Baby Boomers and Hepatitis C: High-Risk Group with Low Rate of Testing

Baby Boomers have been identified as a high risk group for Hepatitis C but only a small percentage have been tested. What are some of the reasons and what can be done to change that?

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Baby Boomers and Hepatitis C: High-Risk Group with Low Rate of Testing

Hepatitis is an inflammation of the liver with a few main genotypes (A, B, C and E), and Hepatitis C is responsible for the vast majority of liver disease among the US population.  Over time, undetected Hepatitis C can severely damage the liver, possibly leading to cirrhosis, liver cancer, or death.

An age group identified as being at high risk for Hepatitis C is the "baby boomer" generation: those born between 1945 and 1965. Individuals born during this period are five times more likely than other adults to be infected with the Hepatitis C virus (HCV) - 75 % of adults with hepatitis C were born within this timeframe, and an estimated 15,000 HCV-associated deaths of this age group will occur each year.  In the United States, it is estimated that between 3 and 5 million people have chronic hepatitis C, and most of these people feel fine and do not suspect that they are infected. Most cases are insidious, and often a suspicion may only arise from a routine check preceding a blood donation or a lab test showing elevated liver enzymes done as part of a physical examination.

Barriers to Testing

The CDC highly recommends testing for Hepatitis C for these adults; however, certain barriers associated with this virus may delay or deter testing.

In the years immediately following World War II, the number of surgical procedures greatly expanded nationwide, and the sterilization techniques for common procedures were not as advanced as they are today. As Hepatitis is transmitted via the blood, improper sterilization of equipment was a factor.  Before widespread screening of the nation's blood supply began in 1992, the hepatitis C virus could spread via blood transfusions and organ transplant procedures. In the past, doctors had no protocol or screening method to check if a blood supply was virus-free.

Most baby boomers were exposed decades ago and have little or no symptoms, so they do not perceive themselves as being at risk.

When thinking about the transmission of the Hepatitis C virus, a common misunderstanding is that a positive result for someone indicates that they are or were a drug abuser.  Many are reluctant to get tested as they feel they would be judged harshly and seen in a negative light, the effects of which can lead to a delay in getting tested and diagnosed, receiving treatment, and having an increased risk of complications and poor quality of life.

Although IV drug use rose to a significant level in the '60s, it is not the only risk factor for contracting Hepatitis C.  As outlined above, there are several explanations as to why they may have contracted Hepatitis C not related to the use of recreational drugs.  Patients should not fear having a blood test to determine the presence of HCV due to exposure to tainted blood from whatever source.  It is certainly not a reflection of a person's behavior.

Recent advances in treatment over the last five years have shown remarkable results in eradicating the virus from the system in almost 95% of those treated and eliminating any further damage to the liver, and limiting spread.  Treatment recommendations and evidence-based guidelines for healthcare professionals have been established through a collaboration of the Infectious Diseases Society of America, the American Association for the Study of Liver Diseases, and the International Antiviral Society for HCV management. They are available here.

Nurses can play a key role in educating this population on the health impact of Hepatitis C.  Encouraging patients to discuss their concerns with their personal healthcare provider and requesting a lab test is the first step in understanding and managing Hepatitis C.  Incorporating this test with other screening protocols as part of an ongoing healthcare management plan for baby boomers is a practical and expedient way to identify new cases.   Based on CDC estimates, expansion of testing for baby boomers could identify more than 800,000 cases of HCV and, when connecting those requiring treatment to appropriate care, could save more than 120,000 lives in the ensuing years.

"Nothing in life is to be feared. It is only to be understood."
--Marie Curie

References/Resources

Improving hepatitis C screening and diagnosis in patients born between 1945 and 1965 in a safety-net primary care clinic: Pub Med-National Library of Medicine

Hepatitis C Treatments Give Patients More Options: U.S. Food & Drug Administration (FDA)

Phylogenetic estimation of the temporal spread of hepatitis C genotype 1a in North America: a retrospective phylogenetic study: Pub Med-National Library of Medicine

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Barb S

About Barb S

Barbara has worked in numerous nursing specialties over her 40+ year career, with over 25 years in Occupational Health. She has participated in HCV educational programs at local medical facilities and appeared in an HCV educational video for Quest Diagnostics.

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Specializes in ICU.

