Showing posts with label HCV Baby Boomers. Show all posts
Showing posts with label HCV Baby Boomers. Show all posts

Tuesday, February 5, 2019

Baby Boomers and the Flu

As we move into March please visit the Centers for Disease Control and Prevention (CDC) website to review current U.S. flu activity.

Latest CDC Update: Feb 22, 2018
2018-2019 Influenza Season Week 7 ending February 16, 2019

View Interactive Map

CDC Update:
Influenza activity continues to increase in the United States. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses continue to co-circulate. Below is a summary of the key influenza indicators for the week ending February 16, 2019:
Viral Surveillance: The percentage of respiratory specimens testing positive for influenza viruses in clinical laboratories increased. While influenza A(H1N1)pdm09 viruses predominated in most areas of the country, influenza A(H3) viruses have predominated in HHS Region 4 and accounted for 47% of subtyped influenza A viruses detected nationally during week 7. During the most recent three weeks, influenza A(H3) viruses were reported more frequently than influenza A(H1N1)pdm09 viruses in HHS Regions 6 and 7 and influenza A(H1N1)pdm09 and influenza A(H3) viruses were reported in approximately equal numbers in HHS Region 2.

Virus Characterization: The majority of influenza viruses characterized antigenically are similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses.

Antiviral Resistance:The vast majority of influenza viruses tested (>99%) show susceptibility to oseltamivir and peramivir. All influenza viruses tested showed susceptibility to zanamivir.

Influenza-like Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) increased to 5.1%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above their region-specific baseline level.

ILI State Activity Indictor Map: New York City and 30 states experienced high ILI activity; the District of Columbia and 11 states experienced moderate ILI activity; six states experienced low ILI activity; the U.S. Virgin Islands and three states experienced minimal ILI activity; and Puerto Rico had insufficient data.

Geographic Spread of Influenza: The geographic spread of influenza in Puerto Rico and 48 states was reported as widespread; one state reported regional activity; the District of Columbia reported local activity; the U.S. Virgin Islands and one state reported sporadic activity; and Guam did not report.

Influenza-associated Hospitalizations A cumulative rate of 27.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported. The highest hospitalization rate is among adults 65 years and older (75.6 hospitalizations per 100,000 population)

Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.

Influenza-associated Pediatric Deaths: Seven influenza-associated pediatric deaths were reported to CDC during week 7.

Continue reading:

Preliminary In-Season U.S. Influenza Burden Estimates
The 2018-2019 flu season is the first season CDC has reported in-season burden estimates of flu in the U.S. These in-season estimates will be updated over the course of the flu season.CDC estimates that, from October 1, 2018 through January 26, 2019, there have been:
--10.1 million – 11.7 million flu illnesses
--4.7 million – 5.6 million flu medical visits
--118,000 – 141,000 flu hospitalizations
Read the report, here...….

Public Health Agency of Canada:
The most up-to-date influenza information from Canada is available at
British Columbia Influenza Surveillance Bulletin Influenza
Influenza activity remains elevated in BC and is dominated by the H1N1 strain. 
Joint ECDC - WHO/Europe Weekly Flu Update:

Feb 22, 2019
U.S. News - CDC: 41 Child Deaths Linked to Flu
The pediatric death total continues to tick up during the current flu season. The deaths of seven more children in connection with the flu have been reported to the Centers for Disease Control and Prevention, bringing the total number of pediatric deaths this season to 41 as of Feb. 16. In total, the CDC estimates there had been 13,600 to 22,300 flu deaths from October through mid-February, and that up to 20.4 million people had gotten sick. Flu season typically peaks in February, and agency researchers previously said that so far, this has been a "low-severity influenza season."
Read the article, here.

HealthDay Reporter - More Severe Flu Strain Starts to Spread Widely
FRIDAY, Feb. 22, 2019 (HealthDay News) -- Americans aren't out of the woods yet, as the flu season continues to spread across the country, health officials reported Friday. One major shift that's occurred is in the viruses that are circulating. At the start of the flu season, the predominant strain was influenza A H1N1, but now a more severe strain, influenza A H3N2, accounts for nearly half of all the new cases, according to the U.S. Centers for Disease Control and Prevention. "It looks like we are moving from an H1 wave to an H3 wave," said Lynnette Brammer, lead of CDC's domestic influenza surveillance team. "There's still a lot of flu to come."
Read the article, here.

Why Flu Vaccines Don’t Work as Well in the Elderly, as we age, something hampers our immune system’s ability to produce ever-stronger antibodies in response to infections. As a result, older people are relying on mostly memory B-cells to make antibodies from long-past immune responses that are ill-equipped to squash rapidly evolving pathogens like the flu virus.

Feb 18
Research: 'Killer' cells raise hope of universal flu vaccine.

Feb 13
Earlier Tamiflu May Cut Death Risk in Some Severe Cases, observed 30% decrease in mortality with early oseltamivir among influenza A/H3N2 patients in ICU.
Influenza Vaccines Prevented 8,000 Deaths Last Flu Season
Fighting the Flu: Paid Sick Leave Reduces Infection Rates 

Feb 6
Influenza Vaccine Tied to Lower Hospitalization Rates in COPD Patients
Previous research has shown that people with HCV, especially older patients, have increased prevalence and faster progression of COPD. Over at MD Magazine, a recent study found people with COPD vaccinated for the flu were 38% less likely to require influenza-related hospitalization, read it here.
SURVEY: Three In Ten Parents Believe Flu Shot Is Conspiracy...
CDC: 2 More Child Deaths Linked to Flu
Pregnant women with severe flu more likely to have poor outcomes


This flu season should serve as a wake-up call – we need to redouble our efforts to prevent and treat the flu
Seasonal outbreaks of the flu cause thousands of deaths even in a good year, and the last flu season, 2017-2018, was a terrible one. It killed 80,000 Americans and sent 900,000 to the hospital, making it the worst influenza season in decades.

Baby Boomers and the Flu 
Did you know that you are more susceptible to flu-related complications if you're over 65, living with chronic liver disease, or viral hepatitis? Yep, I knew it too. 

