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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 

 

imageNed 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.

‘stealth virus’
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 became available.

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 38,000.

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 population.

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 surprising proportions.”

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 shortages
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,” he said.

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 virus.

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 for.”


Allison Wright has been researching this issue for 18 months and produces a newsletter called HCV Update.  Reprinted from the VFW Magazine, June 1999

 

 

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