Your Fireman are now called 'junkies' by the CDC

February 22, 2000

Among firefighters, the call for testing is now nationwide.

Hepatitis worries cast a long shadow

By Lin

INQUIRER STAFF WRITER

Firefighters across the country are scrambling to find out whether the

hepatitis C crisis in Philadelphia is a problem they face as well.

Philadelphia firefighters have three times the national infection rate for

the virus that causes hepatitis C, a disease more prevalent than AIDS and so

destructive that 15 percent of patients will suffer liver failure, requiring

transplants.

" We realize today it's them, tomorrow it could be us, " said Kemery, a

firefighter in Gloucester Township.

Firefighters in San Francisco and Chicago are pushing for testing, and those

in Miami and Honolulu already have testing plans. Even the small fire and

rescue squad in Brigantine, N.J., has bought 33 test kits.

Coming to their aid, U.S. Rep. A. Brady (D., Phila.) last week

proposed spending $10 million for national testing of firefighters. The

virus

for hepatitis C is transmitted by blood and can be detected through a simple

blood test, available at drugstores.

About half of the 4,400 active and retired firefighters in Philadelphia have

been tested confidentially for the hepatitis C virus. Of those, 6 percent

tested positive. Among the public, the infection rate is 1.8 percent of the

population, according to the federal Centers for Disease Control and

Prevention.

What's more, the disease is hitting veterans of the department hardest.

Philadelphia firefighters ages 50 to 59 have an infection rate that is four

times the national average for men in the same age group. For local

firefighters in their 40s, the incidence rate is nearly double the national

rate for men that age, according to statistics provided by the Home Access

Health Corp. of Chicago, which tested Philadelphia firefighters last fall.

If untreated, the hepatitis C virus can lead to cirrhosis, advancing to

liver

failure or liver cancer.

" There's panic, " said Casey, president of Local 22 of the

Philadelphia

Fire Fighters' Union.

Firefighters fear that they run a greater risk of contracting the disease

because of the changing nature of their work. In many cities, including

Philadelphia, firefighters do more than put out fires. Locally, three out of

four calls are for emergency medical rescues that put firefighters in direct

contact with blood - the chief medium for transmitting the hepatitis C

virus.

Many suburban fire departments, such as those in South Jersey, also handle

rescue work. But in the Pennsylvania suburbs, most fire services respond

only

to fires, leaving emergency medical calls to hospitals.

Some medical experts doubt that firefighters run a greater risk of

contracting hepatitis C on the job. The most common cause of infection is

through intravenous drug use.

But the local union rejects that explanation, saying it cannot account for

the alarmingly high infection rate. It argues that the constant exposure to

blood in uncontrolled situations is a more logical cause.

" We're the first ones on the scene, so it's not similar to health-care

workers, " Casey said. " Doctors look like astronauts today. But sometimes we

have to rescue people from auto wrecks. You have to take off your helmet,

your coat, your mask to get under a car to help them. "

Only about two dozen of the 132 local firefighters with the virus have

notified the department or the union. Casey said many are afraid doing so

will hurt their careers. Others fear the stigma that this is a drug user's

disease.

Casey has heard enough stories to know that this crisis is worse than any

other.

He has seen families exhaust savings and use credit cards to buy the only

drug therapy - a combination of interferon and ribavirin that costs $17,650

for a year's supply.

He has witnessed the shock of firefighters like 37-year-old Kohler, who

has seen her love for rescue work eclipsed by a fear that someone she helped

made her sick.

And he has prayed for victims like Myers, 51, who is so stricken by

liver failure that he lies on the sofa waiting for the hospital to call with

news of a liver donor.

Overnight, Casey, 53, has become an expert on the disease. He spends hours

at

home scanning Web sites for information and highlights passages with a

yellow

marker as he pores over medical texts.

One of the people to call him was Greg Matney, a 55-year-old Honolulu

firefighter who needs a new liver. He told Casey that the Honolulu Fire

Department had stymied his earlier efforts to get fellow firefighters

screened for the virus. But the news in Philadelphia changed attitudes

overnight. This week, the Honolulu department started making plans to test

all 1,129 firefighters.

" Everyone jumped and started changing all their thinking on dealing with

hepatitis C, " Matney said.