Currently information on this blog is aimed at people living with or treating hepatitis C, for the most part that is the baby boomer generation; born between 1946 to1964. 

Speaking of baby boomers, if you haven't read the CDC's eye- opening report on last years flu season, it was reported 80,000 flu-related deaths occurred in the US, the highest in 40 years. The death rate among young baby boomers, aged 50 to 64 were shocking as well; 
"Death rates were highest in the over-65 age group, which is typical, but the second most affected group comprised those aged 50 to 64 years old; normally, the second highest death rates occur in children, from birth through age 4 years. The ferociousness of the flu season overall, combined with above-average impacts on younger baby boomers, made 2017-2018 one for the record books."
Read the article: Flu Season 2017-2018: A Look at What Happened and What's to Come, CDC report, here. Or read this more recent article, updated Oct 19, 2018: 80,000 Americans died of the flu last winter.That’s more than the number killed in traffic collisions, from gun violence, or from opioid overdoses.

Liver Disease & The Flu
As we age our immune system is less effective in fighting infections, and new infections can have a severe impact on the liver. This can be especially serious for liver transplant recipients and people who have cirrhosis. Flu-related complications could develop into bronchitis or pneumonia, which in rare cases can also be fatal.

Even though the flu vaccine won’t keep everyone from getting sick, it helps prevent serious flu complications. For instance people over 65 who were vaccinated had a lower rate of flu-related death, according to a 2017 study, found on the CDC's website.
"Flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients; with the greatest benefits being observed among people 65 years of age and older."
October - In The News
October 29, 2018
Getting Flu Vaccine One Year Doesn't Reduce Vaccine Effectiveness the Next Year
By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Getting the flu vaccine every year doesn't reduce its effectiveness — and might even boost its performance — suggests a study in JAMA Network Open.

Researchers examined the vaccination status of nearly 3400 children who presented with acute febrile respiratory illness during one of three successive flu seasons between 2013 and 2016. About one-fourth had flu confirmed on reverse-transcription polymerase chain reaction testing; the rest were considered negative for flu.

The researchers found that while vaccine effectiveness varied by vaccine type (e.g., live attenuated influenza vaccine [LAIV) or inactivated influenza vaccine) and flu virus strain, past-season vaccination did not reduce vaccine effectiveness. In fact, in some cases — for example, the effectiveness of LAIV against influenza A(H3N2) — previous vaccination appeared to improve the vaccine's effectiveness.

Of note, residual protection from past-season flu vaccine alone was observed only for influenza B.
A commentator writes, "The results thus suggest additional support for the current Advisory Committee on Immunization Practices' recommendation that children be vaccinated annually against influenza."
JAMA Network Open article (Free)
JAMA Network Open commentary (Free)
Background: Physician's First Watch coverage of American Academy of Pediatrics recommendation of inactivated flu vaccine over LAIV (Free)

Oct 28, 2018
New Flu Drug Offers Convenience, Fast Activity, and a Novel Mechanism — at a Price
Last week, the FDA approved a new drug for treatment of influenza, baloxavir marboxil (Xofluza).
The drug is indicated for treatment of symptomatic influenza in patients 12 years of age or older. As with existing treatments, it should be started within 48 hours of symptom onset....

Oct 24, 2018
"I figured [the flu] was something that's dangerous to the elderly and the young, not somebody who is healthy and in their 30s," says Hinderliter, who is 39 and the director of government affairs at the St. Louis Realtors association
"Turns out, I was wrong," he says
Read the article, here.....

Should I or Shouldn't?
September 27, 2018
"People say they never had the flu until they got the shot. That argument doesn’t hold water. Either you got your shot too late, you got a strain of the flu that isn’t covered by the vaccine, or you had a one-day immune response which may make you feel like crap for the day, but isn’t anywhere like having the flu. If you are over 65, high dose flu shots are recommended, and some people feel a bit low and fluish the next day. This is not the flu – it is an immune system reaction"
Read the article: The Flu Shot Debate, written by HCV advocate Lucinda Porter.

CDC Information
People 65 years and older should get a flu shot and not a nasal spray vaccine.
They can get any flu vaccine approved for use in that age group with no preference for any one vaccine over another. There are regular flu shots that are approved for use in people 65 and older and there also are two vaccines designed specifically for people 65 and older:
High Dose Flu Vaccine:
The “high dose vaccine” contains 4 times the amount of antigen as a regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production). Results from a clinical trial of more than 30,000 participants showed that adults 65 years and older who received the high dose vaccine had 24% fewer influenza infections as compared to those who received the standard dose flu vaccine. The high dose vaccine has been approved for use in the United States since 2009.
Learn more about high dose flu vaccine here.

Adjuvanted Flu Vaccine:
The adjuvanted flu vaccine, Fluad, is made with MF59 adjuvant an additive that creates a stronger immune response to vaccination. In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots. There are no randomized studies comparing Fluad with Fluzone High-Dose. This vaccine was available for the first time in the United States during the 2016-2017 season. Learn more about adjuvanted flu vaccine here.

For Adults with LIVER DISEASE: Important information about a dangerous infection
If you have chronic liver disease, you are more likely to have serious complications if you get pneumococcal disease

Get pneumococcal vaccines 
People who are 65 years of age and older should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. Talk to your doctor to find out which pneumococcal vaccines are recommended for you. Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death. 

You can get the pneumococcal vaccine your provider recommends when you get the flu vaccine.

CDC - Got Questions?
Flu vaccines recommended this season.

Detailed flu and flu vaccine information specific to the current flu season

If you have HIV, you are at high risk of serious influenza-related complications and should get an injectable influenza vaccine (a flu shot).

Recommended Reading:
Flu and Colds: In Depth
What do we know about the effectiveness of complementary approaches for flu and colds?

Is It A Nasty Cold Or The Flu?
So, if you do have the flu, it's important to consult with your health care provider about treatment. And distinguishing between a cold and flu may be easier than you think, Ejnes says.

Stay healthy!

