A new report indicates the hepatitis C (HCV) epidemic peaked between 1940 and 1965 with reused medical syringes to blame, not injection drug use or high risk sexual practices among baby boomers, as has often been claimed.
Researchers and advocates alike hope this new information will help dispel some of the stigma attached to having hep C — particularly for older adults — and encourage more people to get tested and connected with potentially life-saving treatment. The research is further proof that anyone born between 1945 and 1964 should be tested for HCV, even if they feel like they've never been at risk.
Published in The Lancet Infectious Diseases journal, the research shows that the hepatitis C epidemic can be traced to hospital transmissions caused by the practice of reusing needles in medical settings.
Dr. Julio Montaner from the British Columbia Centre for Excellence in HIV/AIDS partnered with the Centers for Disease Control and Prevention to investigate why 75 percent of the up to 6 million adults living with Hep C in North America were born between 1945 and 1964.
“The theory was that in North America the hepatitis C epidemic in baby boomers was due to some behavioral indiscretions that generation had in their younger years,” Montaner said in a statement to the press. “That understanding led to the significant development of stigma around Hep C.”
To trace the disease back in time, the researchers scoured over 45,000 records, discovering that most of the baby boomers were roughly five years-old around the peak of the hep C epidemic in 1950.
“Thus, it is unlikely that past sporadic risky behavior — experimentation with injecting drug use, unsafe tattooing, high risk sex, travel to endemic areas — was the dominant route of transmission in this group,” the study concludes.
According to AIDSmap, the scientists analyzed 45,316 sequences of HCV genotype 1a, the most common strain, and then utilized a technique called phylogenetic analysis to focus on five HCV genes and trace the dynamics of the HCV epidemic.
The results indicate that 1948 to 1963 saw the greatest expansion of the HCV epidemic, which the authors note is “substantially earlier than previously suggested.”
That timeline suggests the epidemic had its roots in World War II, when lifesaving battlefield medical procedures (like blood transfusions and various injections, including immunizations) combined with the global flow of troops to help the disease spread. In the post-war boom, new medical technologies were adopted across the U.S.., without the knowledge of the invisible risks they posed.
Prior to 1950, doctors typically used glass and metal syringes, which were washed, disinfected, and reused. Disposable syringes came into vogue in the decade between 1950 and 1960, reducing the re-use of needles in medical settings, just as the use of recreational drugs and needle sharing was rising (injection drug use peaked in the late 1960s). Still, HCV continued to spread, likely due to infected blood products, prior to the AIDS-inspired, government mandated screening established in 1992.
In the new millennium, hep C became associated with injection drug use, and it is also an increasingly common HIV comorbidity (acquired through unprotected sex or injection drug use).
Bottom line, the investigators determined, “The prevailing view that the North American epidemic is predominately attributable to past sporadic risky behaviors is not supported by our data.”
Separating HCV from the stigma could lead more baby boomers to follow the CDC’s recommendation that anyone born from 1945 through 1965 get tested for hepatitis C.