Testing for hepatitis C is critical because symptoms can take 10 to 30 years

to develop. That's why former U.S. Surgeon General C. Everett Koop dubbed

the

disease " a silent epidemic. " Few people even know they are infected, even

though an estimated 4 million Americans test positive for the hepatitis C

virus.

Unlike hepatitis B, there is no vaccination for hepatitis C and it typically

is a chronic condition that attacks the liver over a longer period. Before

blood banks screened for the hepatitis C virus, it was transmitted via blood

transfusions. The virus also can be spread by sharing needles, or coming

into

contact with tainted blood from tattoos, body piercing or sexual activity.

Since the AIDS crisis came to light in the mid-1980s, firefighters have

known

about the dangers of blood-borne diseases. But until a decade ago, many of

them took a lax approach to precautions. Firefighters, especially the

paramedics on the force, wore blood on their uniforms like a badge of honor.

Today, they know better.

Not long ago, Casey was off duty when he came across a woman who had

cut her forehead after falling on ice.

" I hesitated, " said Casey, a 32-year veteran firefighter. " For the first

time

in my life, I actually hesitated. "

Kohler is No. 132 - the latest firefighter to test positive for the

hepatitis C virus.

" It's very scary to get the paperwork in the mail that tells you how to ask

about medical coverage for a liver transplant, " said Kohler, whose husband,

Bill, is a former city firefighter. They live in the Northeast.

Kohler talks about her work as a calling. Her hometown of Nahunta, Ga., was

so small there wasn't a hospital for 30 miles. The funeral director used his

hearse for emergency runs to the hospital. When the town got its first

emergency rescue squad, Kohler was entranced.

" They were my heroes, " said Kohler, a paramedic for 11 years and the

department's first female lieutenant.

Now, not a moment goes by when she doesn't wonder who gave her the disease.

Was it the newborn delivered by a middle-aged woman into a toilet bowl? All

Kohler could see were the baby's buttocks. She pulled the child out, cut the

umbilical cord and put her lips over the baby's mouth and nose, never

stopping to wonder about the blood on the baby, never stopping to put on

gloves.

" We don't think that way, " she said. " We have a duty to act and for the most

part nothing gets in our way. "

Kohler said that when she joined the department, latex gloves were available

in only one size - men's. They slipped off her hands and made her fumble

with

instruments. In the cold, they cracked.

" Hepatitis C was never a subject we discussed. Never were we trained about

it, " said Kohler, who was a paramedic instructor at the Philadelphia Fire

Academy before taking a job at headquarters.

Today, firefighters wear better gloves that resist punctures. They are

equipped with goggles and special masks to put on victims before

administering mouth-to-mouth resuscitation. They approach every victim as a

potential carrier of disease.

" There was a time we wouldn't fear children, " said Bill Kohler. " It wasn't

even a thought. A child could never hurt you. Now we know it's not true. "

Kohler went public as soon as she found out she was infected with the

virus. " I have nothing to be ashamed of, " she said. " I know I never used

drugs. I've never had a transfusion. I've never been promiscuous. There is

no

other place that I could have gotten it than doing my job. "

If Kohler started to develop symptoms, she would have to prove to the city

that she contracted the disease on the job in order to qualify for workers'

compensation. The union is lobbying burg lawmakers to extend automatic

coverage for hepatitis C to firefighters, as it has to other emergency care

workers.

Miriam Alter, a CDC epidemiologist, said a majority of hepatitis C

infections

are from lifestyle risk factors, rather than occupational risks. Although

the

CDC has not studied firefighters, she said it has looked at health-care

workers as an overall group.

" We've studied hepatitis C among health-care workers with frequent exposure

to blood, such as orthopedic surgeons, " Atler said. " They do not have

elevated rates of hepatitis C.

" Therefore, even though the firefighters are first on the scene and exposed

to blood in uncontrolled situations, it is likely that a majority of their

infections are due to non-occupational risk factors, " she said.

In addition, she said that studies of hepatitis B, another blood-borne

disease, have shown that a majority of infections among so-called first

responders such as firefighters and paramedics came from non-occupational

risk factors.

Only a few cities - Phoenix, Tucson, Portland, Ore., and a handful of towns

in Florida - have screened firefighters for the hepatitis C virus. In each

case, the infection rate was close to the national average.