Monday, January 21, 2019

Opioid and HCV Epidemics - Spreading rapidly in new generations, but boomers bear biggest burden

For Patients: Basic HCV Information
In this program launched by PeerView, Dr. Mark Sulkowski heads an expert panel addressing the evolving opioid and Hepatitis C epidemics. The good doctor will discuss basic HCV information for both the baby boomer generation (born between 1945 and 1965) and a younger at risk population, people less than 40 years old. 

Here are a few highlights to get you started, followed by tips for navigating the presentation.

Did you know?
Hepatitis C is spreading rapidly in new generations, but boomers bear the biggest burden.
Dr. Sulkowski: This group is critically important, because they’ve lived so long with the infection. They’re now presenting with liver disease, such as cirrhosis, decompensation—and they’re what’s behind the rise in liver cancer.. We’ll talk a bit more about that in a minute. And these individuals are dying about 15,000 deaths per year.

Dr. Sulkowski: So, let’s move into the first lecture portion of this, where we’re going to try to cover some of the basics about the burden of hepatitis C, where we stand with treatment and cure, and then we’re going to focus more on the local picture. Hep C is a major cause of mortality in America, more than any other infectious disease, even when you combine them. And I’ll come back to that with some actual data from the CDC. So, [HCV is] a major problem in the United States.

Opiate epidemic in the United States 
18-to 29-year-olds and 30- to 39-year-olds.
Dr. Sulkowski: In parallel with that is hepatitis C. One thing that characterizes this virus is it is very transmissible by blood contamination. But it’s not just reuse of needles; it’s reuse of any of the works, including water, that have been used to prepare drugs.

And it’s so contagious that people acquire it unknowingly. So, you can see that staggering increase in hepatitis C among this population, and that’s what’s driving that second hump on our epidemiology graphics in California but also here in Maryland.

A Closer Look at the Burden of HCV Infection in a New Era of Treatment and Cure
Hepatitis C and Injection Drug Use in the Urban Setting: Perspectives From the Front Lines 
Hepatitis C and Injection Drug Use in the Rural Setting: Perspectives From the Front Lines 
Practice Aids, Slides, Monograph and Live Roundtable Discussion Summary 
Experts discuss working with patients with substance use disorder 

For Patients: How To Navigate The Program 
Begin: Click here
-Select any specialty or profession
-The program will begin
-Interactive questions will appear; respond by clicking "N/A" or click "Next Button" on the top of your screen.
-Pause program click on the video presentation. 
-No registration is required

Recommended Reading
Screening For HCV Is Lacking - Baby Boomers
Screening strategies have been in place for baby boomers since 2012, but according to research, and the American Liver Foundation, "Few boomers are getting screened for hep C'

Screening For HCV Is Lacking - Young People At Risk
Screening young people most at risk for HCV is lacking as well, last month an article written by Michelle Andrews, published by Kaiser Health News (KHN) found facilities ready to serve people who use drugs are not always screening patients, read the article here.

The opioid epidemic is a major contributor to the current rise in HCV infections. Recently, HepVu launched a map on the impact of hepatitis C across the U.S. In some states the map shows a concentration of infections most impacted by the opioid epidemic.

Taking Down the Opioid Crisis 
Andrew Reynolds writes about the opioid crisis online at POSITIVELY AWARE (PA)
This article will provide you with a broad overview of the scope of the problem, basic information to understand what opioids are and how they lead to overdoses, and some harm reduction tips and resources so that you, or someone you know who uses drugs, can be safe. 
Read it here, follow Andrew on twitter. Visit Project Inform to read additional articles about the opioid crisis. 

Andrew Reynolds
Andrew Reynolds is the Hepatitis C Education Manager at Project Inform, and facilitates several HCV support groups in the San Francisco Bay Area. He's also a counselor on the HELP-4-HEP HCV phoneline (877-435-7443). Call him if you have any questions about HCV care and treatment.

Healio’s Opioid Resource Center
Healio’s Opioid Resource Center compiles the latest stories across a range of specialties, covering the latest research into the epidemic, FDA decisions on treatments and other related announcements.

Thanks for stopping by

Tuesday, November 6, 2018

Over 2 Million Americans Have Hepatitis C; Affects nearly every generation

CDC Press Release
CDC Estimates Nearly 2.4 Million Americans Living with Hepatitis C
New data highlight urgent need to diagnose and cure more Americans, and to address rising infections due to U.S. opioid crisis.

Nearly 2.4 million Americans – 1 percent of the adult population – were living with hepatitis C from 2013 through 2016, according to new CDC estimates published today in the journal Hepatology.

** Link to full-text journal article provided below

Medications that cure hepatitis C offer the hope of eliminating the disease in the U.S., yet, today’s report suggests that millions are infected and have not benefited from these new treatment options. Expanded testing, treatment, and prevention services are urgently needed, especially in light of the surge in new infections linked to the opioid crisis.

Every American who has been cured of hepatitis C is living proof that ending this epidemic is possible,” said CDC Director Robert R. Redfield, M.D. “Hundreds of thousands of Americans have already been cured. In order to achieve our goal, we must commit to ensuring that everyone living with hepatitis C is tested and treated.”

To estimate total hepatitis C prevalence in the United States, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) from 2013 through 2016. They also analyzed data from other studies of groups not surveyed in the NHANES, including active duty members of the military, and people who are incarcerated or homeless.

Opioid crisis puts new generations at risk of hepatitis C infections 
Adding to the burden of those already living with hepatitis C, separate CDC surveillance data indicate that the number of new infections each year in the United States is disturbingly high and on the rise. Acute hepatitis C cases reported to CDC more than tripled from 2010 to 2016, with most new hepatitis C infections due to increased injection drug use associated with the nation’s opioid crisis. Based on these data, CDC estimates that more than 41,000 Americans were newly infected with hepatitis C in 2016 alone.

Seeing an undiagnosable infection become a curable disease has been a public health highlight of the past 30 years. But the shadow of the opioid crisis puts our nation’s progress at risk,” said Jonathan Mermin, M.D., director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Tackling hepatitis C requires diagnosing and curing people living with the virus and cutting off new infections at the source.”

