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Hepatitis C outbreak raises public health concerns in 8 states

A health care-associated hepatitis C outbreak in New Hampshire has left health officials in eight states scrambling to identify and test people who might have been exposed to the virus, which can be fatal if left untreated. Those states are Arizona, Georgia, Kansas, Maryland, Michigan, New Hampshire, New York and Pennsylvania, according to the Centers for Disease Control and Prevention.

The CDC is helping investigate the situation, which the agency said could become one of the nation’s largest health care-related hepatitis C outbreaks.

“Hepatitis C is a terrible illness, and viral hepatitis often doesn’t present any symptoms until there’s already damage to the liver,” said Melissa Dankel, a spokeswoman for the CDC’s Division of Healthcare Quality Promotion. “It’s a bad situation.”

The suspected source of the outbreak is a former New Hampshire medical technician with hepatitis C who injected himself with syringes containing fentanyl that were meant for patients. The technician, who worked at Exeter Hospital in New Hampshire between April 2011 and May 2012, replaced the anesthetic in the syringes with another liquid, which then was injected into patients, said the U.S. attorney’s office in New Hampshire. The individual was arrested July 19 and charged with obtaining controlled substances by fraud and tampering with a consumer product.

The former employee is believed to have infected at least 30 Exeter Hospital patients with hepatitis C, said the New Hampshire Dept. of Health and Human Services. The CDC identified genetic similarities between the technician’s virus strain and that which infected the 30 patients.

But health professionals are concerned that significantly more people could have been affected, because the technician held similar jobs in at least six other states before moving to New Hampshire. Hepatitis C testing is being conducted among former patients at health centers where he worked.

“I think this is an important wake-up call to prompt [health professionals] to take a very careful look at their narcotic policies and procedures in order to make certain that we all have a very secure and effective process in place to help prevent this from happening” again, said Neil Fishman, MD, an infectious diseases physician and associate chief medical officer at the University of Pennsylvania Health System.

He recommends that medical institutions properly secure and track narcotics at all times and foster a culture in which employees feel they are able to report abnormal or questionable activities of staff members without retribution.

Health professionals also should pay close attention to instances when a sedative does not work as well as it should, because that could be an indication of drug diversion, Dr. Fishman said.

About 75% to 85% of people infected with hepatitis C develop a chronic infection that can lead to serious liver problems, including cirrhosis and liver cancer, the CDC said. An estimated 3.2 million people in the U.S. have chronic hepatitis C virus infection, most of whom don’t know they’re infected because they are asymptomatic.

The CDC recommends that all adults born between 1946 and 1965 be tested for the virus, because data show one in 30 such individuals has been infected with hepatitis C.

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