But several medical and public health experts argue that it would be a

mistake to dismiss the problem in Philadelphia. They said that a nationwide

survey is necessary to determine whether Philadelphia is an anomaly or the

norm.

" These are staggering numbers, " said Alan Brownstein, president of the

American Liver Foundation. " It's important for the awareness of hepatitis C

and for firefighters in Philadelphia not to trivialize this. "

For Myers, the debate over how firefighters are infected is

meaningless. He faces a bigger dilemma: He will die unless he gets a new

liver.

He is embarrassed to let his friends see him nowadays and spends all his

time

at home in Southwest Philadelphia. He has lost 65 pounds. He looks 70 rather

than 51. His belly is distended. His liver no longer functions. So much

ammonia builds up in his system that thinking clearly is difficult for him.

" I'm convinced I got it on the job, " said Myers, too weak to talk much. " If

only a couple of people had it, that would be different. But 132? "

When he retired in 1996, he was diagnosed with cirrhosis, a severe scarring

and obstruction of the liver. Even though he was under a doctor's care for

hernia problems, he was not tested for hepatitis C until the union called

everyone in for testing in November. His test came back positive.

His wife is angry and afraid. " The guys he went to fire school with haven't

been tested yet and it bothers him, " Shirley Myers said.

If her husband had been tested years ago, she said, " maybe he wouldn't be

going through this today. "

VA: Vets last year, 31% were positive for HCV

>Dear Philly Firefighters,

>

>Note: US Veteran Population is 26 Million today, and growing.....

> " The present veteran population is estimated at 25.6 million, as of July 1,

>1997. " http://www.va.gov/organization/Vavdva.htm

>

>31% HCV infection rate, times 26 million = 8.06 million US Veterans that

>might have HCV today.

>

>Where's the outrage?

>

>The CDC has told America that HCV is from IV Drug use. The WWII and Korean

>War vets with HCV are not junkies and their families are not pleased to

find

>this Government in a process of yet another cover-up. This time concerning

>million, if not tens of millions, of US Citizens.

>

>The Veterans have tried to carry the message for 2 years now but many are

>gone and most are very ill. We need for you to speak now strongly on this

>matter and have this government explain why children are mandated to

receive

>HBV vaccines. Simply put, this Government is now misleading millions of

>Citizens to the

>point of our demise.

>

>This Government may claim that all the US Veterans that have died from

>hepatitis in the past 58 years, from a vaccination that began at the

>Rockefeller Foundation [Yellow Fever and HBV] and was given to US Military,

>is a National Security issue. But, the death of your fireman should not be

>covered up as well.

>

>I hope that your brave fireman are not labeled in the same manner that

three

>generations of proud US Veterans and their families have been.

>

>Almost every veteran has a prior HBV, but America is not to know that HBV

>transduces to HCV. Ask National Security why.

>

> Donnelly

>Captain, USAR

>

>``In 95,447 tests for hepatitis C conducted among veterans last year, 31

>percent were positive for the hepatitis C antibody.''

>

>Friday April 16, 3:38 pm Eastern Time

>Company Press Release

>SOURCE: House Committee on Veterans' Affairs

>Briefing Unveils Hepatitis C Virus as Emerging Health Threat to U.S.

>Veterans

>

>WASHINGTON, April 16 /PRNewswire/ -- Congressman Vic Snyder (D-AR) joined

>with health policy experts today to brief Congressional staff on the impact

>of the hepatitis C virus on U.S. veterans and the need to ensure that

>infected servicemen can receive the treatment they need through Department

>of Veterans' Administration (VA) facilities.

>

>Symptoms of hepatitis C may not appear for 10 to 30 years after infection.

>As a result, veterans infected with the virus during military service can

>have difficulty establishing a service-to-disease connection. Without proof

>of a service-related infection, most of these veterans have difficulty

>obtaining treatment for this disease in VA facilities.

>

>Hepatitis C is the most common blood-borne infection in the United States.

>About 1.8 percent of Americans are infected. In comparison, infection rates

>among American veterans are estimated to be considerably higher.

>

>``The number of hepatitis C cases reported among veterans has increased in

>the last decade,'' said panel member Dr. Roselle, VA Medical Center,

>Cincinnati. ``In 95,447 tests for hepatitis C conducted among veterans last

>year, 31 percent were positive for the hepatitis C antibody.''

