to top
March 30th, 2007
Hepatitis C Outbreak Hits Sydney
http://www.smh.com.au
Source of hepatitis C identified
AdvertisementInjections at a Sydney medical practice have been linked to an outbreak of the potentially deadly disease hepatitis C.
Three women have been infected and public health professionals have contacted another 127 patients who received vitamin or mineral injections at a general medical practice in Sydney's eastern suburbs between late 2004 and late 2006.
Health officers from the South Eastern Sydney Illawarra Health Service (SESIH) have narrowed their search to four days in the two-year period when patients were injected.
But they have urged anyone who has received such treatment at eastern suburbs medical practices to ring the NSW Health Information Line on 1800 451 600.
Symptoms may not occur for decades, leading to ongoing liver damage, including cirrhosis and liver failure.
Treatment typically includes weekly injections and daily medication to combat the hepatitis.
A woman in her 50s was diagnosed in January and another in her 40s in February, while a third woman in her 50s who contracted the disease in 2004 has also been linked to the general practice.
Tainted serums have been ruled out as a cause of the infection but health officials have yet to confirm if the outbreak resulted from contaminated equipment.
"We haven't identified specific events which might have resulted in the spread of the infection, but it seems that there are, I guess," SESIH Director of Public Health Mark Ferson told reporters.
"Infection trial practices may have led to microscopic amounts of blood contaminating equipment and then infecting other patients."
The health service has not revealed in which suburb the GP practice is located, or the dates on which the suspect injections were given.
The practice initially contacted health officials, prompting the investigation.
Because the 2004 case was an isolated one it did not warrant such an investigation, but it was later linked to the two cases diagnosed early this year, Professor Ferson said.
"Hepatitis C is not a common disease, but a certain percentage of the population are infected and when we hear about an individual case then certain things would be done to routinely follow that person up," he said.
"Now that we've been informed of three cases, obviously we're concerned something needs to be done.
"The 127 patients have been selected because we think that if there are other people at risk then we would start with that group.
"And we hope that out of the 127 there are none, but there may be some."
The medical practice is still operating, but it is not offering the injecting services under investigation.
There is no vaccine against hepatitis C.
Successful treatment depends on which of the many strains of the disease a person is infected with and how early they receive treatment.
Back to top
Back to News Review
|
