US Army Times (page 20) July 6, 1998
Article: THIS WEEK * MEDICAL AFFAIRS
by Deborah Funk
Times staff writer
The Pentagon has clarified its medical discharge policy on regarding hepatitis C. The change comes in the wake of a controversy about the fairness of discharging new recruits found to have hepatitis C after volunteering to donate blood. Under the revised policy, if have the hepatitis C disease, you can be discharged from the military, but only if you have been in uniform for less than six months. After that, you can be medically discharged only when you become too sick to perform your duties. Hepatitis C is a liver disease caused by the hepatitis C virus that infects tens of thousands of Americans each year. An estimated 4 million Americans now have the disease, but most don't know it.
Most people don't feel sick when they first are infected because flu-like syptoms appear in only about 10 - 15 % of cases at first. Instead, hepatitis C slowly damages the liver for 20 years before syptoms of chronic liver disease appear. There are treatments, but they don't work for everyone. New infection estimates vary widely, from about 30,000 a year to as many as 200,000. A recent six-week survey of inpatients at the VA Medical Center in Washington, D.C., revealed that 20 % of those surveyed tested positive for ehpatitis C antibodies, an indication that the disease is present. A similar survey at the VA Medical Center in San Francisco resulted in 10 % of the patients there testing positive. The virus claims the lives of 8,000 to 10,000 Americans each year.
Under the military's revised policy, the blood donated by service members will continue to be screened for the virus. But a positive test relust at that stage means the military must take a second step to determine whether the recruit or service member really has the hepatitis C disease. Those who test positive fore the virus will be referred to a physician, who will have to perform liver enzyme tests to determine the clinical presence of hepatitis C, said John Mazzuchi, deputy assistant secretary for clinical services.
Pre-existing Conditions
If the disease is present and the person has been in the servicfe for less than six months, hepatitis C will be considered a pre-existing condition and he or she will be discharged.
Service members who have been in for more than six months will be treated for the disease and allowed to continue service until they no longer are fit and are medically discharged. At that point, the ill person probably could get a disability rating from the VA. "Once you're here (beyond six months), we will take care of you until you can't do your job anymore", Mazzuchi said.
Risk Factors
People who are most at risk for hepatitis C are those who could come into contact with infected blood. They include people who received transfusions before 1992, when the most accurate blood-screening test was developed. The Pentagon policy change resulted from the complaints of the Armed Services Blood Program Office, which advises the military on blood policy.
Officials there questioned the fairness of dischargeing recruits who tested positive for the virus after donating blood. The ASBPO Blood Coordinating Committee said it "seems to be prejudicial to recruits who donate while those who do not donate are not tested and are allowed to continue to active duty even if infected.
If it is in the best interest of the services to discharge recruits who are positive for (hepatitisC), then the most equitable mechanism would be to test all recruits," according to minutes of an April 29 meeting.
The policy clarification coincides with a national effort by the U.S.Department of Health and Human Servives to educate primary-care doctors and the public about the virus and to contact people who received blood from donors who later tested positive for hepatitis C.
Meanwhile, the Department of Veterans Affairs recently told its health care providers to evaluate all patients for the virus. If a patient's medical or behavioral history raises a red flag, the patient will be screened.
At the Pentagon, health officials have no plans to screen the entire force, including recruits, for hepatitis C except through blood donations or through testing people with symptoms. Mazzuchi said, too, that the military's random drug testing and screeng for HIV and sexually transmitted diseases identifies some people who might be at risk for hepatitis C.
"Silent Epidemic" may spread faster than AIDS
by Deborah Funk
Times staff writer
Hepatitis C has been called the "Silent Epidemic" It infects tens of thousands of Americans each year, and kills about 10,000 others who have been living with the disease for years. As estimated 4 million Americans have hepatitis C, but most don't know it because they don't have any symptoms until they develop liver disease or liver failure decades after infection. Some predict that hepatitis C will become a bigger problem than AIDS in coming years.
Patients are at risk of unwittingly spreading the disease while it damages their liver. The hepatitis C virus that causes the disease is spread mainly through blood-to-blood contact, such as getting pricked with a needle that has infected blood on it. Blood-screening tests to detect the virus weren't developed and used until 1990, and were improved in 1992.
Hepatitis C is the most common cause of liver failure in people requiring liver transplants. Twenty percent of those infected develop cirrhosis of the liver, Surgeon General David Satcher told Congress earlier this year in testimony on the disease. Patients with the disease are treated with injections of Interferon, but it does not work for everyone. If the drug does not work after three months, treatment is stopped. IF the drug does work, regular injections are given for a year.
Those who relaps are treated with a combination of Interferon and a second drug, ribavirin, for 24 weeks. The Department of Veterans Affairs is particularly interested in the disease because of its prevalence in their patient population. Why the VA population may have high rates of hepatitis C is the subject of debate. VA patients tend to have lower incomes and it may be that such groups have a higher prevalence for hepatitis C.
Veterans Affairs is directing its doctors to evaluate all patients for hepatitis C risk factors. If they identify even one of 10 risk factors, the patient would be referred for testing. They are asking the patients if they have a history of:
How You Get It:
Sources: National Institutes of Health; American Liver Disease
Symptoms:
Sources: National Institutes of Health; American Liver Disease
Treatment:
Sources: National Institutes of Health; American Liver Disease
Get your own Free Home Page