Medical -- Hepatitis C Information
||Hepatitis C, a blood-borne virus, is now
appearing in an alarming number of Vietnam vets after lying
dormant for years. By Allison Wright
Reprinted from the VFW Magazine, June 1999
Foote went to Vietnam when he was 19. As a Marine grunt, he
spent perhaps the longest year of his life there. He served with
the 3rd Plt., I Co., 3rd Bn., 4th Marines, 3rd Marine Div.,
below the DMZ between October 1968 and April 1969. Like
thousands of other Americans, he found himself in combat with
the North Vietnamese and in contact with blood—blood of fellow
Marines and of the enemy.
Seven months into his tour, Foote was badly wounded, lost a leg,
and received numerous blood transfusions. Those transfusions may
be responsible for the disease that keeps him fighting, even now
that the war is long over.
Like nearly 4 million Americans and hundreds of thousands of war
veterans, Foote was infected with the potentially deadly
hepatitis C virus. The virus had not been identified in 1968
when he received the transfusions, but some experts now suspect
that much of the blood and blood products shipped to Vietnam
during the war were contaminated with the stealth virus. In
fact, some of the U.S. blood supply was contaminated with
hepatitis C until 1992, when the first reliable screening test
Blood transfusions are one of the most common routes of
hepatitis C transmission. However, because the virus is passed
through blood to blood contact, there are a hundred ways Foote
could have gotten this disease that has badly damaged his liver.
A good day for infantrymen involved scrapes, cuts and plenty of
opportunities for blood to blood contact, he said.
“It’s possible the virus could have been passed during
routine vaccinations,” said Foote. “Who’s to say the
needles were changed? Who’s to say they didn’t reuse
needles. Or maybe it was [spread by] sharing tooth brushes [and
razors]. We did that.” For anyone with hepatitis C, there is a
lot of uncertainty about how, when and where it was contracted.
But one thing is sure: Thousands of veterans who fought in
Vietnam now have the virus and are experiencing chronic liver
disease, fibrosis, cirrhosis, hepatic failure and liver cancer.
infected for life
Because hepatitis C often produces no symptoms for the first
10-30 years, many veterans are just now learning that they are
ill. Of the people exposed to the virus, about 85% are infected
for life. The American Liver Foundation estimates that by the
year 2010, the annual death rate from hepatitis C will be
VA acknowledges that the prevalence among veterans is higher
than in the general population. Studies conducted by the
Washington and San Francisco VA medical centers found rates of
hepatitis C among inpatients to be 20% and 23%, respectively.
Infection rates among otherwise “healthy” veterans is
approximately 10%, as compared to 1.8% in the general
Researchers predict that the rate of hepatitis C will rise
sharply over the next 10 years as more veterans are diagnosed
with the disease. VA researchers Gary Roselle and Charles
Mendenhall call hepatitis C an “emerging pathogen of
In 1997, they published the shocking results of the first
large-scale study of hepatitis C among veterans. They found that
the number of hepatitis C-infected veterans seeking treatment at
VA facilities rocketed from 6,612 in 1991, to 18,854 in 1994.
“This represents an increase of more than 285% during the
four-year period,” they reported.
Liver transplant shortage due to hepatitis C is a serious
problem, say experts.
Hepatitis C is now the leading cause of liver transplants in
this country and liver-for-transplant is the organ experiencing
the greatest shortage. Liver specialist Dr. Kenneth Washburn of
the University of Texas Health Science Center in San Antonio
said there is a major shortage of livers due to hepatitis C.
“It’s a huge problem. There are not enough to go around,”
Transplant Recipients International Organization said there are
now more than 11,000 people waiting for liver transplants. These
patients have about a 50% chance of getting an organ, said
United Network for Organ Sharing President Dr. William Pfaff.
A recent study by University of Florida Researcher Gary Davis
indicates that by 2008 current cases of chronic hepatitis C will
result in a 528% increase in the need for liver transplants and
a 223% increase in liver-related deaths. Davis concluded that
while our health care system has developed effective treatments
for chronic HCV, only a small percentage of people with the
disease are being treated.
The Food and Drug Administration approved a new therapy for the
treatment of hepatitis C last year. The therapy combines two
anti-viral drugs—ribavirin and interferon. Studies indicate
that the therapy is effective in 40% to 50% of treated patients.
Foote was treated with interferon alone and is now clear of the
VA recently launched a $250 million program to screen and treat
veterans. The program was prompted in part by studies showing
that hepatitis C may be more common among Vietnam veterans.
Veterans can get tested for the disease at any of the 172 VA
hospitals, but treatment is not mandatory.
Guidelines released by VA indicate that treatment will be
provided to suitable candidates, but not all suitable candidates
are getting treatment, according to Audrey W. Spolarich of
Health Policy Analysis, Washington, D.C., a private group
founded in 1997.
“We don’t know why various VA medical centers are not
treating veterans who are positive for hepatitis C and are good
candidates for treatment,” Spolarich said. “But we know
it’s going on because we are getting reports from veterans
saying they are not being treated.”
VA, however, has established two hepatitis C centers at its
Miami and San Francisco hospitals.
One problem is that the VA is not responsible to treat veterans
if they cannot prove their hepatitis C infection was contracted
during service, according to John McNeill, assistant director of
benefits policy at VFW’s National Veterans Service. Veterans
must be service-connected to get treatment, and getting
service-connection can be difficult, he said.
“A veteran would have to get an exam and ask his doctor to
write a medical opinion stating that the virus was contracted
during service,” McNeill said. “Some doctors won’t give
[such an] opinion because they can’t prove it.” In such a
case, the veteran would be responsible for coming up with
“mountains of evidence” to prove the connection, he added.
A solution to the service-connection problem may be found in
legislation recently introduced by Sen. Olympia Snowe (R-Maine)
and Representative Vic Synder (D-Ark.). Under the legislation,
veterans would be eligible for treatment at VA facilities if
they received a blood transfusion during a period of service
before Dec. 31, 1992; were exposed to blood during a period of
service; underwent hemo-dyalisis; were diagnosed with
unexplained liver disease; worked in a health care occupation,
or have an unexplained liver dysfunction value or test.
VFW is urging veterans to get tested for hepatitis C now. “All
veterans, especially Vietnam veterans, should get tested,”
McNeill said. “If they test positive for hepatitis C they need
to contact a VFW service officer and get a claim going.”
Foote also urged fellow veterans to get tested and continue
fighting for treatment. “Hepatitis C is just one more battle
to be fought,” he said. “And treatment is worth fighting
Allison Wright has been researching this issue for 18
months and produces a newsletter called HCV Update. Reprinted
from the VFW Magazine, June 1999