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Military's Hepatitis C Risk Low,
But
DoD Still Concerned (corrected copy)
By Douglas J. Gillert
American Forces Press Service
WASHINGTON -- The military doesn't have to worry as much as the rest of
America about Hepatitis C, a senior defense health official said.
But DoD doesn't want service members or their families to ignore the
viral disease that can be treated but not prevented.
"What makes Hepatitis C so dangerous for us is that there is no
vaccine," said John Mazzuchi, deputy assistant secretary of defense for
health affairs clinical and program policy.
A viral disease that attacks the liver, Hepatitis C causes fatigue and
other symptoms that resemble "a bad case of the flu," Mazzuchi said. "It
can be very debilitating." The most common way of infection is through
shared needles. Before screening tests were developed in the 1990s,
Hepatitis C could also be contracted through blood transfusions.
According to a recent sampling of 20,000 service members and new
recruits, less than 1 percent of service members have Hepatitis C, about
one-third the national average. In fact, only one of the 1,000 recruits
sampled tested positive for Hepatitis C.
Mazzuchi attributes the low Hepatitis C rates to recruiting from a
healthy population, and in-service drug and HIV screening programs.
"We screen people coming into the military for drug use, and we also
have an active random urinalysis program," Mazzuchi said. "So drug use in
the military is very low and needle drug use is minuscule."
Some behaviors related to human immunodeficiency virus are possibly
related to Hepatitis C, so HIV screenings also reveal the presence of the
virus, he said.
DoD was alerted to the Hepatitis C danger by Department of Veterans
Affairs reports of high incidences of Hepatitis C among Vietnam veterans.
Mazzuchi said the higher rates of infection could be due to the higher
rate of drug use among service members in the 1960s as well as
contaminated blood.
The problem only surfaced recently because it takes up to 30 years for
Hepatitis C symptoms to appear, Mazzuchi said. In fact, a nationwide alert
by the Centers for Disease Control and Prevention of a possible Hepatitis
C epidemic "is really more of an epidemic of discovering what was,"
he
said. "The actual number of new cases is declining."
A test for antibodies that is used to screen blood supplies can also be
used to test humans for the virus. But because the prevalence of Hepatitis
C in DoD is so low, the department has followed the CDC's advice not to
routinely test service members who don't show symptoms.
Meanwhile, DoD has pooled its resources with the National Institutes of
Health, CDC and VA in researching new treatment methods for Hepatitis C,
with the ultimate goal of developing a vaccine. Any breakthroughs,
however, are likely years away, Mazzuchi said.
"We can assure our service members and families that Hepatitis C is not
a major problem in the military," he said. "But because it is a serious
disease, if they have symptoms, they need to go to their health care
providers and discuss that with them."
Results of the DoD Hepatitis C study and risk factors associated with
the disease are available under "Hot Issues" on the Military Health System
home page at www.tricare.osd.mil.
Original study
(Note: test used failed to identify as many as 15% that took it.)
Prevalence and Incidence of Hepatitis C Virus Infection
in the US Military: A Seroepidemiologic Survey of 21,000 Troops
Authors: Mazzuchi J.F.2; Hyams K.C.1; Bailey S.2; Riddle J.2; Rubertone
M.3; Trump D.2; Alter M.J.4; Cruess D.F.5; Han X.4; Nainam O.V.4; Seeff L.B.6
Source: American Journal of Epidemiology, Volume 153, Number 8, 15 April 2001 ,
pp. 764-770(7)
Publisher: Oxford University Press
Abstract:
Because of a high prevalence of hepatitis C virus (HCV) infection (10–20%) among
veterans seeking care in Department of Veterans Affairs (VA) hospitals, current
US military forces were evaluated for HCV infection. Banked serum samples were
randomly selected from military personnel serving in 1997 and were tested for
antibody to HCV (anti-HCV). Overall prevalence of anti-HCV among 10,000
active-duty personnel was 0.48% (5/1,000 troops); prevalence increased with age
from 0.1% among military recruits and active-duty personnel aged <30 years to
3.0% among troops aged 40 years. Prevalence among 2,000 Reservists and
active-duty troops was similar. Based on sequential serum samples from 7,368
active-duty personnel (34,020 person-years of observation), annual incidence of
infection was 2/10,000. Of 81 HCV RNA-positive troops for whom genotype was
determined, genotypes 1a (63%) and 1b (22%) predominated, as in the civilian
population. These data indicate that HCV infection risk among current military
forces is lower than in VA studies and the general civilian population aged <40
years. The low level of HCV infection may be attributed to infrequent injection
drug use in the military due to mandatory testing for illicit drugs prior to
induction and throughout military service.
Keywords: hepatitis; hepatitis C; hepatitis C antibodies; hepatitis C, chronic;
hepatitis, viral, human; hepatitis viruses; military medicine; substance abuse,
intravenous
Document Type: Original article
Affiliations: 1: Epidemiology Department, Naval Medical Research Center, Silver
Spring, MD. 2: Office of the Assistant Secretary of Defense–Health Affairs, the
Pentagon, Washington, DC. 3: Army Medical Surveillance Activity, US Army Center
for Health Promotion and Preventive Medicine, Washington, DC. 4: Hepatitis
Branch, Division of Viral and Rickettsial Diseases, National Center for
Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. 5:
Department of Preventive Medicine and Biometrics, Uniformed Services University
of the Health Sciences, Bethesda, MD. 6: Department of Gastroenterology,
Veterans Affairs Medical Center, Washington, DC.
http://www.ingentaconnect.com/content/oup/
aje/2001/00000153/00000008/art00764;jsessionid=1u74f7sc99tag.alice
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