Bureau of Epidemiology
Bureau of Epidemiology November 1997 Utah Department of Health
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One in Five Americans Infected with Herpes
Welcome
Potential Risk of Hepatitis C Virus (HCV) Infection of Prior Transfusion Recipients
Monthly Morbidity Summary

One in Five Americans Infected with Herpes

One in five Americans has herpes infection, and the number of people living with this incurable sexually transmitted disease has increased 30% since the late 1970s, according to the results of a national survey released recently by the Centers for Disease Control and Prevention (CDC).

The findings are reported in the October 16, 1997 New England Journal of Medicine. The report, "The Evolving Epidemiology of Herpes Simplex Virus Type 2 in the United States, 1976 to 1994," documents that nearly 22% of the population overall (45 million Americans) and almost 45% of African-Americans are infected with herpes simplex virus type 2 (HSV-2).

Since the last national survey of HSV-2 prevalence (conducted between 1976 and 1980), prevalence has increased most dramatically among young white teens. HSV-2 prevalence among 12 to 19 year-old whites is now five times higher than it was in the late 1970s. Young people aged 20 - 29 are now twice as likely to have HSV-2.

"Herpes is perhaps the most common sexually transmitted disease in America today. It continues to spread across all economic and social boundaries and is spreading fastest among teens," said Helene Gayle M.D., M.P.H., Director of CDC’s National Center for HIV, STD, and TB Prevention (NCHSTP).

In addition to ongoing sexually transmitted disease prevention activities, CDC is now working in consultation with other public health experts to develop a national plan which will specifically address the prevention of herpes. The plan will address development of comprehensive national prevention guidelines, outline enhanced monitoring of levels of herpes in the U.S., and propose new educational activities for health care professionals and the general public.

Although the exact number of individuals affected is difficult to assess, Utahns are increasingly being infected with genital HSV. While oral acyclovir has been proven to be an effective agent for the treatment of genital herpes infection, no known cure currently exists. However, scientists, including those from Utah, are concentrating their efforts in several areas of investigation. Most recently, scientists from the University of Utah have been researching possible triggers in the reactivation of herpes. These physicians have been attempting to understand how herpes is reactivated biochemically, so that a drug can then be developed that would interfere with the process and prevent repeated outbreaks.

With or without visible symptoms, herpes can be transmitted between sex partners, from mothers to newborn babies, and it can greatly increase a person’s risk of becoming infected with HIV.

"We believe herpes plays a major role in the heterosexual spread of HIV in this country, Herpes can make people more susceptible to HIV infection and make HIV-infected individuals more infectious," said Judith Wasserheit, M.D., M.P.H., Director of the Division of STD Prevention, NCHSTP. "Preventing herpes can help us stop both epidemics."

The study also found that HSV-2 is more common among women (approximately one out of four women) than men (almost one out of five). This may be related to the higher efficiency of transmission from men to women and to higher prevalence of infection in sexual partners.

The consistent and correct use of latex condoms is the best protection. Because condoms do not cover all areas where herpes blisters could be present, people should also avoid any direct contact with herpes sores and blisters.

This article adapted from HHS News, U.S. Department of Health and Human Services, October 15, 1997

Welcome

We would like to welcome Jenifer Lloyd and Brent Neal to the Communicable Disease Control Program in the Bureau of Epidemiology. Jenifer received her B.S. in biochemistry from the University of Wyoming, M.S.P.H. from the University of Colorado, and her D.V.M. from Colorado State University. Prior to moving to Utah, Jenifer was an Epidemic Intelligence Service (EIS) Officer with the National Immunization Program at the CDC. Brent graduated from Weber State College with a B.S. in Psychology, an English teaching minor including a teaching certificate, and another B.S. in Computer Information Systems with a minor in Computer Science. He has worked for IBM in Boca Raton, Florida and Endicott, New York. Upon returning to Utah, he started working at the Utah Department of Health in the Bureau of HIV/AIDS as an Applications Programmer Analyst.

Jenifer will be coordinating the "Epidemiology and Laboratory Capacity for Infectious Diseases" grant and Brent will manage all programming activities and surveillance systems associated with the grant.