>

>On March 4, 1999, Congressman Vic Snyder and Senator Olympia Snowe (R-ME)

>introduced legislation (H.R. 1020 and S. 71, respectively) which would

>establish a presumption of service connection for veterans with hepatitis

C.

>Both bills have been referred to the appropriate House and Senate VA

>committees for review.

>

>``Because of exposure to risk factors, veterans appear to have a much

higher

>incidence of hepatitis C than in the general population,'' Snyder said.

>``Establishing service connection can be difficult under current law for

>many veterans.''

>

>``Service connection will enable veterans infected with hepatitis C to

>receive potentially life-saving treatments without experiencing the delays

>they often face now,'' said panelist Bill Russo, Director of Benefits,

>Vietnam Veterans of America.

>

>``The expense of treatment now will be nearly recouped by preventing

>expensive procedures, like liver transplantation, in the future,'' said

>panelist B. Wong, MD, New England Medical Center, Tufts University

>School of Medicine, Boston. Hepatitis C is now the leading cause of liver

>transplantation in the United States and accounts for about half of liver

>transplants conducted at VA facilities.

>

>Hepatitis C is spread primarily by direct contact with contaminated blood.

>The Centers for Disease Control and Prevention (CDC) estimates that nearly

4

>million Americans have been infected with the virus. Left untreated,

>hepatitis C can lead to chronic hepatitis, cirrhosis (scarring of the

>liver), liver cancer, and death.

>

>Other panelists included, Miriam Alter, Ph.D, Hepatitis Branch, Centers for

>Disease Control and Prevention; Terry Baker, Veterans Service Officer,

>Delaware VA, hepatitis C patient; and Doug Wallin, Assistant Director,

>Compensation and Pension Services, Department of Veterans' Affairs.

>

>SOURCE: House Committee on Veterans' Affairs

>

>---------------------------------------------------------------------------

-

>http://biz./prnews/990416/dc_congres_1.html

>

>Hep C Bill Would Aid Firefighters

>

>http://www.phillynews.com/daily_news/2000/Feb/16/local/HEPC16.htm

>

>by Knipe Brown

>Daily News Staff Writer

>

>The plight of Philadelphia firefighters struggling with the deadly

>hepatitis

>C virus has led to a proposed federal law that may help save the lives of

>firefighters and paramedics across the country.

>

>U.S. Rep. Bob Brady of Philadelphia yesterday introduced a bill to provide

>more than $10 million nationwide for hepatitis C treatment, testing and

>education for firefighters and other emergency response workers.

>

> " This is just the beginning, " Brady said. " We want to get it known that

this

>is a national problem affecting people who put their lives on the line

every

>single moment, never knowing whether they're going to come home at the end

>of

>the day or night. "

>

>Philadelphia is the first major city in the nation to test its firefighters

>for hepatitis C, a blood-borne disease that attacks the liver.

>

>In November, 130 city firefighters, or 6 percent of the 2,100 tested, were

>diagnosed with the hepatitis C virus. At least two firefighters have died

of

>the disease and others are seriously ill.

>

>The rate, health experts say, is three times the national average of 1.8

>percent.

>

>Since Philadelphia's epidemic became public, Casey, president of the

>city Firefighters' Union, has fielded dozens of calls from fire departments

>across the nation concerned about the disease.

>

> " This is not just a Philadelphia problem, " Casey said yesterday. " I have

>taken calls from Chicago, Miami and Las Vegas indicating that this is

>something affecting firefighters across the country. "

>

>Legions of firefighters are expected to descend on Washington in March to

>push for passage of the bill as part of their annual legislative lobbying

>effort, he said.

>

> " We believe we should be taken care of by our municipalities and our

federal

>government, " Casey said.

>

>Federal, state and local action is necessary because, while there is no

>vaccine or cure, the disease can be controlled with early diagnosis and

>treatment, Casey said.

>

>Firefighters also are pushing for changes in the Pennsylvania Workers

>Compensation Act which would designate hepatitis C as an occupational

>illness.

>

>In support of changes in the act, state Rep. Curtis of Philadelphia

>has introduced a bill calling for an investigation to determine whether a

>statewide epidemic exists among firefighters and paramedics.