Hepatitis C affects nearly every generation 
Hepatitis C now poses a serious health threat to three generations of Americans, all of whom need to be reached with prevention services, testing, and treatment:
Baby boomers (born between 1945 and 1965) account for a large portion of all chronic hepatitis C infections in the United States and currently have the highest rate of hepatitis C-related deaths. CDC recommends that all adults born between 1945 and 1965 get a one-time test for hepatitis C, but only a small fraction have done so. 

Adults under 40 have the highest rate of new infections, largely because of the opioid crisis.

Infants born to mothers with hepatitis C are a growing concern. The overall risk of an HCV-infected mother transmitting infection to her infant is approximately 4 percent to 7 percent per pregnancy. From 2011 through 2014, national laboratory data indicate that the rate of infants born to women living with hepatitis C increased by 68 percent. 

Eliminating hepatitis C requires substantial national commitment 
Even though new treatments can cure hepatitis C virus infections in as little as two to three months, far too many Americans have not been effectively treated. They may be unaware of their infection or they are unable to access medication because they lack healthcare coverage or have financial restrictions.

In addition to expanding testing and removing barriers to treatment, authors of the new report stress that intensified programs to prevent, track, and respond to new hepatitis C infections are also essential to reducing the number of infections. Prevention efforts to address new infections include support for comprehensive community-based prevention services. Such services focus on drug treatment and recovery and reducing transmission of viral hepatitis and HIV through hepatitis A and B vaccination, testing, linkage to care and treatment, and access to sterile syringes and injection equipment. 

“Until we as a nation remove the barriers to hepatitis C testing and treatment, it will continue to cost us dearly – both in terms of dollars and American lives,” said Dr. Mermin. “Every death from hepatitis C is a reminder of a promise not yet realized for far too many.” 

For more information from CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, visit

Read More From The CDC:
Hepatitis C Prevalence Estimates 2013-2016

In The Journal Hepatology
Full-Text Article
First published: 6 November 2018 - In Hepatology
Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013‐2016
Hepatitis C virus (HCV) infection is the most commonly reported bloodborne infection in the United States, causing substantial morbidity and mortality and costing billions of dollars annually. To update the estimated HCV prevalence among all adults aged ≥18 years in the United States, we analyzed 2013‐2016 data from the National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of HCV in the noninstitutionalized civilian population and used a combination of literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for four additional populations: incarcerated people, unsheltered homeless people, active‐duty military personnel, and nursing home residents. We estimated that during 2013‐2016 1.7% (95% confidence interval [CI], 1.4‐2.0%) of all adults in the United States, approximately 4.1 (3.4‐4.9) million persons, were HCV antibody‐positive (indicating past or current infection) and that 1.0% (95% CI, 0.8‐1.1%) of all adults, approximately 2.4 (2.0‐2.8) million persons, were HCV RNA–positive (indicating current infection). This includes 3.7 million noninstitutionalized civilian adults in the United States with HCV antibodies and 2.1 million with HCV RNA and an estimated 0.38 million HCV antibody‐positive persons and 0.25 million HCV RNA–positive persons not part of the 2013‐2016 NHANES sampling frame. Conclusion: Over 2 million people in the United States had current HCV infection during 2013‐2016; compared to past estimates based on similar methodology, HCV antibody prevalence may have increased, while RNA prevalence may have decreased, likely reflecting the combination of the opioid crisis, curative treatment for HCV infection, and mortality among the HCV‐infected population; efforts on multiple fronts are needed to combat the evolving HCV epidemic, including increasing capacity for and access to HCV testing, linkage to care, and cure.
Continue to article:

Follow On Twitter
- This full-text research article was downloaded and shared today by @HenryEChang on Twitter.

In The Media
Over 2 Million Americans Have Hepatitis C; Opioids Help Drive Spread
By Amy Norton
HealthDay Reporter
TUESDAY, Nov. 6, 2018 (HealthDay News) -- More than 2 million Americans have hepatitis C -- and the opioid epidemic is a major contributor to the problem, according to a new government study.

The study, by the U.S. Centers for Disease Control and Prevention, does highlight progress against the potentially fatal liver disease. It also shows how much more work remains, CDC officials said.

Between 2013 and 2016, the agency estimated, nearly 2.4 million Americans had hepatitis C infections.

That's a small decline from previous years. And the CDC said that may indicate the effects of new therapies that have changed the face of hepatitis C treatment in the past several years.

Thursday, February 22, 2018

Hepatitis C: The Bane of Baby Boomers, Though Treatable

Hepatitis C: The Bane of Baby Boomers, Though Treatable
FEBRUARY 21, 2018
Jeannette Y. Wick, RPh, MBA, FASCP

More than 3 million Americans have chronic hepatitis C virus (HCV), and physicians diagnose about 17,000 new cases annually. HCV is a silent disease, and most infected individuals are unaware that they are infected until they develop liver damage, cirrhosis, or liver cancer. Consequently, 12,000 Americans die from HCV complications each year.1,2,3 And people born between 1945 and 1965 are 5 times more likely to have hepatitis C than others.4 Although treatments have been available for many years, the consistent ability to cure HCV is recent.

Choosing the Treatment Regimen
Treatment goals include a persistent absence of HCV ribonucleic acid in serum 6 months or more after completing antiviral treatment, and preventing progression to serious complications.

Since 2013, oral regimens combining direct-acting antivirals from different classes (Table 1) have effectiveness exceeding 90%. These therapies have shorter durations and fewer adverse effects than older options.

Thursday, September 28, 2017

CDC - Mandating HCV Screening Increased Newly Diagnosed and Access to Care

Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report (MMWR)

Evaluation of the Impact of Mandating Health Care Providers to Offer Hepatitis C Virus Screening to All Persons Born During 1945–1965 — New York, 2014
Colleen A. Flanigan, MS1; Shu-Yin J. Leung, MA2; Kirsten A. Rowe, MS2; Wendy K. Levey, MA3; Andrea King, MPH4; Jamie N. Sommer, MS5; Johanne E. Morne, MS6; Howard A. Zucker, MD, JD7

Weekly / September 29, 2017 / 66(38);1023–1026

Implementation of the New York law mandating health care providers to offer HCV testing to persons born during 1945–1965 was associated with an increase in HCV testing, and an increase in the percentage of persons with newly diagnosed HCV infections who were linked to care. Marked increases in the number of HCV tests performed and rates of testing were observed immediately after enactment of the law and remained steady over a 12-month period. Smaller increases were noted in the number of persons who accessed care after receiving a positive HCV screening test result.


