Dec 04 2008
Heptatitis B and C Viruses
Disease: Hepatitis
Hepatitis B Virus (HBV; serum hepatitis) is an ENVELOPED, dsDNA virus (class I). It is a serious disease that aggressively attacks the liver, causing injury and scarring (CIRRHOSIS). HBV can cause a life-long, chronic infection (>1 million Americans affected) that can lead to liver cancer, liver failure, and death. There are 70,000-160,000 symptomatic infections and about 5,000-6,000 deaths from chronic liver disease and primary liver cancer every year.
Hepatitis C Virus (HCV) is an ENVELOPED, ssRNA (+ strand) virus (class IV). Due to a high mutation rate, HCV escapes immune surveillance by the host, leading to chronic infections (4 million Americans affected). There are 10,000-70,000 symptomatic infections and 8,000-10,000 deaths each year. In the next 10 years, it is estimated that 20% of patients with chronic infections will develop cirrhosis and 1-5% of cirrhotic individuals will develop liver cancer.
Egypt has one of the highest hepatitis C prevalence rates in the world. About one in every 10 presons is infected with the hepatitis C virus. It is widely believed that mass vaccinations of Egypt’s rural population against a parasitic disease called schistosomiasis in the 1960s and 1970s is responsible for the current rates. Egyption health officials did not use clean needles or follow rigorous hygiene standards. But that was in a developing nation with poor sanitary conditions. Such infections in a developed nations, such as the United States, is almost unthinkable, yet it happened–big time– about a year ago.
Nearly 40,000 people learned that a trip to a surgical center or any of five affiliated clinics in Las Vegas may have made them sick. Apparently the center and clinics had been reusing syringes and vials of medication for the past four years! This announcement was the biggest public health notification ever in U.S. history. The surgical center and clinics were immediately closed.
Such careless and irresponsible practices may have led to an outbreak of the potentially fatal hepatitis C virus and exposed patients to HIV, the virus responsible for AIDS.
As a result, thousands of patients were urged to be tested for the viruses. In fact, six acute cases of hepatitis C had already been confirmed at the time of the announcement. Michael Bell, an associate director at the Centers for Disease Control and Prevention (CDC) in Atlanta found it “baffling that in this day and age anyone would think it was safe to reuse a syringe.”
Michael Washington, 67, a retired airplane mechanic, was the first to report his infection. It all started in July when his doctor schedule a routine colon exam at the Endoscopy Center of Southern Nevada.
In September, Washington started to get sick. He was losing weight, his urine turned dark, and his stomach hurt. By January, it was clear what had happened–he had hepatitis C.
In letters that began arriving that week, patients who received injected anesthesia at the endoscopy center between March 2004 to mid-January, 2008 were urged to get tested for hepatitis B and C, and HIV.
Since all three viruses are transmitted by blood, they could have been passed from one patient to the next by the unsafe practices at the clinic. Health officials said they are most worried about the spread of hepatitis C, which targets the liver but shows no symptoms in as many as 80% of infections.
Hepatitis C results in the swelling of the liver and can cause stomach pain, fatigue and jaundice. It may eventually result in liver failure. Even when no symptoms occur, the virus can slowly cause damage to the liver.
Officials estimated that 4% of the patients already had the virus when they entered the clinic, compared with 0.5% for heaptitis B and less than 0.5% for HIV. Hepatitis C is easier to transmit than HIV.
However, it’s sophisticated tests were needed to make a complete evaluation of risk factors, and a clear pattern of infection to determine whether the virus was caught at the facility.
Health inspectors say they observed clinic staff using the syringe twice to textract anesthesia from a single vial, which was then inappropriately used to treat more than one patient. Such a practice allows contaminated blood in a used syringe to contaminate the vial and infect the next patients.
Of the six patients diagnosed with acute hepatitis C at the time of the announcement, five had been treated at the clinic on the same day in late September.
Health officials say that the improper procedures appeared to be more common in outpatient surgical centers like the endoscopy center. Unlike hospitals, such centers often do not have employees whose sole responsibility is to monitor and educate staff on best practices.
In Las Vegas, clinic staff told inspectors they had been ordered by management to reuse the vials and syringes. Investigators were told the practice was an attempt to cut costs.
Washington’s wife, Josephine, a registered nurse, wonders how any health care professional could be so reckless: “To maximize profit? For what? What are you going to save?”