>

>Philadelphia firefighters and their doctors believe they were infected in

>the

>line of duty through contact with the blood and body fluids of sick

patients

>and fire and accident victims.

>

>Brady's bill comes little more than a month after a special Daily News

>report

>detailing the epidemic among city firefighters, and how the city had

refused

>to recognize the problem.

>

>Shortly thereafter, Mayor Street pledged to allocate up to $3 million a

year

>to help cover the costs of treatment for stricken firefighters and

>paramedics.

>

>Volunteer firefighters also are included in Brady's bill.

>

>The legislation has been sent to a House committee, which will review it

and

>determine whether to hold public hearings on the issue. Brady said he plans

>to fight to ensure the bill doesn't languish in committee for eternity.

>

>Brady, a Democrat, said his bill has bipartisan support, with Rep. Curt

>Weldon, R-Pa., of Delaware County, a volunteer firefighter, co-sponsoring

>the

>measure.

>

> " I don't know anybody who could be against it, " Brady said. " How can

anybody

>be against taking care of firefighters? "

>

>-----------------------------------------------------------------------

>Send e-mail to knipej@...

>

>Mortality of Korean War Veterans Infected with Hepatitis C Virus

>

>A cohort of approximately 100 veterans have been identified as Hepatitis C

>Virus (HCV) infected by testing a collection of serum specimens collected

>from approximately 9,500 military recruits during the period 1949 to 1954.

>Along with a control cohort of 400 HCV negative recruits, these individuals

>will be followed up for all-cause and cause-specific mortality endpoints in

>order to describe the long-term natural history of HCV infection. These

>veterans represent an excellent surrogate population for the thousands of

>infected blood donors now being identified as the result of the discovery

of

>HCV and the development of highly specific tests.

>

>Study Director

> , M.D., M.P.H.

>Institute of Medicine

>Email: rmiller@...

>

> http://www2.nas.edu/mfua/2172.html

>

>------------------------------------

>TITLES

>------------------------------------

>

>Intro:

>

>1999 Jul

>Natural and iatrogenic variation in hepatitis B virus.

>

>1999 Aug

>A likelihood-based method of identifying contaminated lots of blood

product.

>

>1998 - May

>Incidence of hepatitis C in patients receiving different preparations of

>hepatitis B immunoglobulins after liver transplantation.

>

>1987 Apr

>A serologic follow-up of the 1942 epidemic of post-vaccination hepatitis in

>the United States Army.

>

>1986

>Transmission of AIDS virus by transfusion and blood products. Risks and

>preventive strategies].

>

>1984 Dec

>Antibody to the hepatitis B virus-associated delta-agent in immune serum

>globulins.

>

>1980 Jan-Feb

>Levels of anti-A and anti-B in commercial immune globulins.

>

>1976 Mar-Apr

>Hepatitis B virus and hepatitis B surface antigen in human albumin

products.

>

>1975 Sep-Oct

>Antibody to the hepatitis B surface antigen in immune serum globulin.

>

>1972 Nov

>Posttransfusion hepatitis after exclusion of commercial and hepatitis-B

>antigen-positive donors.

>

>------------------------------------

>ABSTRACTS

>------------------------------------

>

>Rev Med Virol 1999 Jul;9(3):183-209

>

>Natural and iatrogenic variation in hepatitis B virus.

>

>Ngui SL, Hallet R, Teo CG

>Section of Hepatology, Rush-Presbyterian-St. Luke's Medical Centre, 1725

>West on, Chicago, Illinois 60612, U S A.

>

>The existence of HBV as quasispecies is thought to be favoured by the

>infidelity of HBV RT, which would account for the emergence of the many

>natural mutants with point substitutions.

>

>RT infidelity may also underlie the hypermutation phenomenon.

>

>Indeed, the oft-reported point mutation in the preC gene that leads to

>failure of HBeAg synthesis may be driven by a hypermutation-related

>mechanism.

>

>The presence of mutants with deletions and insertions involving single

>nucleotides and oligonucleotides at specific positions in the genome, and

of

>mutants with deletions of even longer stretches particularly in the C gene,

>suggests that other mutagenic mechanisms operate.

>

>Candidates include

>

>slippage during mispairing between template and progeny DNA strand,

>

>the action of cellular topoisomerase I, and

>

>gene splicing using alternative donor and acceptor sites.

