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Peginterferon-Ribavirin, Failed it twice. Incivek, Failed it. Sovaldi Olysio, failed it. Harvoni, failed it... Transplant Patient Zepatier and Sovaldi...we'll find out!

Tuesday, April 7, 2015

Not enough resources

The CDC's role in regards to Hepatitis C (HCV), is largely informative and occasionally it supports testing.

I often find their lack of information, or accidental misinformation disturbing.
I check the site every now and again, to see what materials they've updated/corrected. While looking at the demographic specific fact sheets i read something that didn't seem right.
According to the CDC(2013) of the 2.2 million members of the US population that are incarcerated, 1/3rd have hepatitis C.

Additionally, it claims that " ...Bleaching, boiling, heating with a flame, or using common cleaning fluids, alcohol, or peroxide will not clean needles, tools, and other instruments. These methods are not strong enough to kill the Hepatitis C virus. The virus can still spread easily from one person to another."

Hold up, what?

Canada's CATIE explains a method of cleaning after HCV infected blood is accidentally spilled.

In fact, the CDC's website contradicts the claim made in the Hepatitis C fact sheet for prisoners.

But as i've stated, fact sheets can be wrong, so this is all well and good, but here are the facts: 

 A 1:10 Bleach solution has 0% of the virus remaining after a minute, which means wipe the bleach off the surface after letting it sit in the area for over a minute.
Bleach wrecks living organisms, but what about Ethyl Alcohol? A 70% solution can knock it down to 7-19% after a minute. While there hasn't been a study using 90+, nor a longer time, it can be assumed the range is slightly lower.  

I've used bleach, and/or alcohol depending upon the spill. Often cleaning the surface multiple times. However one go with bleach will do the trick.

If you don't clean that surface off, the virus can remain on the surface, at room temp, for about six weeks.

Why the CDC gives the wrong information in their Hepatitis C for Prisoners Fact Sheet, I can't say. But let's look at that 1/3rd claim...

The truth of the matter is that somewhere between 16-41% have had contact with HCV, while somewhere between 12-35% are chronically infected.PREVIOUS INFORMATION WAS BASED ON POTENTIAL CONTACT RATHER THAN ACTUALLY INFECTED. So
CORRECTION: ~16% of prisoners + people in jail have reported HCV 

Perhaps I'm nitpicking on the 1/3rd, but lets critically understand the scope of this shitty piece of information.

The prison population is medically evaluated via physicals, and despite this fact, we don't know how many people are infected. Prisons are effectively an incubator for a disease like this.
Consider the length of treatment: 12-48 weeks. During the time, it's imperative that those receiving treatment do not re-infect themselves. Without knowing who has it, and who doesn't, those undergoing treatment run the risk of an exposure rate nearly 20 times higher than those outside of prison.

It means treatments will be less effective, and cost more for everyone involved.
It's also worth mentioning that a large portion of this population are released within a year, never having been tested despite the massive risk of exposure. When incarcerated individuals return to society they can potentially re-introduce Hepatitis C into the non-incarcerated population especially if they're unaware they have it.

So how can we help? 

It's all about testing, if we can get a national dialogue going about HCV testing, information, and care, we can get help the those who need it, and stop this epidemic. 
Testing in at-risk populations is always the first step, and while we've focused primarily on baby-boomers, the incarcerated population can be the most readily mandated and as it's rates grow, so will the entire population's.

The CDC has been upping it's game the last few years,(The CDC does have a more ambitious action plan for 2014-2016, and yes it's a division of aids.gov.  If you want the typically most accurate CDC info, aids.gov is the place for HCV CDC info) and it's started getting the ball rolling in regards to at-risk populations. But HCV advocacy needs your help, in addition to the CDC there are dozens of organizations that provide testing, information and help connect patients with the care they need. Most of which are small, and HCV is just a part of what they do.

It's a silent epidemic on two fronts: not only is it a silent killer, sometimes going decades unnoticed, the national dialogue has been largely silent. 

National Hepatitis Testing Day Site
Testing is an important part of helping to eradicate the virus. National Testing day is May 19th 2015.

When i type in San Diego, the closest test location is Phoenix, or San Francisco. Encourage your local municipality to register a testing site for test day.
If we want to make Hepatitis C history, we need to properly inform, test, cure, and clean up.

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