By Andrea K. Walker, The Baltimore Sun
7:10 PM EDT, July 6, 2012
When Alan Shackelford's ankles would swell up, he brushed it off as another sign of getting older — only to find out it was a symptom of something much worse.
The 59-year-old Windsor Mill man was shocked when his doctor recently diagnosed him with hepatitis C. Even more disturbing to the IT specialist at Johns Hopkins University was that he had probably been living with the disease for years.
"I was completely freaked out that this had happened to me and I probably had this for 35 to 40 years," Shackelford said.
He isn't the only one unknowingly walking around with the fatal and often symptom-less liver disease, which is attacking people mostly in his age range.
One in 30 baby boomers, or those born between 1945 through 1965, has hepatitis C, but most don't know it, according to the Centers for Disease Control and Prevention. Baby boomers account for more than 75 percent of the cases and are five times more likely than other adults to become infected.
Health officials are trying to raise awareness and get more people tested for the virus, which can lead to liver cancer and kill nearly 15,000 people a year. That's more deaths than from AIDS.
The CDC has recommended revising guidelines to have all baby boomers be tested for hepatitis C. Current guidelines call for testing those with risk factors, such as previous drug use or having had a blood transfusion.
If the disease is caught and treated, there can be fewer life-threatening complications.
In Baltimore, the city's Health Department has budgeted to hire an epidemiologist devoted to working on hepatitis C cases. The city's current staff was insufficient to follow up on the large number of diagnoses reported to them by labs and health care providers.
"It is a prevalent problem," said Evelyn Rodriguez, deputy commissioner for communicable diseases at the Baltimore City Health Department.
Many baby boomers most likely picked up the disease in their 20s and probably couldn't even remember what they did to put them at risk.
The virus is transmitted by blood, most commonly through a transfusion or intravenous drug use. Before 1992 there was no widely used test to detect the virus in blood.
"It got into the blood supply is basically what happened, and there was no way to detect it," said Rudy Rai, medical director of the Gastro Center of Maryland, who treats hepatitis C.
Shackelford isn't sure how he was exposed to the virus. It may have happened when he worked offshore as a surveyor in the oil fields during his younger days. Sometimes co-workers would get serious injuries and Shackelford would help administer first aid.
"I had a couple of occasions where I was elbow deep in somebody else's blood trying to keep them from bleeding to death," he said. "We didn't have face masks and safety suits. We were just trying to keep people alive."
Or he may have picked up the virus from a blood transfusion he received after getting hit by a car while riding his bike as a teenager.
Shackelford said he had never talked to his doctors about hepatitis C. His doctor ordered a battery of tests after finding out he hadn't had a physical in years.
The swollen ankles and some fatigue might have offered a clue that something was wrong with Shackelford's liver. But often there are no signs of the disease. It is a slow-growing illness that can linger in people for years.
It's not detected in routine blood work.
"Unless you look for hepatitis C and take a specific test for it, no other test will pick it up," Rai said.
Health problems associated with hepatitis C have been increasing for the last decade and are projected to grow even more rapidly in coming years, if the disease is not better controlled, according to the CDC.
Liver cancer is the fastest-rising cause of cancer deaths and the leading cause of liver transplants.
The new epidemiologist in Baltimore will improve on tracking of the disease to determine how big an issue it is in the city. The epidemiologist will also educate residents and identify outbreaks to try to curb the spread of the virus.
The drugs to treat hepatitis C have gotten better through the years. The rate for successful treatment used to be less than 30 percent but is now as high as 80 percent.
The drugs Interferon and Ribavirin have been used in treatment for years and effective for patients with Type 2 and Type 3 of the disease. The most common and most resistant Type 1 now is treatable with a combination of these and one of the newly approved protease inhibitors, Telaprevir and Boceprevir.
The CDC estimates that screening all boomers would reveal an additional 800,000 infected people and save 120,000 lives.
Hepatitis C Facts
More than 2 million baby boomers affected
Baby boomers account for 75 percent of all cases
More than 15,000 Americans die from disease each year
Can lead to cirrhosis and liver cancer
Copyright © 2013, The Baltimore Sun