>

>Natural substitutions, deletions or insertions involving the Cp/ENII locus

>in the X gene can significantly alter the extent of viral replicative

>activity.

>

>Similar mutations occurring at other locations of Cp/ENII, and at B-cell

>epitope sites of the S gene are associated with failure to detect

>serological markers of HBV infection.

>

>HBV variation can also arise from recombination between coinfecting

strains.

>

>S gene mutations that become evident following HBIG [HB Immune Globulin]

>administration and HBV vaccination are all point substitutions, as are

>mutations in functional RT domains of the P gene after treatment with viral

>RT-inhibitory drugs.

>

>Widespread and long-term use of prophylactic and therapeutic agents may

>potentially generate serologically occult HBV variants that might become

>difficult to eradicate.

>

>PMID: 10479779

>

>[NOTE: in short - HBV Immune globulin [HBIG] mutates the same way HBV does

>when exposed internally to radiation therapy........ that leads to the

>below.....]

>

>Int J Epidemiol 1999 Aug;28(4):787-92

>

>A likelihood-based method of identifying contaminated lots of blood

product.

>

>Reilly M, Lawlor E

>Department of Statistics, University College Dublin, Ireland.

>

>BACKGROUND:

>

>In 1994 a small cluster of hepatitis-C cases in Rhesus-negative women in

>Ireland prompted a nationwide screening programme for hepatitis-C

antibodies

>in all anti-D recipients.

>

>A total of 55 386 women presented for screening and a history of exposure

to

>anti-D was sought from all those testing positive and a sample of those

>testing negative.

>

>The resulting data comprised 620 antibody-positive and 1708

>antibody-negative women with known exposure history, and interest was

>focused on using these data to estimate the infectivity of anti-D in the

>period 1970-1993.

>

>METHODS:

>

>Any exposure to anti-D provides an opportunity for infection, but the

>infection status at each exposure time is not observed. Instead, the

>available data from antibody testing only indicate whether at least one of

>the exposures resulted in infection. Using a simple Bernoulli model to

>describe the risk of infection in each year, the absence of information

>regarding which exposure(s) led to infection fits neatly into the framework

>of 'incomplete data'.

>

>Hence the expectation-maximization (EM) algorithm provides estimates of the

>infectiousness of anti-D in each of the 24 years studied.

>

>RESULTS:

>

>The analysis highlighted the 1977 anti-D as a source of infection, a fact

>which was confirmed by laboratory investigation.

>

>Other suspect batches were also identified, helping to direct the efforts

of

>laboratory investigators.

>

>CONCLUSIONS:

>

>We have presented a method to estimate the risk of infection at each

>exposure time from multiple exposure data.

>

>The method can also be used to estimate transmission rates and the risk

>associated with different sources of infection in a range of infectious

>disease applications.

>

>PMID: 10480712, UI: 99408589

>

>Ann Intern Med 1998 May 15;128(10):810-6

>

>Incidence of hepatitis C in patients receiving different preparations of

>hepatitis B immunoglobulins after liver transplantation.

>

>Feray C, Gigou M, D, Ducot B, Maisonneuve P, Reynes M, Bismuth A,

>Bismuth H

>Centre Hepato-Biliare, Laboratoire d'Anatomo-Pathologie et Transfusion

>Sanguine, Hopital Brousse, and Universite Paris-Sud, Villejuif,

France.

>

>BACKGROUND: Recurrence of hepatitis B virus (HBV) or hepatitis C virus

(HCV)

>infection after liver transplantation is a clinical problem. Polyclonal

>immunoglobulins against hepatitis B surface antigen (HBIGs) prevent the

>recurrence of HBV infection, but no effective prophylaxis is available for

>HCV infection.

>

>Before screening of blood donors was introduced in France, HBIGs may have

>contained antibody to HCV (anti-HCV).

>

>OBJECTIVE: To determine the influence of HBIG on the occurrence of

hepatitis

>C after liver transplantation before and after 1990. DESIGN: Retrospective

>cohort study. SETTING: Liver transplantation unit of a university hospital.

>PATIENTS: 428 consecutive patients who had liver transplantation because of

>cirrhosis between 1984 and 1994. MEASUREMENTS: Detection of serum HCV RNA

>before and 1 year after transplantation and findings on liver graft biopsy.

