That the field of medicine and health care includes significant and ongoing changes is a concept readily apparent to all. Such change requires its practitioners to be aware of new diseases, new treatments and modifications of practice required in contemporary medicine. Physicians in Minnesota are required to attend 75 hours of "classroom-type education" every three years to maintain their license to practice; similar requirements exist in other professional fields.
Last Friday, I attended an excellent conference presented by the staffs of the University of Minnesota Medical School, the Minnesota Department of Health, and the Mayo Clinic titled "Emerging Infections."About 270 physicians, nurses, laboratory professionals, and public health staff spent the day being advised about the "emerging" (and ongoing) infections pertinent to our environment.
As expected, the very serious outbreak of fungal meningitis related to the injection of contaminated steroid medication was thoroughly discussed. Diseases due to contaminated infant formulae, the spread of tick-borne diseases, and the significant epidemic of West Nile Virus infection were reviewed.
However, the increasing importance of a relatively new disease, Hepatitis C, was a noteworthy subject of discussion.
The viral diseases affecting the liver causing hepatitis (inflammation) and serious life-threatening conditions have an alphabetical spectrum. Hepatitis A is the disease associated with food-borne illness, contaminated water supplies, and travel. Hepatitis B is usually associated with perinatal transmission, blood transfusions, intravenous drug use, and sharing of body fluids, often resulting in serious acute and chronic illness.
Hepatitis C was "discovered" in 1989 following the examination of patients with hepatitis uncharacteristic of Hepatitis A or B, and thus called "Non-A, non-B hepatitis." The disease occurs only in humans and chimpanzees and is found throughout the world, mainly in South America, East Africa and China. One hundred and seventy million people are affected; about 4 million people carry the disease in the U.S. More than 150,000 patients are affected each year here at a cost of treatment of a billion dollars per year. Unfortunately, there is no preventive therapy (vaccine) for Hepatitis C.
Patients at high risk for Hepatitis C include persons with intravenous drug use, cocaine snorting, tattoos, multiple sexual partners, and children with infected mothers. Only 5-50 percent of infected patients know they are infected since they may have no symptoms.
Persons who are at risk and who should be tested (screened) for infection with Hepatitis C include intravenous drug users, those persons who had a blood transfusion before 1991, men who have sex with men, and persons who have a tattoo! This year public health authorities have recommended that all persons born between 1945 and 1965 be screened for Hepatitis C. The "baby boomers" may have been exposed to conditions conducive to infection with Hepatitis C.
Much like the "silent" epidemic of undiagnosed and untreated high blood pressure, the epidemic of Hepatitis C must be recognized and treated. Generalized routine screening and behavioral changes are part of the solutions for these serious public health challenges.