What is already known about this topic?

Persons born during 1945–1965 account for approximately 75% of all hepatitis C virus (HCV) infections in the United States and 73% of HCV-associated mortality. Most infected persons do not know their status. In January 2014, New York became the first state to enact an HCV testing law, which is expected to increase the number of persons who are aware of their HCV status.

What is added by this report?

One year after implementation of the 2014 New York HCV Testing Law, marked increases were observed in the number of HCV screening tests and rates of testing. Increases were observed almost immediately after enactment of the law and remained steady at levels substantially higher than those in the years preceding enactment of the law. Smaller increases were noted in the number of persons who accessed HCV care following a positive HCV screening test.

What are the implications for public health practice?

State-level HCV testing laws could increase the number of persons who know their HCV status and of HCV-infected persons who are linked to care. With the availability of new therapies that can stop disease progression and provide a cure in most persons, testing and linkage to care for infected persons is likely to reduce HCV-related morbidity and liver cancer-associated mortality.

Saturday, July 8, 2017

Looking at the Twin Epidemics of HCV

AGA Reading Room

Looking at the Twin Epidemics of HCV
by Pippa Wysong
Contributing Writer, MedPage Today

Younger cohorts at risk of HCV need more attention
They are a unique group of individuals in which most new infections are happening," he told MedPage Today. "Treating them is more complicated than simply giving them medical therapy." He was lead author of a recent large study in BMC Infectious Diseases that elucidated the characteristics of the twin epidemics.
When researchers look at the causes of mortality among this younger cohort, deaths are often related to acquisition-related causes such as injection drug use and drug overdose. Baby boomers, on the other hand, are more likely to present later with HCV and to die from chronic diseases and liver-related causes.
Continue reading....

Free registration may be required.

Wednesday, July 5, 2017

Healio Hepatology - Top HCV reports for June 2017 focus on guides, screening

Top HCV reports for June 2017 focus on guides, screening
July 5, 2017
In the direct-acting antiviral era, researchers and medical professionals are continuing their efforts to eliminate hepatitis C by defining the most instrumental guides for screening, treatment and management. presents some of the highlights in HCV research data and formal reports for June 2017. The reports include EASL’s response to a controversial review of DAA studies, recommendations for the elimination of HCV from Georgetown University, the utility of electronic screening for HCV among the baby boomer generation, and a survey that identified gaps in current HCV and hepatitis B testing guides in Europe.

The European Association for the Study of the Liver responded with serious concern to a systematic review published by the Cochrane Group Review....

Continue reading

** Free registration required

Sunday, March 12, 2017

Recent Hepatitis C Virus Testing Patterns Among Baby Boomers

Approximately 3.5 million people are chronically infected with hepatitis C virus (HCV) in the U.S., 80% of whom are “baby boomers” (born between 1945 and 1965).1 Most infected individuals are not aware of their infections despite availability of treatments that may reduce their risk of HCV-related diseases, including chronic hepatitis, cirrhosis, and liver cancer.2 To curb the growing burden of these HCV-associated diseases, the U.S. Preventive Services Task Force (USPSTF) recommended one-time HCV testing for baby boomers in 2013.3 The authors previously noted low HCV testing prevalence among baby boomers in 2013, at baseline4; however, it is unknown whether HCV testing has changed following the USPSTF recommendation.

Data from the 2013 and 2015 National Health Interview Survey, including 23,967 baby boomers, were used. Self-reported HCV blood testing was the primary study outcome. Analyses were restricted to respondents with non-missing HCV testing data (n=21,827). Weighted prevalence of HCV testing (ever) was calculated by sociodemographic and lifestyle factors. Multivariable prevalence ratios (PRs) and 95% CIs of HCV testing according to the 2015 survey were estimated using predicted margins. Interaction terms between survey year and each covariate were included in additional models using 2013 and 2015 survey data to determine if changes in HCV testing varied across subgroups; none were statistically significant (data not shown). All statistical analyses were conducted in 2016 with SAS-callable SUDAAN, version 9.0.3.

From 2013 to 2015, HCV testing prevalence among baby boomers slightly increased from 12.3% to 13.8% (p=0.013) (Table 1). Of the 76.2 million estimated baby boomers in 2015, only 10.5 million reported ever receiving HCV testing. Relative to privately insured adults, those with Medicare plus Medicaid (PR=1.83, 95% CI=1.32, 2.53), Medicaid only (PR=1.35, 95% CI=1.04, 1.76), or military insurance (PR=1.62, 95% CI=1.16, 2.26) had higher HCV testing prevalence. HCV testing was also greater in men versus women (PR=1.25, 95% CI=1.08, 1.44) and among people who had lived with someone with hepatitis versus those who did not (PR=2.44, 95% CI=2.01, 2.96). Individuals with less than or only a high school diploma had lower HCV testing than college graduates (PR=0.63, 95% CI=0.48, 0.82 and PR=0.58, 95% CI=0.48, 0.72, respectively).

