Up to 4,800 patients potentiall exposed to hepatitis C at Ogden hospital

OGDEN — Up to 4,800 people may have been exposed to hepatitis C by a now-fired nurse at McKay-Dee Hospital between June 2013 and November 2014, according to the Standard Examiner.

Per information released by the hospital Friday, 49-year-old nurse Elet Neilson (also known as Elet Hamblin), of Layton, was released in November 2014 after her admission of diverting emergency department drugs intended for patients, the Examiner reports. Neilson and a patient treated in the emergency department were both infected with the same hepatitis genotype, the Utah Department of Health reported, and the infections could be connected.

Due to concerns of exposure to the virus, letters to 4,800 people who may have been in contact with either individual were sent out Friday, the Examiner reports. It was unclear who infected whom or the method by which the infection took place, a hospital spokesman said, and officials are unsure if the disease has spread further.

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Medicaid officials want to expand access to pricey hepatitis C drug

Health care officials in Washington state thought thousands of Medicaid patients would line up to receive a breakthrough hepatitis C treatment that went on the market late last year.

Yet by June, the state had treated only a third as many hepatitis C patients as it had planned for — about 1,200 people.

Now, the state’s Medicaid authority wants to use the $44 million it didn’t spend over the past year to start covering the drug for a wider range of patients, instead of just the sickest ones.

State officials estimate about 75,000 to 100,000 people in Washington have hepatitis C, a blood-borne virus that can cause liver failure or liver cancer if left untreated. Nationwide, many people living with the disease are low-income patients who are eligible for Medicaid, officials said.

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Tattoos drawing attention

Note:  the article discusses the risk of tattoos and hepatitis C, but as this articles points out that it is a transmission route in unsafe settings--NOT in commercial settings were safety is being carefully followed.

Tattooing, once a fringe, minority pursuit, is going mainstream in Dunedin, local tattoo artists say, with everyone from law students to nurses inking their skin.

But, the council says as legitimate operations flourish, there has been a spike in tattooing of the underground, backyard variety, too.

There were eight registered tattoo studios in Dunedin, but many more illegal operators were working out of private homes, with no training, risky hygiene practices and cheap tools and ink, Dunedin City Council Environmental Health and Animal Services manager Ros MacGill said.

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Cherokee Nation Working to Eliminate Hepatitis C

The Cherokee Nation is on a mission to eliminate Hepatitis C, which officials call an epidemic.

According to the Centers for Disease Control and Prevention, the highest increase in Hepatitis C incidence from 2000 to 2013 was among Native Americans.

Dr. Jorge Mera oversees Cherokee Nation Health Services’ infectious diseases division. He said the first step is screening everyone age 20–69 for Hepatitis C, even though two out of three Americans with the disease were born between 1945 and 1965.

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Study suggests unprecedented 3-week hepatitis C cure

Yet another stunning victory in the drug battle against the liver-damaging hepatitis C virus (HCV) may be in the offing: A small study suggests it may be possible to cure some people of their infections in as few as 3 weeks.

Fresh on the heels of recent approvals of four new combinations of HCV drugs that clear infections of many different types of the virus in about 3 months, a team led by hepatologist George Lau of the Humanity & Healthy GI and Liver Centre in Hong Kong, China, has mixed and matched various compounds to see whether they could further shorten the route to a cure. Following 3 weeks of treatment, 18 HCV infected people given three different combinations of drugs met the standard definition of being cured—at 12 weeks after treatment began, they had no signs of HCV’s genetic material, RNA, in their blood on standard tests. The researchers plan to present this data publicly for the first time at a scientific conference known as The Liver Meeting in 2 weeks.

Until the new HCV drugs emerged, infected people required treatment for 8 months, and the therapies often failed and had severe side effects. Now, standard treatment protocol calls for taking HCV drugs for just 12 weeks. Cutting that treatment time even more dramatically is “really, really intriguing” says Shyam Kottilil, an HCV researcher at the Institute of Human Virology in Baltimore, Maryland. And if the results hold, it could slash the overall treatment cost of $100,000 required by the most popular drugs used for the 12-week treatment. Kottilil’s own study of a 4-week treatment—which tested different drug combinations on a different patient population—had only a 40% cure rate in the 50 participants. (That study is in press at Annals of Internal Medicine.)