I'm unsure as to why Hep C will be some common in the baby boomers. I have not noted this statistic in my own practice - I treat mainly individuals between 50-75 years old and I think I've had only a handful of patients' with Hep C. 
If the Hep C is not from recreational drug use and lifestyle - potentially it's caused from a predisposition of these individuals to liver damage. 
I know only Hep A and B are from food and water, but I wonder if there's any correlation between Hep C and intake.

Could it possibly be related to alcohol use? There are a few possibilities of causal agents.

Thank you for letting me brainstorm! ? 

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Specializes in Occupational Health.

Hi Alexa, 

Thanks for your comment and you raise some great points.  Certainly excessive alcohol intake can lead to cirrhosis and liver damage but I am not aware of any direct causality of alcohol with Hep C.  Recreational IV drug use most definitely can be related, as well as increased risk at unlicensed tattoo places. 

I've had some discussions with several hepatologists that manage a large Hepatitis C Center in Philadelphia and are involved in a widespread community outreach targeting this age group.  I was surprised to learn many of their patients contracted the virus through blood transfusions prior to 1992 before testing was available, which is one of the reasons it would impact the baby boomers age group, among other reasons you mentioned. CDC recommends all adults in this age group be tested. 

So appreciate your feedback! 

Regards, 

Barbara

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Specializes in Oncology, ID, Hepatology, Occy Health.

Having worked in this field in the 1990s I would say that the fact that the Hepatitis C virus wasn't actually isolated before 1989 means infection rates in previous generations are actually unknown.  We do know that much of what we used to call "Non A Non B" hepatitis was actually due to hepatitis C. Since many cases of hepatitis C are often asymptomatic for many years, before testing there were undoubtedly people walking around with it who never knew they even had anything. Even many of the symptomatic people will have been diagnosed as choronic fatigue syndrome and other such labels without even thinking they had a chronic liver virus. 

Greter use of tranfusion and blood products will have increased infection rates before testing, and yes, undoubtedly increases in IV drug use. 

I would just take issue with your introduction. In addition to A, B, C and E there exists Hepatitis D (delta virus) and Hepatitis G (or GB-C). I would also argue that perhaps genotype is not the correct terminology to describe the different hepatitis viruses. Things may have changed but when I was in the field we talked of for example the Hepatitis C virus having 6 genotypes (1 to 6) whilst each letter (Hepatitis A, B etc) were actually distinct viruses and not genotypes of the same virus. Each hepatitis virus is quite distinct. 

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Specializes in Private Duty Pediatrics.

Hepatitis C is blood-borne. While I am a Boomer, I have never done drugs, I'm a teetotaler, I have never had a blood transfusion. I didn't have surgery of any kind until the late 1980s. 

To my knowledge, I have not been exposed to blood at work. But . . . before 1980, we did not use gloves at work unless it was a sterile procedure. Could I have been exposed?

My doctor did test me, and I am negative. 

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Specializes in Oncology, ID, Hepatology, Occy Health.
Kitiger said:

Hepatitis C is blood-borne. While I am a Boomer, I have never done drugs, I'm a teetotaler, I have never had a blood transfusion. I didn't have surgery of any kind until the late 1980s. 

To my knowledge, I have not been exposed to blood at work. But . . . before 1980, we did not use gloves at work unless it was a sterile procedure. Could I have been exposed?

My doctor did test me, and I am negative. 

If you tested negative that's it - you're negative unless you've had a new exposure since your test. I agree with you we were very  exposed in the old days and I shudder now when I think of the procedures we carried out without  gloves. What a mistake it was to label some patients "high risk" and take no precautions with all the others. Thankfully Universal Precautions for all patients has become standard. I can't believe now that I ever took blood and sited IVs without gloves back  then. 

You're the second person to mention alcohol. While alcohol can cause alcoholic hepatitis and liver cirrhosis it doesn't directly increase your risk of contracting viral hepatitis - only indirectly in a behavioural sense in that if you're drunk, you're more likely to indulge in behaviours which expose you to the hepatitis viruses (unprotected sex - hep B, sharing needles for IV drug use - Hep B and C etc.) Once you actually have viral hepatitis alcohol will increase your risk of further liver damage and in chronic hepatitis may well speed up the progression of further fibrosis leading in some cases to cirrhosis, which in turn can sometimes lead to liver cancer.

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