Table 1Hepatitis C Testing Among Adults Born Between 1945 and 1965, NHIS 2013–2015 (n=21,827)a
CharacteristicUnadjusted prevalence2013 vs 2015, p-valueaPR (95% CI) among respondents in the 2015 surveyb
2013, % (95% CI)2015, % (95% CI)
Total12.3 (11.5, 13.1)13.8 (12.9, 14.7)0.013
 Non-Hispanic white12.4 (11.5, 13.4)13.9 (12.9, 15.0)0.0371.00
 Hispanic11.5 (9.3, 14.0)11.3 (9.2, 13.9)0.9280.96 (0.71, 1.30)
 Non-Hispanic black12.6 (10.7, 14.7)14.5 (12.2, 17.3)0.2241.09 (0.87, 1.35)
 Non-Hispanic Asian10.1 (7.4, 13.7)13.9 (10.0, 18.9)0.1511.24 (0.84, 1.83)
 Non-Hispanic other19.5 (12.0, 29.9)25.4 (16.6, 36.9)0.3661.61 (1.01, 2.55)
Health insurance
 Private11.7 (10.6, 12.9)12.8 (11.7, 14.0)0.2001.00
 Medicaid16.5 (13.0, 20.8)18.5 (15.1, 22.6)0.4691.35 (1.04, 1.76)
 Medicaid+Medicare21.3 (16.0, 27.7)26.1 (19.9, 33.4)0.3181.83 (1.32, 2.53)
 Medicare9.5 (7.9, 11.4)12.5 (10.8, 14.4)0.0120.89 (0.74, 1.06)
 Military22.1 (17.6, 27.5)22.5 (16.9, 29.2)0.9281.62 (1.16, 2.26)
 Uninsured11.2 (9.2, 13.4)11.1 (8.6, 14.2)0.9560.96 (0.70, 1.31)
 Other17.1 (13.4, 21.5)17.9 (13.2, 23.8)0.8041.22 (0.86, 1.74)
 Female11.1 (10.1, 12.3)12.4 (11.3, 13.5)0.1101.00
 Male13.5 (12.3, 14.8)15.4 (14.0, 16.9)0.0601.25 (1.08, 1.44)
 College graduate13.7 (12.2, 15.3)14.5 (12.9, 16.2)0.4631.00
 Some college15.2 (13.7, 16.8)16.5 (14.9, 18.4)0.2451.03 (0.86, 1.22)
 HS or GED8.9 (7.4, 10.6)11.0 (9.4, 12.8)0.0880.58 (0.48, 0.72)
 Less than HS diploma9.3 (7.7, 11.2)11.4 (9.4, 13.8)0.1490.63 (0.48, 0.82)
Marital status
 Married11.3 (10.3, 12.4)13.1 (12.1, 14.3)0.0151.00
 Not currently marriedc14.0 (12.7, 15.3)15.3 (13.7, 17.1)0.2261.09 (0.94, 1.28)
 Never married14.2 (12.1, 16.6)14.3 (12.1, 16.8)0.9730.93 (0.75, 1.16)
Born in U.S.
 Yes12.5 (11.6, 13.4)14.2 (13.2, 15.2)0.0111.00
 No11.3 (9.5, 13.3)12.0 (10.1, 14.3)0.5780.89 (0.67, 1.19)
Alcohol consumption
 0−1 drinks/day12.2 (11.4, 13.1)13.9 (13.0, 14.9)0.0071.00
 ≥2 drinks/day12.9 (10.7, 15.4)12.8 (10.0, 16.2)0.9731.23 (0.93, 1.61)
Lived with someone with hepatitis
 No9.5 (8.8, 10.3)11.2 (10.4, 12.1)0.0041.00
 Yes29.4 (24.4, 35.0)27.9 (23.3, 33.0)0.6882.44 (2.01, 2.96)

Note: Boldface indicates statistical significance (p<0.05).
aWeighted number receiving hepatitis C virus testing in 2013 was 9,144,299 and in 2015 was 10,511,639. Weighted number eligible for hepatitis C virus testing in 2013 was 74,506,656 and in 2015 was 76,178,472. Weighted numbers take into account the assigned sampling weights of respondents.
bIncludes 10,176 respondents from the 2015 survey only. Model is adjusted for race/ethnicity, health insurance, sex, education, marital status, alcohol consumption, and having lived with someone diagnosed with hepatitis.
cIncludes divorced, separated, and widowed. aPR, adjusted prevalence ratio; GED, General Educational Development test; HS, high school; NHIS, National Health Interview Survey.

There was a small, albeit statistically significant, increase in HCV testing (from 12.3% to 13.8%) among baby boomers 2 years after the 2013 USPSTF recommendation for one-time HCV testing. Reasons for the overall slow uptake of testing may include barriers to preventive care; unapparent symptoms; lack of awareness of the need to be tested among patients, who may not be fully covered by insurers2; and lack of physician awareness of the USPSTF recommendations. The relatively higher prevalence of testing in military-insured individuals may reflect ongoing HCV testing in the Veterans Health Administration to reduce the disproportionately high burden of HCV-associated disease in this population.5, 6, 7

Greater HCV testing in those with dual Medicare and Medicaid and Medicaid-only insurance coverage may reflect more risk factors for HCV and associated diseases in this population.8 People with lower educational attainment and the uninsured had especially suboptimal HCV testing, despite having greater HCV burden, perhaps as a result of lower awareness about testing and barriers to accessing care.1 Limitations of this study include recall bias due to self-reported HCV testing and exclusion from the National Health Interview Survey of institutionalized baby boomers (e.g., incarcerated individuals and active-duty military) in whom HCV testing and infection may be more common.6, 7 The HCV testing estimates are substantially lower than those from recent studies among baby boomers,9, 10 where 90% of patients in a safety net clinic were tested, and in a New York community hospital where testing increased from 47% before to 88% after an intervention to improve HCV testing was put into place.9, 10 The lower proportion of HCV testing in the current study’s population could be a result of under-reporting of HCV testing, as well as differences between the current study population and these institutional-based studies.9,

Prevalence of HCV testing among baby boomers did not substantially increase and remains low 2 years after the USPSTF recommendation in 2013. Notably, only 10.5 million of 76.2 million baby boomers reported ever receiving HCV testing. These findings underscore the need for increased awareness for HCV testing among healthcare providers and baby boomers and other innovative strategies such as state-mandated HCV testing.

Monday, February 20, 2017

HCV Screening Shouldn't Just Focus on At-Risk Populations

HCV Screening Shouldn't Just Focus on At-Risk Populations
At the Conference on Retroviruses and Opportunistic Infections (CROI 2017) in Seattle, Washington, researchers from MedStar Health Research Institute in Maryland presented new data on hepatitis C virus (HCV)-positive non-baby boomers.

