Casting a Wider Net for Cases of Hepatitis C, the ‘Baby Boomer’s Virus’

Lilo H. Stainton | March 17, 2016 | Health Care
Pending legislation would require screening for high-risk patients at clinics, doctors’ offices, and hospitals

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Baby boomers are five times more likely to be carrying the Hepatitis C virus, healthcare experts have found, but efforts to expand screening in New Jersey could help protect hundreds of thousands of residents — and make the state a leader in addressing this persistent infection.

An estimated 150,000 Garden State residents now carry the disease, many without showing signs or knowing they are sick, according to advocates for more testing. If the virus becomes active it can cause liver disease, cancer, and even death. It can also infect others who come into contact with contaminated blood. Symptoms can include fever, jaundice, and vomiting, among others.

While the reasons are not entirely understood, baby boomers — those born between 1945 and 1965 — now make up more than 75 percent of the 3.2 million adults diagnosed with the infection nationwide, according to the Centers for Disease Control and Prevention. Since the disease can lie dormant for decades, CDC scientists believe these boomers probably became infected during the 1970s and 1980s when Hep-C rates were the highest, and the symptoms of the virus are just becoming visible now.

Other groups at risk for Hep-C include people who use or used intravenous drugs, have or had multiple unprotected sexual partners, or were exposed to the virus through a pre-1992 blood transfusion or from working around infected patients. Vaccines have been developed to ward off Hepatitis A and B — generally less severe forms of the disease — but there is no preventative medicine to guard against Hep-C.

Identifying Hep-C is the first step toward any treatment and containment. That’s why Sen. Joseph Vitale (D-Middlesex) has worked for several years on a plan to expand screening for high-risk patients at clinics, doctors’ offices, and hospitals. The full Senate approved the measure (S-1279) Monday and a companion bill (A-3337) sponsored by Assemblyman Reed Gusciora (D-Mercer) awaits a hearing in the Assembly health committee.

The CDC recommends baby boomers and groups at high risk for the infection get tested for Hep-C. Many states require doctors to offer the screening and connect patients with follow-up care, as needed. The bill sponsored by Vitale and Sen. Fred Madden (D-Gloucester) takes this further by mandating that hospitals also make the test available, with certain exceptions for patients in crisis. New York State was among the first to require hospitals to play a role, through a law that took effect in 2014.

[related]“We need to make sure that there is a pathway for anyone who needs testing and information,” explained Vitale, whose own father lost his life to the disease after contracting the infection through a blood transfusion. The legislation would require providers, including hospital ER staff, to offer the test along with any other bloodwork required, or on its own. Patients can decline to be tested.

Linda Schwimmer, who leads the New Jersey Healthcare Quality Institute, said hospital testing is particularly important for patients who have a history of intravenous drug use or other risky behavior. This prompted providers in Alabama and Oakland, CA, to advocate for hospital testing, she said.

“Although the CDC encourages the testing to be done in a primary-care setting, which makes sense, many people who are more likely to test positive do not have a primary-care provider and testing them in the emergency department may be the most likely way to get to testing, and then education, and referral to a community provider for treatment,” Schwimmer said.

The New Jersey Hospital Association, the trade association for more than 300 hospitals, nursing homes, and other care facilities, opposed the bill at first, pointing out that the federal Medicare program recommends testing be handled by primary-care doctors. Vitale took the group to task at a legislative hearing earlier this month, suggesting their position “did not serve the public interest.”

NJHA spokeswoman Kerry McKean said Tuesday the group was reconsidering and would be discussing the measure with its board. “We have had ongoing conversations with Sen. Vitale and we appreciate his position,” she said.

At least one hospital has already embraced the testing process, thanks in part to a grant from Gilead Sciences, the drug company behind a pair of new, promising, but costly treatments for Hep-C. Holy Name Medical Center in Teaneck began earlier this month to offer the blood tests to baby boomers who came through the emergency room; hospital officials anticipate screening 9,000 people this year.

Doctors say that while the initial Hep-C test is easy and inexpensive, providers don’t always include it when they conduct an annual physical — and patients don’t know to ask. If the test reveals Hep-C antibodies — chemicals in the blood released by the body to fight specific diseases — it means the patient has been exposed to the virus. If antibodies are found, a second test is required to determine the level of exposure and an appropriate treatment.

New Jersey’s Department of Health encourages baby boomers and others at risk to get tested and provides links to CDC information and other resources on its website. The department can also connect patients with facilities that can offer low-cost or free testing to those in need.

Gusciora, sponsor of the Assembly bill, said proactive testing makes sense on many levels. “Hep-C comes with so much social and economic cost to the state,” he said, noting that public funds are often required to help cover the medical bills for un- and under-insured patients with serious liver disease. “The more the disease advances the more it costs the state.”