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New Study Debunks Negative Hep C Stigma

June 2, 2016

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In baby boomers, Hepatitis C infection appears to be a casualty of modern medicine’s evolution – not a consequence of risky behavior.

Hepatitis C is a disease that frequently carries a stigma, which is defined as shame or disgrace attached to something regarded as socially unacceptable. The main reason for Hepatitis C’s stigmatization is the assumption that this infection was acquired due to participation in risky behaviors. However, a recent analysis of the largest generation impacted by Hepatitis C, baby boomers, disproves this assumption.

Baby Boomers

An estimated 6 million people in North America, over half of which reside in the U.S., are infected with chronic Hepatitis C. Experts estimate that 75 percent of people with Hepatitis C are baby boomers, those born between 1945 and 1965. Because Hepatitis C is frequently asymptomatic for decades, many baby boomers remain undiagnosed.

According to the CDC, baby boomers are five times more likely to have Hepatitis C than those in different generations. In May 2012, the U.S. Centers for Disease Control (CDC) announced a recommendation that all baby boomers get tested for Hepatitis C. By testing those born between the mid-1940s and mid-1960s, the CDC proposed that an additional 800,000 people with Hepatitis C would be identified and diagnosed – potentially saving the lives of hundreds of thousands of people.

Previous studies have identified infected blood products and experimentation with injection drugs as the main factors driving the spread of Hepatitis C in baby boomers. Although there can be several ways to acquire this blood-borne virus, the potential of injection drug use as the cause of infection has shrouded Hepatitis C with a negative stigma.

The Canadian Debunking Study

A Vancouver-based retrospective phylogenetic study examined the timing of the initial spread of Hepatitis C virus genotype 1a in North America by analyzing over 45,000 sequences. Genotype 1a is the most dominant Hepatitis C strain in the United States. As published in a March 2016 edition of The Lancet: Infectious Diseases, the researchers found:

  • The majority of the spread of genotype 1a in North America occurred before 1965.
  • Hepatitis C saw its greatest infection rates between 1940 and 1965.
  • The effective population size of the North American Hepatitis C epidemic stabilized around 1960.

More specifically, the Canadian phylogenetic analysis strongly suggests that the period of 1948 to 1963 saw the biggest expansion of the Hepatitis C virus – substantially earlier than previously thought. According to the authors of this study,

“Based on our results, the oldest members of the demographic cohort with the highest burden of Hepatitis C virus (the baby boomers) were roughly five years of age around the peak of the spreads of genotype 1a in North America in 1950. Thus, it is unlikely that past sporadic risky behavior (experimentation with injecting drug use, unsafe tattooing, high risk sex, travel to endemic areas) was the dominant route of transmission in this group.”

The patterns identified point to unsafe medical procedures as the root cause of Hepatitis C’s spread among baby boomers. The early expansion of Hepatitis C coincided with the increase in the number of medical procedures conducted during World War II and its immediate aftermath:

  • After World War II, injection and blood transfusion technologies were still in their infancy.
  • Prior to 1950, injections were given in glass and metal syringes, which were sterilized manually and re-used.
  • Improper or incomplete sterilization could easily transmit small blood-borne pathogens, like Hepatitis C.
  • Eventually, disposable syringes were phased in between 1950 and 1960.

This study demonstrates that the spread of Hepatitis C between 1948 and 1963 is a casualty of the development of modern medicine.

The researchers hope their findings will help de-stigmatize Hepatitis C infection in the baby boomer generation and encourage more people to access testing and potentially life-saving treatment. By spreading this information, the origins of Hepatitis C become clearer – and any negative stigma associated with this virus will transform into compassion for those afflicted.

http://hcvadvocate.org/hepatitis/factsheets_pdf/stigma_guide.pdf, A Guide to: Stigma & Hepatitis C, Lucinda K. Porter, RN, Retrieved April 24, 2016, Hepatitis C Support Project, 2016.

http://www.aidsmap.com/page/3047870/?utm_source=NAM-Email-Promotion&utm_medium=aidsmap-news&utm_campaign=aidsmap-news, HCV epidemic in North America peaked between 1940 and 1965 with medical procedures likely source of most infections, Michael Carter, Retrieved April 24, 2016, NAM Publications, 2016.

http://www.cdc.gov/knowmorehepatitis/Media/PDFs/FactSheet-boomers.pdf, Why Baby Boomers Should Get Tested, Retrieved April 24, 2016, US Centers for Disease Control, 2016.

http://www.healthmap.org/site/diseasedaily/article/cdc-recommends-hepatitis-c-testing-all-baby-boomers-52412, CDC Recommends Hepatitis C Testing for All Baby Boomers, Lauren Edmundson, Retrieved April 24, 2016, Health Map, 2016.

https://www.hepmag.com/article/looks-like-boomers-get-hepatitis-c-youthful-drug-use, Looks Like Boomers Didn’t Get Hepatitis C From Youthful Drug Use After All, Retrieved April 24, 2016, Smart + Strong, 2016.

http://www.ncbi.nlm.nih.gov/pubmed/27039040, The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study, Joy JB, et al, The Lancet: Infectious Diseases, March 2016.

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