It’s widely acknowledged that those individuals belonging to the baby boomer age group (those born between 1946 and 1964) are at higher risk of acquiring HCV infection. According to the Centers for Disease Control and Prevention (CDC), these individuals are five times more likely to be infected with HCV. However, other at-risk populations may not be getting adequately tested for the virus.

Monday, December 26, 2016

Hepatitis C - Screening for HCC in the Post-SVR12 Setting

2018 - Updates
Letter to the editor
Jan 2018

SVR Reduced HCC by 71%
from Jules: there never was any doubt that SVR would reduce or eliminate risk for HCC. In this study cirrhosis prior to treatment had a higher HCC risk then for those without cirrhosis, but that is to be expected and merely reinforces how crucial it is to treat HCV as early as possible...
Full Text

Direct-acting antiviral treatment for hepatitis C did not correlate with an increased risk for hepatocellular carcinoma in a large cohort study of both treated and untreated patients with or without cirrhosis. Those with incident HCC after DAA treatment had higher risk factors at baseline.

Dec 2016
The following articles appeared in the December print edition of HCV NEXT, published online at Healio.

Monday, October 31, 2016

Dating after Hepatitis C: Hope on the horizon for the 1 in 30 boomers estimated to be infected

Dating after Hepatitis C: Hope on the horizon for the 1 in 30 boomers estimated to be infected

Baby boomers are 6 times more likely to be infected than other adults. We need to talk about testing and treatment

Recently I went on a first date — a stroll in a city park — that went rather well. We had so much in common, from a love of reading to a history of youthful troublemaking. If I wasn’t convinced already he was someone I could relate to, my new friend shared that he’d been cured of Hepatitis C.

I could hardly believe it. Instead of having to awkwardly explain my medical history, I’d met someone who shares it. It was a first. The only other time I’d met people who’d been cured of Hepatitis C, I was at an event at Johns Hopkins celebrating the first 1,000 successes of the new drugs. Some of my fellow drug program participants had gotten it from blood transfusions, some from vaccinations in the military. Some had no idea how.

Continue reading..

Tuesday, September 20, 2016

NVHR Webinar: Conveying the Urgency of Baby Boomer HCV Testing

National Viral Hepatitis Roundtable (NVHR)

NVHR Webinar: Conveying the Urgency of Baby Boomer HCV Testing
Published on Sep 20, 2016
This webinar, held on September 16, 2014, featured Dr. Cami Graham, Co-Director, Viral Hepatitis Center, Division of Infectious Diseases at Beth Israel Deaconess Medical Center on why and how to make the case for the importance and urgency of screening baby boomers (those born 1945-1965) for hepatitis C. We also shared information about how NVHR's educational program offers resources for implementing screening and linkage to care programs in your health care setting or community.

NVHR Website

The National Viral Hepatitis Roundtable is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics. We seek an aggressive response from policymakers, public health officials, medical and health care providers, the media, and the general public through our advocacy, education, and technical assistance. We believe an end to the hepatitis B and C epidemics is within our reach and can be achieved through addressing stigma and health disparities, removing barriers to prevention, care and treatment, and ensuring respect and compassion for all affected communities.

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National Viral Hepatitis Roundtable (NVHR)

Sunday, April 3, 2016

New research says hep C epidemic not caused by 1960s sex and drug lifestyle

New research says hep C epidemic not caused by 1960s sex and drug lifestyle

Peak of hep C infection epidemic actually occurred in 1950, not 1965 as previously thought

By Karin Larsen, CBC News Posted: Apr 03, 2016 7:00 AM PT Last Updated: Apr 03, 2016 7:00 AM PT

A new study, worked on by B.C. researchers, says baby boomers living a sex and drug lifestyle in the 1960s aren't to blame for hepatitis C infections in their demographic.
In fact, the research suggests all baby boomers should be tested for the hep C virus because widespread hospital practices predating the 1950's likely led to many accidental transmissions.

The findings suggest an increase in medical procedures post World War II and inadequate hospital sterilization of reusable needles and syringes are the culprits.

Continue reading...

Friday, January 30, 2015

PODCAST: Baby Boomers Should Get Tested For Hep-C

Posted Friday, January 30th 2015 @ 9am

Houston's Morning News with Matt Patrick welcomes KTRH Medical expert Dr. Joe Galati, to discuss more about baby boomers who overall, need to be tested for Hep C. Some reports advise against it, but Dr. Galati defuses that by explaining why more baby-boomers have the Hepatitis C today, adding it's highly curable. Listen in for details.


Tuesday, January 27, 2015

Quest in broad deal with CDC for hepatitis analysis

Quest in broad deal with CDC for hepatitis analysis
Tuesday, January 27, 2015 2 p.m. CST

(Reuters) - Laboratory testing company Quest Diagnostics Inc said on Tuesday it had signed a $520,000 agreement with the Centers for Disease Control and Prevention to identify trends in screening, diagnosis and treatment of four strains of viral hepatitis.

Quest will provide the U.S. public health agency with analytics and access to Quest's national database of clinical testing hepatitis data, which includes information from more than 20 billion test results.

The agreement expands on Quest's previous efforts with the CDC on hepatitis C testing data for Baby Boomers, or individuals born between 1945 and 1965, one of the groups most exposed to the virus.

The government in 2012 recommended that Baby Boomers be screened for hepatitis C, which can cause death.

The expanded agreement aims to identify trends in screening for hepatitis A, B, C and E and will focus on data for hepatitis B and C in pregnant women to find possible gaps that the CDC could use to target screening and treatment.

The data have been modified to protect the identity of the patients.

"If you can get people diagnosed, then the next obvious stage is to get them into care," said Rick Pesano, medical director for infectious diseases at Quest.

Treatment for hepatitis C has changed dramatically since Gilead Sciences Inc introduced its Sovaldi drug in December of 2013 with few side effects. It has since introduced a second combination drug Harvoni and AbbVie Inc has launched a competitor that offers similar cure rates above 90 percent.

