The U.S. Centers for Disease Control and Prevention is urging everyone born between 1945 and 1965 to be tested for hepatitis C.
The bold move, announced Friday, will help draw attention to this silent epidemic. The liver-destroying disease is caused by infection with a blood-borne virus, HCV. Infection occurs principally in people who have used injection drugs (most of whom share needles, which get contaminated with trace amounts of blood), and in people who received transfusions of blood and blood products.
An estimated 3.2 million Americans are infected with hepatitis C, and most of them don't know it. They tend to learn of their infection when they fall ill. Hepatitis C kills more than 15,000 people annually in the U.S., more than HIV-AIDS.
More than 75 per cent of the infections and deaths occur among baby boomers.
The Canadian numbers are proportionally similar: An estimated 250,000 infected and more than 1,000 deaths annually, according to the Public Health Agency of Canada. Canadians with hepatitis C are also living in blissful ignorance.
To date, however, Canada has no plans to follow the lead of the U.S. and urge all baby boomers to be tested. Spokesman Robert Cyrenne said PHAC is currently reviewing its options, and a report to be completed by March 2013 "will help shape our future hep C screening guidelines."
Canada should not drag its feet. Our baby boomers are no less at risk.
The sad story of Canadian comedian Mike MacDonald is a case in point. The 56-year-old learned only a year ago that he was infected with hepatitis C. At first he suffered strange symptoms like lethargy, itchiness and confusion. Then came the acute pain and jaundice, signs his liver was shutting down, leading to weeks of hospitalization and dramatic weight loss.
Mr. MacDonald, who is candid about his past drug use, now needs a new liver, and he has taken to Facebook looking for a donor. (It is possible to donate a part of your liver to another person if you are a match. The wait for a cadaver liver is 2.5 years on average.) He has also received almost $35,000 in donations to help him with related expenses.
While his case is well publicized, countless others are going through similarly painful and costly battles far away from the spotlight.
Hepatitis C is the No. 1 reason for liver transplants and is fuelling the soaring demand.
It is also the leading cause of cirrhosis of the liver and liver cancer. Two small asides warrant mention: 1) Cirrhosis is not strictly a disease of alcoholics, though many with the condition suffer that stigma; 2) Various forms of cancer are actually caused by infections. It's another reason vaccination is important.
There are two reasons the baby boomer demographic is being hard hit by HCV: 1) They are paying for the excesses of their youth; 2) They are the forgotten victims of the tainted blood tragedy. Urging high-risk groups such as IV drug users and transfusion recipients to be tested has not worked. Injection drug use is a lot more common than we like to admit, and individuals are reluctant to admit to these youthful indiscretions, especially once they have families and established careers. Second, a lot of people have received blood transfusions, and many of them don't necessarily know it, or remember.
Let's not forget that the hepatitis C virus was not discovered until 1989. (Prior to that time, it was known as non-A-non-B hepatitis.) Effective screening of blood and blood products did not begin until 1991, so anyone who received a transfusion prior to that date is at risk of having contracted HCV. Most infected people live symptom-free for 20 years or more, so those cases are just coming to light now.
There is no vaccine to protect against hepatitis C. There are, however, vaccines that protect against hepatitis B, a sexually transmitted disease, and hepatitis A, which is largely food-borne.
The most effective means to begin tackling this stealth epidemic is a universal screening program. This does not imply some huge, elaborate new bureaucracy but, rather, adding one more lab test when patients go for routine primary care visits. (Which almost all boomers do already.)
Currently people tend to learn of their infection when they donate blood and the screening test comes back positive, or when they fall ill.
For a long time, it was argued that knowing one was infected with hepatitis C was not particularly useful information. The virus destroys the liver slowly, over a period of decades, so people tended to die with the infection, not because of it.
Treatments such as interferon are for the most part horribly debilitating and not always effective. But there are new antiviral treatments that can slow the virus's progression.
So too can lifestyle changes: For example, people infected with HCV should reduce their intake of alcohol and other drugs that can damage the liver.
Targeting baby boomers for testing is an approach known as secondary prevention – limiting the damage from the infection – and it should be embraced.
Critically, we should not lose sight of the need for primary prevention, trying to halt or slow new infections, of which there are still 8,000 each year in Canada, almost all in injection drug users.
Hepatitis C, while little discussed, is an unrecognized public-health crisis, one that is having an ongoing impact on the streets.
This is a devastating virus with a long memory and an even longer reach; its tentacles reach across every strata of society, into Bay Street, bingo parlours and nursing homes.
André Picard