Potential Risk of Hepatitis C Virus (HCV) Infection of Prior Transfusion Recipients

The role of the U.S. Public Health Service (PHS) in ensuring the safety of the nation’s blood supply recently underwent renewed scrutiny. In 1996, the House of Representatives Tenth Report by the Committee on Government Reform and Oversight called for Congress to establish the Blood Safety Committee and the Advisory Committee on Blood Safety and Availability to be coordinated through the Office of the Assistant Secretary for Health, Department of Health and Human Services (HHS).

One of the issues raised by the Congressional report was the identification of persons who may have become infected with HCV through transfusion of HCV-contaminated blood and blood products. The report directed HHS to "take steps to ensure that the estimated 300,000 living recipients of blood and blood products who were infected with HCV before 1990 are notified of their potential infection so that they might seek diagnosis and treatment." In response, the PHS prepared a briefing document on options for the identification of HCV infection among prior transfusion recipients for consideration by the Blood Safety and its Advisory Committee. The three options considered were: 1) targeted lookback of transfusion recipients; 2) broad-based public education of persons at risk of HCV infection, including prior transfusion recipients; and 3) educational efforts directed to health care professionals and community-based prevention programs for identification of persons at risk of HCV infection, including transfusion recipients.

The Advisory Committee on Blood Safety and Availability at its most recent meeting in August 1997 recommended educational programs for providers, a public education campaign to notify and test recipients of blood and blood products transfused prior to 1992, and a targeted lookback program for prior blood and blood product recipients of donors testing positive for anti-HCV by second generation screening and supplemental tests. These recommendations will be forwarded to the Assistant Secretary of Health and the Blood Safety Committee.

In anticipation of recommendations for one or more of these options, and at the request of the PHS agency heads, CDC had previously drafted an outline of a broad nationwide prevention and control plan for hepatitis C which took into consideration the fact that most Americans infected with HCV had acquired their infection from sources other than blood transfusion. The objectives of this plan are early identification of persons with chronic HCV infection, including transfusion recipients, and reducing transmission in groups at high risk of infection. Identification of persons at risk for HCV infection provides them with the opportunity to seek testing to determine their infection status, undergo medical evaluation for chronic liver disease if infected, and receive therapy if eligible. It also provides them with the opportunity to obtain information about how they can prevent transmitting the infection to others. This plan includes: 1) public education to reach the population at current or past risk of infection; 2) educational efforts directed to health care and public health professionals to improve the identification of patients at risk of infection and ensure appropriate diagnosis, treatment, and counseling; and 3) the development of community-based prevention programs.

CDC has placed its initial emphasis on the education of physicians and other health care professionals prior to any formal public information campaign, so that the health care and public health communities will be prepared to respond to persons seeking testing and other information about hepatitis C. In March, 1997, CDC co-sponsored with NIH a Consensus Development Conference on Management of Hepatitis C. In May, a workshop was held with State Epidemiologists to discuss the public health issues related to HCV infection, and how CDC and state and local health departments could work together on the prevention and control of hepatitis C. CDC also developed an interactive satellite teleconference, which was broadcasted November 22, 1997, to educate primary care providers regarding the screening, diagnosis, management, and prevention of hepatitis C. Written educational materials have been developed for conference attendees and will be available for distribution. Informational packages are also being developed for health care provider policy makers (e.g., state and local health departments, managed care organizations, insurance companies).

Educational programs directed at the public are also being developed through partnerships with non-governmental voluntary organizations and professional societies. CDC recognizes that the medical and public health communities need to be made aware of any recommendations prior to their dissemination to the public, and that issues such as testing and follow-up for those without access to medical care need to be addressed. The hepatitis C prevention plan is still in its early stages, and these issues are among many that CDC will need to address with its partners. The following portion of this article is a factsheet which includes information to assist you with answering questions from the public about hepatitis C and may be photocopied for dissemination. The first section addresses prevention and includes information about who should be tested for hepatitis C; the other provides information to persons who have hepatitis C. Persons seeking testing for hepatitis C should be referred to their medical care provider. This article has been adapted from a memorandum from the Department of Health and Human Services, Hepatitis Branch, Division of Viral and Rickettsieal Diseases, National Center for Infectious Diseases dated August 22, 1997.

