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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Hepatitis: Veterans

   

 

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"Military recruits encountered the same hazards as civilians during the 1960s and '70s, and many contracted Hepatitis C Virus. A 1999 study found an Hepatitis C Virus rate of 6 percent to 8 percent among Vietnam vets at San Francisco's VA hospital-roughly four times the rate in the general population. The numbers are no great surprise; VA patients almost always have more health problems than civilians (or other veterans). But some infected vets deny having any known risk factor. "People falsely assume that hepatitis C is due to poor personal conduct," says Bill Schwartz, a West Point graduate who served two tours in Vietnam and retired as a lieutenant colonel before joining Litton Industries as a marketing executive. Like many infected veterans, Schwartz believes the air guns used to vaccinate GIs in long queues may have spread droplets of blood from one person to another. Dr. Lawrence Deyton, the VA's chief public-health officer, is wary of jumping to such conclusions. "Was it combat wounds? Medical procedures? Use of the inoculation guns?" he asks. "We don't have the data yet. We simply don't know." The hazards of military service should become clearer this summer, when the VA releases a survey comparing Hepatitis C Virus rates among veterans of various wars." Hepatitis C: The Insidious Spread of a Killer Virus

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2006 VA HEALTH, INCOME AND OTHER BENEFITS

Many fans of movie musicals can recall Joan Blondell belting out “Remember My Forgotten Man” against a moving tableau of World War I doughboys in Busby Berkeley’s film, Golddiggers of 1933.  In one of Hollywood’s rare early forays into social issues, the song and dance number called for better treatment of the World War I veterans who’d just been spurned by President Hoover, the lame-duck GOP Congress and even future World War II hero General Douglas MacArthur, who used tanks to disperse thousands of unemployed and disabled veterans demonstrating peacefully for benefits in Washington the year before.

But over 70 years later, Blondell’s torch-song lament still rings true:  Most of us aren’t aware of benefits which are available to all veterans – and especially disabled veterans  -- and they and the benefits due them too often remain “forgotten.”  (For just one example, in 2000 Lawrence Deyton, MD, the VA’s national coordinator of  HIV care, estimated that only 18,000 of an estimated 85,000 to 130,000 eligible HIV-positive veterans had signed up for the VA health care to which they’re entitled.) Here’s a brief survey of income and health coverage programs for veterans of active duty with general or honorable discharges.
 

 

BLOODBORNE PATHOGENS EXPOSURE CONTROL PLAN Department of the Army control plan- To prescribe policies, responsibilities and procedures for implementation of the Bloodborne Pathogen Exposure Control Plan (BBPECP) to meet the letter and intent of the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030). OSHA has enacted this standard to "reduce occupational exposure to Hepatitis B Virus (HBV), Human Immunodeficiency Virus (HIV) and other bloodborne pathogens". This plan details measures WRAMC and its employees will take to decrease the risk of transmission of bloodborne pathogens and provide appropriate treatment and counseling should an employee be exposed to bloodborne pathogens.  

Ethical Challenges in the Care of Persons With Hepatitis C Infection: A Pilot Study to Enhance Informed Consent with Veterans

 

Four million Americans are currently infected with HCV. The high response rate to combined antiviral therapy for HCV suggests that this treatment is both cost-effective and clinically beneficial. The patients with the strongest clinical indications for treatment with interferon and ribavirin are most often those who possess addictive and psychiatric disorders that are potential barriers to successful treatment. The ability of these patients to provide informed consent for treatment is thus essential if they are to take advantage of scientific and institutional progress in the area of HCV therapy. Our early work with an HCV informed consent assessment process designed to identify clinician-, patient-, disease-, and treatment-specific factors influencing informed consent can provide the basis for educational and therapeutic interventions to maximize patients’ decisional capacity to enter into and complete combined HCV therapy. Pdf 82 kb
Ethical Challenges in the Care of Persons With Hepatitis C Infection: A Pilot Study to Enhance Informed Consent With Veterans Four million Americans are currently infected with HCV. The high response rate to combined antiviral therapy for HCV suggests that this treatment is both cost-effective and clinically beneficial. The patients with the strongest clinical indications for treatment with interferon and ribavirin are most often those who possess addictive and psychiatric disorders that are potential barriers to successful treatment. The ability of these patients to provide informed consent for treatment is thus essential if they are to take advantage of scientific and institutional progress in the area of HCV therapy. Our early work with an HCV informed consent assessment process designed to identify clinician-, patient-, disease-, and treatment-specific factors influencing informed consent can provide the basis for educational and therapeutic interventions to maximize patients’ decisional capacity to enter into and complete combined HCV therapy.  
Hepatitis C in Vietnam Era Veterans Hepatitis C is a major problem in United States military veterans. In several studies of Veteran’s Affairs (VA) Medical Center patients, we find that 8-9% are positive for hepatitis C antibodies. Some VA Medical Centers had 10-20% of patients with hepatitis C antibodies.1,2 The highest rate of hepatitis C is found in the Vietnam era veterans. Several studies have been initiated to better understand the high frequency of hepatitis C in veterans of the Vietnam conflict. Areas of research include the demographic characteristics, risk factors for infection and the potential role of military service in the acquisition of hepatitis C1. Underlying this research is the question of what is unique about Vietnam or Vietnam-era veterans to help explain a high prevalence of hepatitis C which was not observed in World War II or Korean era veterans.  