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Findings about WWII-Era Spread of Hepatitis C Could Inform Future Prevention Efforts

The breakneck pace of clinical research means that, by necessity, there is little time to assess the past. But research published earlier this year in the Journal of Virology on the origins of the Hepatitis C virus (HCV) shows that such examination is not a morbid trip down memory lane, but rather can deliver key insights into current prevention efforts.   

The study, from researchers at the University of Glasgow, dates the beginnings of HCV to the 1940s and says it most likely arrived through the mass treatment of soldiers in field hospitals across the country during WWII. Under circumstances of war, hastily organized and overwhelmed care units meant that HCV was easily spread easily between soldiers as their injuries were treated.   

Using statistical analysis to examine the transmission dynamics, the researchers say, can help provide a basis for identifying HCV transmission hotspots. They posit that a more comprehensive understanding of exactly how hepatitis C virus is transmitted during times of significant spread could facilitate public health initiatives to reduce the prevalence of HCV in people who contract it through intravenous drug use.

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Article: Hepatitis B Virus Reactivation During Successful Treatment of Hepatitis C Virus with Sofosbuvir and Simeprevi

This article is being re-posted from a previous newsletter.  I have been hearing from patients who have been inquiring about treatment with a DAA and who are also co-infected with chronic hepatitis B.  People co-infected with HCV and HBV should make their medical providers aware that their chronic hepatitis B should be monitored on a regular basis.  The article below recommends that people being treated with a DAA should be monitored every 2 weeks.  -Alan

Snapshots - Alan Franciscus

Article:  Hepatitis B Virus Reactivation During Successful Treatment of Hepatitis C Virus with Sofosbuvir and Simeprevir—J. M. Collins et. Al
  Source:  Clinical Infectious Diseases Advance Access

Results and Conclusions: This was a case report of two individuals with hepatitis C. 

The first case was a 55 yo man who was coinfected with hepatitis B and hepatitis C genotype 1a.  He had been previously treated with pegylated interferon plus ribavirin but did not achieve a cure.  He was started on sofosbuvir and simeprevir.  After week 4 he was HCV undetectable, but at week 7 he started to have severe liver symptoms (AST of 1792 IU/L, ALT of 1495 IU/L, total bilirubin of 12.2 mg/dl and INR of 1.96) and his hepatitis B viral load rose to 22 million.  His other tests (antinuclear antibody, ferritin, a-fetoprotein, etc.) were also abnormal.

The HCV treatment was discontinued, and hepatitis B treatment (tenofovir/emtricitabine) was started and the hepatitis B viral load subsequently decreased to less than 20 IU/mL.  The hepatitis B treatment was continued for ongoing hepatitis B suppression.

The second case was a 57 yo man with HCV genotype 1a.  He had been treated for HCV with pegylated interferon plus ribavirin but had not been cured. He was positive for the hepatitis B virus, but the hepatitis B viral load was below the level of detection (20 IU/mL).  He was started on HCV treatment—sofosbuvir and simeprevir and his HCV and hepatitis B viral loads were monitored every two weeks.  After two weeks, his HCV viral load was undetectable and his hepatitis B viral load increased to 353 IU/mL.  After four weeks of HCV treatment, HCV was still undetectable, but the hepatitis B viral load increased to 11,255 IU/mL.  The liver function tests were normal, and there were no other signs of liver disease.  The patient remained on sofosbuvir/simeprevir treatment.  Tenofovir was added to the HCV treatment regime to treat hepatitis B. 

The Bottom Line:  The reactivation of HBV in people who were coinfected with HBV and HCV was rare in the days of pegylated interferon based therapies.  This was most likely because PEG works against HBV whereas the new HCV direct acting antivirals do not have antiviral properties that will suppress hepatitis B while treating HCV.   

Editorial Comment:  A couple of important points:

• Everyone with hepatitis C should be tested for hepatitis B (and A), and if not previously infected should be vaccinated.
• People who are chronically infected with HBV and HCV who are being treated with the direct-acting antiviral medications (Harvoni or Viekira Pak) and monitored very closely—every two weeks as listed in the second study—for HBV flares and treated for chronic HBV as needed.