HEPATITIS C PREVENTION

What is hepatitis C? Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. The infection is spread by contact with the blood of an infected person.

How serious is hepatitis C? Hepatitis C is serious for some persons, but not for others. A small number of persons die of liver failure shortly after getting hepatitis C. Most persons who get hepatitis C carry the virus for the rest of their lives. Most of these persons have some liver damage but many do not feel sick from the disease. Some persons with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure which may take many years to develop.

How can I protect myself from getting hepatitis C?

     - If you shoot drugs, stop and get into a treatment program. If you can’t stop, use a clean needle and works every time and don’t share them.
     - If you have sex with multiple partners, lower your number of partners and always use barrier precautions, such as latex condoms.
     - If you are a health care worker, always follow routine barrier precautions and safely handle needles and other sharps.
     - Do not share toothbrushes, razors, or other personal care articles that might have blood on them.

Could I already have hepatitis C? Ask your doctor for a blood test for hepatitis C, if:

     - You received a blood transfusion or solid organ transplant (e.g., kidney, liver, heart) before 1992.
     - You received clotting factor concentrates before 1987.
     - You ever injected street drugs, even once.
     - You were ever on long-term kidney dialysis.

Why should I be tested for hepatitis C? Early diagnosis is important so you can be:

     - Counseled about how to prevent transmission of HCV to others.
     - Checked for liver disease and get treatment, if indicated.

IF YOU HAVE HEPATITIS C

What can I do now that my hepatitis C test is positive? Contact your doctor. Additional tests may be needed to check your diagnosis and to see if you have liver damage.

What if I don’t feel sick? Many persons with long-term hepatitis C have no symptoms and feel well, but should still see their doctor. For some persons, the most common symptom is extreme tiredness.

How can I prevent spreading HCV to others?

     - Do not donate your blood, body organs, other tissue, or sperm.
     - Do not share toothbrushes, razors, or other personal care articles that might have your blood on them.
     - Cover cuts or open sores on your skin.
     - If you shoot drugs, stop and get into a treatment program. If you can’t stop, use a clean needle and works every time and don’t share them.
    - There is a very low chance of giving hepatitis C to a partner through sexual activity. However, if you want to lower the chance of spreading HCV to                        your partner, use latex condoms. Ask your doctor about having your sex partner tested.
    - If you have sex with multiple partners, lower your number of partners, inform them that you have hepatitis C, and always use barrier precautions,                        such as latex condoms.

What if I am pregnant? Five out of every 100 infants born to HCV infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening. However, infants infected with HCV at the time of birth seem to do very well in the first few years of life. More studies are needed to find out if these infants will be affected by the infection as they grow older. Breast feeding does not spread HCV.

Hepatitis C is not spread by:

- Sneezing, hugging, coughing, sharing eating utensils or drinking glasses, food or water, or casual contact.

There is no vaccine available to prevent hepatitis C.

Is there a treatment for hepatitis C? A drug called interferon is licensed for the treatment of persons with long-term hepatitis C. About 2 out of every 10 patients who are treated get rid of the virus. You should check with your doctor to see if treatment would help you.

How can I take care of my liver? See your doctor regularly, do not drink alcohol, tell your doctor about all medicines that you are taking, even over the counter and herbal medicines.

People with liver damage from hepatitis C should get vaccinated against hepatitis A and hepatitis B. See your doctor.

Utah Department of Health, Bureau of Epidemiology

Monthly Morbidity Summary - November 1997 - Provisional Data

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The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

Send comments to:
The Bureau of Epidemiology Box 142870 Salt Lake City, UT 84114-2870 or call (801) 538-6191
Approval 8000008: Appropriation 3705
Rod Betit, Executive Director Utah Department of Health
Charles Brokopp, Dr.P.H. Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Cristie Chesler, BA Managing Editor