>RESULTS: Among the 218 patients who had HCV infection before

>transplantation, the incidence of HCV viremia after transplantation was

>lower in those receiving HBIG than in those not receiving HBIG (25 of 46

>patients [54%] compared with 162 of 172 patients [94%]; P < 0.001). In

>patients receiving HBIG, the incidence of HCV viremia after transplantation

>was lower among those who had transplantation before March 1990 than among

>those who had transplantation after this date (15 of 33 patients [45%]

>compared with 10 of 13 patients [77%]; P = 0.05). Among the 210 patients

>without HCV infection before transplantation, acquired infection was

>significantly less frequent in those receiving HBIG than in those not

>receiving HBIG (18 of 68 patients [26%] compared with 40 of 86 patients

>[47%]; P < 0.001). Passively transmitted anti-HCV was transiently detected

>in patients receiving HBIG before March 1990. Multivariate analysis in

>patients with HCV infection before transplantation showed that the absence

>of HBIG and transplantation after March 1990 were independent significant

>risk factors for chronic hepatitis C after transplantation. CONCLUSIONS:

>Polyclonal immunoglobulins that are treated for viral decontamination and

>contain anti-HCV could prevent HCV infection.

>

>PMID: 9599192, UI: 98243005

>

>N Engl J Med 1987 Apr 16;316(16):965-970

>

>A serologic follow-up of the 1942 epidemic of post-vaccination hepatitis in

>the United States Army.

>

>Seeff LB, Beebe GW, Hoofnagle JH, Norman JE, Buskell-Bales Z, Waggoner JG,

>Kaplowitz N, Koff RS, Petrini JL Jr, Schiff ER, et al

>

>An epidemic of icteric hepatitis in 1942 affected approximately 50,000 U.S.

>Army personnel.

>

>This outbreak was linked to specific lots of yellow-fever vaccine

stabilized

>with human serum.

>

>To identify the responsible virus and the consequences of the epidemic,

>during 1985 we interviewed and serologically screened 597 veterans who had

>been in the army in 1942.

>

>These subjects were selected from three groups.

>

>Group I consisted of patients who had received the implicated vaccine and

>had jaundice;

>

>Group II had received the implicated vaccine but remained well;

>

>Group III had received a new, serum-free vaccine, with no subsequent

>jaundice.

>

>Ninety-seven percent of Group I,

>76 percent of Group II, and

>13 percent of Group III

>

>were positive for antibodies to hepatitis B virus.

>

>Only one subject had hepatitis B surface antigen, for a carrier rate of

0.26

>percent among recipients of the implicated vaccine.

>

>The prevalence of hepatitis A antibody was similar in all three groups, and

>no subject had antibody to hepatitis delta virus.

>

>We conclude that hepatitis B caused the outbreak, that about 330,000

persons

>may have been infected, that the hepatitis B virus carrier state was a rare

>consequence, and that the outbreak induced hepatitis B antibodies that

>appear to persist for life.

>

>PMID: 2436048, UI: 87172914

>

>Gastroenterology 1984 Dec;87(6):1213-6

>

>Antibody to the hepatitis B virus-associated delta-agent in immune serum

>globulins.

>

>Ponzetto A, Hoofnagle JH, Seeff LB

>

>Fifty lots of immune serum globulin prepared by four United States

>manufacturers between 1944 and 1977 were tested for the presence and titer

>of antibody to the hepatitis B virus-associated delta-agent. Anti-delta was

>detected in 28 of the 50 lots (56%) of immune serum globulin at titers

>ranging from 1:10 to 1:400. Anti-delta was present in 75% (6 of 8) of lots

>produced between 1962 and 1965, in 77% (17 of 21) produced between 1967 and

>1970, in 45% (5 of 11) produced between 1971 and 1972 and in none (0 of 9)

>produced since 1973. A single lot of globulin prepared from plasma that was

>collected in 1944 from United States Army soldiers also contained

detectable

>anti-delta. These data indicate that delta-infection has been occurring

>among hepatitis B surface antigen (HBsAg) carriers in the United States

>since the 1940s. The decrease in prevalence of anti-delta in immune serum

>globulin lots coincided with the start of routine HBsAg screening of blood

>and plasma. The elimination of HBsAg-positive units from plasma pools has

>reduced levels of HBsAg and anti-delta and should have decreased the risk

of

>transmission of both type B hepatitis and delta-hepatitis by plasma

>products.

