ADA 2015: Focus needed on hep C, infection control

2015 11 06 10 42 06 595 Ada2015 200

Oral health professionals should focus on proper infection-control precautions and advise patients at higher risk for hepatitis C to get tested, including IV drug users and baby boomers, according to a presentation on viruses at the recent ADA 2015 meeting in Washington, DC.

Health officials are alarmed at the increasing rates of hepatitis C in the U.S., and the mortality rate for hepatitis C now exceeds that of all other infectious diseases, including HIV, in the U.S., the presenters told the audience of the well-attended session.

Daniel Church, MPH, from the Massachusetts Department of Public Health.Daniel Church, MPH, from the Massachusetts Department of Public Health.

According to Daniel Church, MPH, an epidemiologist at the Massachusetts Department of Public Health, there are epidemics of hepatitis C right among two groups now: baby boomers and young injectable drug users. The boomers make up two-thirds of the more than 4 million people who have hepatitis C in the U.S. The Centers for Disease Control and Prevention (CDC) now recommends that everyone born between 1945 and 1965 be tested for hepatitis C.

"The most important thing oral health professionals can do is focus on proper precautions in the workplace and to review all their procedures, particularly regarding the injection of medications," Church told "That appears to be an important risk factor for the transmission of hepatitis C in the healthcare setting, so we want to make sure that doesn't happen in oral health procedures."

An Oklahoma oral surgeon lost his license following an infection scandal in which 100 of his patients tested positive for hepatitis and HIV. Genetic testing confirmed that at least one patient contracted hepatitis C from a visit to the office of W. Scott Harrington, DMD, the first documented report of patient-to-patient transmission of hepatitis C in a dental setting in the U.S.

Other cases involving lapses in infection control occurred in Pennsylvania and Hawaii, where improper sterilization practices jeopardized patients' health.

Oral health professions play an important role in alerting patients about the risk of hepatitis, since they tend to have more time and discussions with them than primary care doctors, Church noted. Dentists should support testing recommendations for people with a history of injection drug use. Dentists should also encourage baby boomer patients born between 1945 to 1965 to get tested for hepatitis C as recommended by the CDC, Church said.

“If dentists and hygienists aren't comfortable talking about drug use with patients, at least talking with [baby boomers] is a way to get people to consider testing for hepatitis C and get them into care.”
— Daniel Church, MPH

"If dentists and hygienists aren't comfortable talking about drug use with patients, at least talking with this birth cohort is a way to get people to consider testing for hepatitis C and get them into care," he said.

About 2.7 million Americans have chronic hepatitis C, Church noted.

Hepatitis C is a blood-borne virus, but it is much less likely to be transmitted through sex. There is no vaccine, and although many people think they're protected, they've probably only received the hepatitis B vaccine, Church said. The CDC estimates there are about 30,000 acute cases annually, he said.

"But I don't believe it for a second," Church said. "The number is much, much higher."

The U.S. opioid epidemic is having a big impact on the number of people getting infected with hepatitis C, he said. About 4 million people are living with hepatitis C, according to the CDC, but that hugely underestimates of the true number of people who are infected, Church said. Hepatitis C causes almost 20,000 deaths a year, a dramatic increase in the last decade, despite the availability of drugs to cure it.

Like hepatitis B, health officials aren't doing a good job of getting people tested and into care for hepatitis C, he said. Health officials generally have done a good job of getting people tested and into care for HIV, but there hasn't been a similar effort for hepatitis C.

"Only about 50% of people are aware of their status, and most people don't even know if they have chronic infection; HIV is causing fewer deaths per year than hepatitis C does," Church noted.

One reason might be that most people in the acute phase of the disease don't show symptoms. When they do, it's typically jaundice of the skin and eyes. After the acute phase, which usually lasts six months, some people will clear the virus from their systems on their own. Women clear hepatitis C more often than men, Church said. But most people who get infected with hepatitis C get persistent, long-term infections.

Of the 20% of people who develop long-term infections, the biggest concern is that it leads to cirrhosis or scarring of the liver, which in turn leads to serious consequences such as liver cancer, liver failure, and death. For those with long-term hepatitis C infections, heavy and even moderate alcohol use can lead to cirrhosis.

Some people have acquired hepatitis C through blood transfusions before the blood supply was screened. Some get it through sex, especially people with HIV and men who have sex with men. But hepatitis C is not usually transmitted through sex, Church said. For monogamous couples in which one partner has hepatitis C and the other does not, the risk of transmission is very small, he said. But the biggest risk factor is blood transmission through drug injections.

In fact, hepatitis C is easier to acquire than HIV, because it's more prevalent in the population. Hepatitis C is also very durable in the environment; it can be viable for up to 63 days in a syringe, and it can even be viable for five days on an inanimate surface, according to Church.

"So you have a bug that's highly infectious, highly prevalent, and very durable," he said.

Now, young people are driving the increase rates in hepatitis C infection, Church said, including adolescents as young as 15 who get started by taking prescription opioids, then graduating to heroin when those drugs got too expensive.

Current treatments are more effective and tolerable with fewer side effects.

"We can now cure up to 90% of hepatitis C infections with these new drugs that are easier to take," Church pointed out.

But the new medications are expensive, he noted, and most insurers won't pay for them, including Medicaid. In fact, cures for hepatitis C lead to 50% to 75% reductions in all-cause mortality, not just liver-related. But only 38% of people with hepatitis C are getting care, he said.

"We as oral healthcare professionals are primary care providers, and we have an obligation to work interprofessionally with our medical colleagues," Helene Bednarsh, RDH, MPH, told

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