(Reporting by Caroline Humer; Editing by Richard Chang)
Source - Reuters

Friday, October 3, 2014

Be Hip To Hep: Dispelling old myths and discovering the hopes for those with hepatitis C

Be Hip To Hep: Dispelling old myths and discovering the hopes for those with hepatitis C

Good morning folks, over at DentistryIQ an insightful article about living with hepatitis C now available for your reading pleasure.

Dr. Muñoz, professor of English at Cosumnes River College writes from a patients perspective about living with HCV.

The article offers information about; diagnosis, transmission/sexual transmission, risk factors, blood tests, stigma - "In addition to work difficulties, my personal life disintegrated. I felt a sense of shame as I listened to a friend unwittingly joke how Pamela Anderson was repulsive. Not because of her famously exaggerated cup size, but rather (and solely) because she had the misfortune of contracting HCV." as well as treatment, and advice for persons living with the virus.

Be hip to hep

Dispelling old myths and discovering the hopes for those with hepatitis C


"You have hepatitis C."

Those words turned my life upside down. I tell this story not to elicit sympathy but to illustrate what it means to live with hepatitis C (HCV): the physical as well as the emotional. Only now, because I am out of clinical hygiene and because there is a cure in sight, do I feel safe in telling my story.

I also tell this story to urge screening and to give hope to anyone living with HCV.
Continue reading....

Monday, August 4, 2014

Hepatitis C Could Become Rare Disease in 20 Years: Study

Hepatitis C Could Become Rare Disease in 20 Years: Study

Newer medications, better screening would fuel the trend, researcher says

By Amy Norton
HealthDay Reporter

MONDAY, Aug. 4, 2014 (HealthDay News) -- The once tough-to-treat liver infection hepatitis C could become a rare disease in the United States in the next two decades, a new study estimates.

Hepatitis C, a viral infection that harms the liver, is usually passed through infected blood. For most people, the infection becomes chronic and it can eventually lead to scarring of the liver (cirrhosis) or liver cancer.

U.S. health officials estimate that over 3 million Americans currently have chronic hepatitis C -- most of whom don't know it because the infection usually causes no symptoms.

But with recent treatment advances, hepatitis C could become rare by 2036, researchers report in the Aug. 5 issue of the Annals of Internal Medicine.

"Rare" refers to a disease that affects one in 1,500 people at most, said senior researcher Jagpreet Chhatwal, who conducted the study while at the University of Pittsburgh Graduate School of Public Health. Right now, around one in 100 Americans has chronic hepatitis C.

But that could quickly shift, since new drugs are changing the landscape of hepatitis C treatment, according to Chhatwal's team.

"We're in the middle of a very interesting time for hepatitis C patients," said Chhatwal, who is now an assistant professor at the University of Texas MD Anderson Cancer Center in Houston.

For decades, the only treatment for the disease involved the drug interferon -- which had to be injected and taken for up to a year. It also often caused fatigue and flu-like side effects. After all that, the cure rate was only 40 percent to 50 percent, according to the U.S. Food and Drug Administration.

But in just the past few years, new drugs have been approved and more are on the way, Chhatwal said.

One is Sovaldi (sofosbuvir), a pill the FDA approved last December. The treatment lasts just 12 weeks, with no need for interferon injections.

"There are highly effective drugs becoming available, with a shorter duration of treatment," Chhatwal said. "So, patients should be more amenable to taking them."

Besides the treatment advances, more hepatitis C cases could be caught. Since 2012, U.S. health officials have recommended that all "baby boomers" -- Americans born between 1945 and 1965 -- get a one-time blood test to screen for hepatitis C.

Baby boomers are targeted because they account for about 80 percent of chronic hepatitis C cases, Chhatwal said.

That's partly because of experimentation with injection drugs decades ago, and partly from exposure to contaminated blood before widespread screening of the blood supply in 1992.

For the new study, which was funded by the U.S. National Institutes of Health, Chhatwal's team used a computer model to estimate the future effects of both hepatitis C screening and new drug regimens.

The researchers predict that within the next 22 years, hepatitis C could become rare. What's more, nearly 79,000 cases of liver cancer, over 124,000 cases of cirrhosis and 126,500 deaths could be averted by 2050.

"Those are certainly reasonable predictions. I don't think they're overstating the situation at all," said Dr. Eugene Schiff, director of the Schiff Center for Liver Diseases at the University of Miami Miller School of Medicine.

Schiff, who was not involved in the study, explained that traditionally people with hepatitis C have not been automatically treated, because the drugs were so hard to take and not very effective.

"Now we're moving toward an era of 'test and treat,'" Schiff said. "Cure rates are approaching 100 percent with these new regimens, and they're very well-tolerated."

Treatment could also get even easier, Schiff noted. Gilead Sciences, maker of Sovaldi, has another pill in the pipeline. It combines Sovaldi and another drug, called ledipasvir, into a once-daily tablet that can be taken for as few as eight weeks.

The FDA is expected to make a decision on that drug in October, Schiff said.

The obstacle in all of this is money. Sovaldi costs $1,000 a day, or $84,000 for the typical 12-week course. Some insurers and state Medicaid programs are restricting coverage to certain patients, saying the drug's huge price tag could break the bank.

"As a clinician, the big hurdle right now is being able to get this medication to patients," Schiff said. But he added that payers' worries are understandable -- with an influx of people who'd been living with chronic hepatitis C now wanting treatment.

Costs should come down, Schiff noted, as competitors come onto the market.

Chhatwal's team also looked at what could happen if all Americans -- not just baby boomers -- got a one-time hepatitis C screening test. They say that would nearly double the number of cases detected in the next decade -- from 487,000 to almost 934,000.

What the study does not address, Chhatwal said, is costs. He said more research is needed to see whether the costs of screening and treatment could be offset by the reduction in liver disease and liver transplants.

More information

The U.S. Centers for Disease Control and Prevention has more on hepatitis C.

SOURCES: Jagpreet Chhatwal, Ph.D., assistant professor, health services research, University of Texas MD Anderson Cancer Center, Houston, Texas; Eugene Schiff, M.D., director, Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Fla.; Aug. 5, 2014 Annals of Internal Medicine

Last Updated: Aug 4, 2014