>

>PMID: 6092192, UI: 85028257

>

>Transfusion 1980 Jan-Feb;20(1):90-2

>

>Levels of anti-A and anti-B in commercial immune globulins.

>

>Gordon JM, Cohen P, Finlayson JS

>

>Samples from 168 lots of immune serum globulin, tetanus immune globulin,

and

>Rho (D) immune globulin produced by seven American manufacturers during the

>period 1973-1977 were analyzed for anti-A and anti-B content by saline and

>antiglobulin titration. There was appreciable variation among

manufacturers,

>but between 1973 and 1975 all products showed a significant decrease in

>alloantibody titer. This trend did not continue during the interval

>1975-1977; the titers of most manufacturers' products remained near the

1975

>level. The anti-A titer of a given product was approximately one dilution

>higher than the anti-B; both titers were usually increased by anti-human

>serum, though this occurred more often in the case of anti-B.

>

>PMID: 6986683, UI: 80125049

>

>Transfusion 1976 Mar-Apr;16(2):141-7

>

>Hepatitis B virus and hepatitis B surface antigen in human albumin

products.

>

>Hoofnagle JH, Barker LF, Thiel J, Gerety RJ

>

>A collection of 1,985 lots of normal serum albumin (NSA) and 1,361 lots of

>plasma protein fraction (PPF) prepared between 1958 and 1974 were tested

for

>the presence of hepatitis B surface antigen (HBsAg). Twenty-one percent of

>NSA lots and 71 per cent of PPF lots were HBsAg-positive by

>radioimmunoassay. There was considerable variation in frequency of

>HBsAg-positive lots among the 17 different manufacturers of NSA and the six

>manufacturers of PPF.In general, those lots prepared from volunteer donor

>plasma and placental material demonstrated lower rates of HBsAg-positivity

>than those prepared from commercial donor plasma. A striking decrease in

the

>prevalence of HBsAg-positive lots of both NSA and PPF occurred during the

>period 1971 to 1973, coincident with the onset of routine screening of all

>plasma for HBsAg. Although NSA and PPF can be HBsAg-positive, they probably

>do not transmit type B hepatitis. Serologic tests for HBsAg and antibody to

>HBsAg revealed that albumin products prepared from infectious, icterogenic

>plasma were infectious prior to pasteurization, but that they no longer

>transmitted type B hepatitis after heat treatment at 60 C for ten hours.

>

>PMID: 1258115, UI: 76155108

>

>Transfusion 1975 Sep-Oct;15(5):408-13

>

>Antibody to the hepatitis B surface antigen in immune serum globulin.

>

>Hoffnagle JH, Gerety RJ, Barker LF

>

>A collection of 1,278 lots of immune serum globulin (ISG) prepared by 19

>United States manufacturers between 1962 and 1974 were tested for the

>hepatitis B surface antigen (HBSAg) and antibody (anti-HBS). Ten lots

>(0.8%), all of which were produced between 1962 and 1965 by two different

>manufacturers, were weakly positive for HBSAg (by radioimmunoassay). Seven

>hundred and seven lots (55.3%) were positive for anti-HBS (by passive

>hemagglutination). In general, titers of anti- HBS in lots of ISG were low,

>and the prevalence of anti HBS positive lots varied considerably among

>different manufacturers. ISG prepared from placental material was more

>commonly positive for anti-HBS than was ISG prepared from plasma. There was

>a striking overall increase in prevalence and titer of anti-HBS in ISG lots

>prepared during 1973 and 1974. This probably reflects the effect of

>elimination of strongly HBSAg-positive plasma units with the onset of

>routine screening for HBSAg which began in 1972.

>

>PMID: 1198681, UI: 76082214

>

>Ann Intern Med 1972 Nov;77(5):691-9

>

>Alter HJ, Holland PV, Purcell RH, Lander JJ, Feinstone SM, Morrow AG,

>Schmidt PJ

>

>Posttransfusion hepatitis after exclusion of commercial and hepatitis-B

>antigen-positive donors.

>

>No abstract available

>

>PMID: 4628213, UI: 73028623

>

February 22, 2000