Your Article

July 27, 2000

Dear Ms. Clayton:

I have read the attached article, and would like to thank you for

raising this issue to the readers. I do hope that you will review your

information so that certain aspects of the article are not misconstrued.

As a health care provider, and someone who is very active in the

Hepatitis C, (HCV), community, I would like to highlight some of the

issues that may not be as they appear. While, in the U.S., there are no

questions as to the the HCV epidemic, per the CDC, the data on the

transmission of the virus is not entirely accurate. The virus is

definitely blood borne, and therefore, while IV Drug use can not be

overlooked, it is not as frequently transmitted today as it once was. In

fact, while an IVDA risks HIV and HCV, a large majority of the HCV

population did not obtain it from this source.

Sexual transmission is such a small number of cases, and usually is not

documented as the only " risk factor " , that those victims are

undocumentable to state that sexual transmission was the cause. In fact,

there is a far higher risk using someone who has HCV, and using their

toothbrush. then contracting the virus through sexual contact.

In fact, the highest single risk factor for transmission lies in blood

transfusion and blood by products. Today, some of the other main

identified risks include: tattoo's, body piercings, accidental needle

sticks, and the like. For an unknown reason, Veterans and Fire Fighters

seem to have a disproportionate number of infections, and the

epidemiology has not been established.

I hope that you will add, or rewrite your article, because you are in a

position to help the hundreds of thousands of already infected victims,

as well as to increase public awareness. If you would like detailed

references on these and similar facts, I would be more than happy to

assist in directing you to the latest research in this area, as well,

as, I am sure many of your readers may be willing to share their stories

with you.

Sincerely, Schoen, ARNP, RN, MSN, MHA, MBA

Letters to the Editor, The Times Valley Edition, 20000

Prairie St.,

Chatsworth Ca 91311 or via Internet to

FAX: (818) 772-3385

Valley Edition Phone: (818) 772-3200

Janet Clayton

Janet Clayton, Editor of the Editorial Pages " Hep C,

Thriving on Ignorance "

Hepatitis C, a blood-borne, potentially fatal liver

disease spread mostly by sexual contact and

intravenous drug use, has become an underrecognized

epidemic in California, afflicting an estimated

half-million residents in Riverside County, 24% of

jail inmates test positive, and a soon-to-be-released

study from the state's Health and Human Services

Agency is expected to show that fully one-third of all

convicts entering state prisons have the virus. Unlike

for the better-understood hepatitis A and B, there is

no vaccine for hepatitis C. The disease often leads to

liver failure if not treated. That's an increasingly

common occurrence, according to the federal Centers

for Disease Control (CDC), which said that 70% of

those infected don't even realize they have the

disease because symptoms often don't appear for years,

long after liver damage begins. That's why early

detection and public education are so critical to

reining in the epidemic. State health officials should

start by testing, counseling and treating accessible

populations with the high infection rate. These

include:

*Drug users in needle exchange programs. The CDC

urges that all " persons who ever injected illegal

drugs, including those who injected once or a few

times many years ago " should get tested. However, most

needle exchange programs in California do not give out

any information on hep C, much less urge participants

to get tested.

*Patients in veterans hospitals. A study last year of

26,000 patients in Department of Veterans Affairs

facilities found that nearly 8% tested positive for

hepatitis C. Among Vietnam War vets seeking medical

help at VA facilities, the rate was substantially

higher. In California, 140,000 veterans may be

infected.

The Clinton administration has asked Congress to give

the VA $340 million next year to test and treat

veterans with the hep C. That's $145 million more than

what Congress allocated last year. Unfortunately, the

VA has been slow to take advantage of the federal

help. Last week, American Liver Assn. President Alan

Brownstein told Congress that " the Department of

Veterans Affairs has consistently underspent " it's

hepatitis C prevention and treatment dollars.

*Prisioners: In California, at the minimum, state

prisons should determine the overall incidence of

hepatitis C, not just the rates among newly arrived

prisoners. The disease is little recognized outside

high-risk groups, but its public health costs are

growing. According to the American Liver Assn., the

waiting list of potential liver recipients has more

than tripled in the last five years, mostly because of

chronic liver failures brought on by hepatitis C.

Because the disease is " silent " for so long, the true

rate of infection is not known. It is certain,

however, that without better public education and

testing, hepatitis C will continue to spread.

July 27, 2000