CDC proposes testing baby boomers for hepatitis C

HealthDiseases and IllnessesU.S. Centers for Disease Control and PreventionMedicineFamilyHepatitisJohn Ward

A new proposal to screen all baby boomers for hepatitis C means doctors face the prospect of educating an entire generation about an infection often associated with risky behaviors, such as sharing needles and unprotected sexual contact.

A blood-borne virus, hepatitis C also can be spread by mothers to their babies, by unintentional needle sticks in health care settings or by sharing personal grooming tools like razors and toothbrushes.

Baby boomers are considered at risk because they were young adults during the 1960s, 1970s and 1980s when hepatitis C transmission rates were high, partly because of blood transfusions, organ transplants and recreational use of injection drugs before the virus was identified in 1989.

The Centers for Disease Control and Prevention proposed the recommendation, estimating that as many as 800,000 new cases of hepatitis C could be identified by testing baby boomers, many of whom are unaware of their infection. Although there are vaccines for hepatitis A and B, there is no vaccine for hepatitis C, but it can be treated.

"The population of persons born between 1945 and 1965 has a prevalence of hepatitis C infection that is five times higher than any other age group in the United States," said John Ward, director for the CDC's Division of Viral Hepatitis. "This population of exposed people (is) moving through time and, because of their length of infection, are progressively becoming ill without their knowledge."

Because the virus presents few, if any, symptoms during the early stages of infection, it may go unnoticed for years or decades, all the while causing severe damage to the liver. Hepatitis C is the leading reason for liver transplants in the U.S.

Jeff Hagan, 41, was diagnosed with hepatitis C in 2002 following a routine physical. Although not a baby boomer, Hagan was infected during the decades of heightened risk — in 1971, when he underwent heart surgery at just 1 year old.

He never noticed any symptoms, only very minor fatigue.

"At 32, I felt like I was getting old," he said. "The blood test came back showing some liver problems that caused my doctor to ask for a second test to check for hepatitis."

Hagan would like the CDC recommendation to go further, screening anyone born before 1990.

"There was no understanding of hepatitis C, let alone a test for hepatitis C, until the very end of the 20th century," said Hagan, who lives in Bartlett. "Anyone born before 1990, I consider at risk and should have been checked by now."

Current CDC guidelines recommend hepatitis C screening for current and former injection drug users, recipients of blood transfusions or organ transplants before 1992, health care workers after potential exposure and children born to mothers infected with hepatitis C.

The proposed testing recommendations do not extend beyond a birth year of 1965 because the prevalence of hepatitis C among people born from 1966 to1992 is dramatically lower, according to the CDC.

Medical professionals have mixed feelings about screening all baby boomers for hepatitis C.

Dr. Nancy Reau, a liver specialist at the University of Chicago Medicine, has written in favor of the proposal. She hopes that the recommendation, combined with an educational campaign, will remove the stigma for patients to speak with their family doctors about risk factors for hepatitis C.

"There are going to be a lot of scared people, who feel healthy and haven't thought about these risk factors, that will be identified to have hepatitis C," said Reau. "We will be a lot busier."

The greatest impact, she said, will be on the primary care doctors who recommend the screening, which involves a routine blood test.

Gastroenterologist Dawn Sears at Scott & White Healthcare in Temple, Texas, is also in favor of the proposal, but she suggests screening be the responsibility of specialists, not family doctors. Sears would like to see hepatitis C screening offered to baby boomers alongside routine colonoscopies, a combination that she has found to be both efficient and accepted by patients.

"Primary care doctors are so overburdened with so many mandates to educate people about healthy diet and routine vaccinations, talking to them about cholesterol and seat belts and cellphones. This would add one more thing to their list," she said. "This seems to be not a real wise utilization of resources."

A family doctor at Loyola Medicine, Aaron Michelfelder sees patients of all ages, including baby boomers whom he already educates about HIV testing.

"Pretty much everybody is concerned that they could have picked up HIV somewhere along the way," he said. "I've had very few people turn down an HIV test, and I have a feeling that it will probably be similar for hepatitis C."

Michelfelder relies on an electronic medical record system to keep patients up to date on screening recommendations. His patients can look at their personalized medical information online and often come to him with their own screening requests.

Even if the CDC approves the screening proposal, Michelfelder said he will wait for hepatitis C recommendations from the U.S. Preventive Services Task Force, a federally sponsored panel of experts in prevention and primary care. Currently the task force does not support routine screening of the general population for the virus.

The CDC expects to publish its final recommendation later this year.

jmorrison@tribune.com

Copyright © 2014, Los Angeles Times
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