Hepatitis C Screening in the VA

"Hepatitis C is a serious national health crisis with an estimated four million Americans infected, many of whom are veterans and many of whom are not even aware they are at-risk," said Chairman Shays.  "But after two years, the laudable promise of the VA initiative to screen and treat Hepatitis C Virus-infected veterans remains unfulfilled. The decentralized VA health system seems incapable of carrying out the Hepatitis C Virus program aggressively or consistently."  

 

Hepatitis C  treatment guidelines for Vets Treatment guidelines from the Veterans Administration 13 kb pdf

Hepatitis C Origin Points to Possible Military Link

Hepatitis, not Hepatitis C, was a serious medical condition for military personnel during the Vietnam War.  Thousands of servicemen contracted the disease and the Pentagon was determined to do something about it to resolve a drain on combat readiness.

 

Hepatitis C Virus Infection Among U.S. Military Personnel: An Assessment Of Risks and Screening Strategies For recruits enlisting in 1997, the prevalence of infection was just 0.1% (1 per 1000 recruits). The risk of infection for Reservists was similar to active duty personnel after adjusting for age. The prevalence of infection in active duty personnel who had been on duty since the Vietnam era was actually lower (1%) than the prevalence (3%) among other military personnel of similar age (greater than 40 years old). Individuals retiring from the military in 1997 were on average 45 years old and had a prevalence of infection of 1.7%.  
INCARCERATED VETERANS ARE ELIGIBLE FOR VA MEDICAL CARE AT VA HOSPITALS AND CLINICS It is important to note that the VA doesn’t permit armed guards at its medical facilities. While there is no bar to unarmed escorts accompanying persons in correctional custody into VA waiting areas, escorts may well have to negotiate physicians’ consents to accompany inmates into examination and treatment rooms. And there would be even more problems with 24-hour-a-day escorts for hospitalized inmates.  

Jet injectors can regularly transmit relevant volumes of blood

LHI in their reflective practitioner role receive many requests for advice on the prevention and control of infection and outbreaks.  These cover infection control in  hospitals and other, wider aspects of healthcare.  One example of this was recently generated in the  Infection Control Unit  and concerns the transmission of blood borne infectious agents by jet injectors.  These injectors use a high-pressure focussed jet of  fluid to provide a  needleless mechanism for penetrating skin. 

 

Obtaining VA benefits From the Code of Federal Regulation  
Presumption of service-connection for certain veterans with Hepatitis C, and for other purposes. To amend title 38, United States Code, to establish a presumption of service-connection for certain veterans with Hepatitis C,  and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,. SECTION 1. PRESUMPTION OF SERVICE-CONNECTION FOR CERTAIN VETERANS WITH Hepatitis C,   

 

Presumptive Service Connection in VBA Power Point Presentation 86 kb
Prevalence of Hepatitis C and Coinfection with HIV Among United States Veterans in the New York Metropolitan Area US veterans who are receiving medical care at VA medical centers in the New York City metropolitan area have a much higher rate of chronic hepatitis C than the general population…coinfection with HIV is very common in patients with confirmed HCV infection, and these patients should routinely be offered HIV testing 206 kb pdf
VA HEPATITIS C PROGRAM The Centers of Excellence have also developed risk factor and counseling recommendations for all VHAs, as well as treatment guidelines for the care of veterans with hepatitis C. These treatment guidelines will be updated periodically, and as there is a greater experience of clinical care, they can be broadened to be more inclusive. Management guidelines, such as the need of vaccination against hepatitis A and B, have also been distributed throughout the VHA system.  

Veterans and Hepatitis C

When the Balanced-Budget Act passed in 1997, many feared it would have a severely detrimental effect on VA health care.   The fear most frequently expressed was that since veterans discretionary funds were frozen by the BBA, VA health care resources would eventually be stretched too thin.

 

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Veterans Comprehensive Hepatitis C Health Care Act (Introduced in Senate) To amend title 38, United States Code, to establish a comprehensive program for testing and treatment of veterans for the Hepatitis C virus.  
Veterans’ Health Care: Observations on VA’s Assessment of Hepatitis C Budgeting and Funding GAO report on identified differences in both Hepatitis C activities that were included in VA’s original fiscal year 2000 budget: screening and antiviral drug therapy.  VA budgeted $195 million for these activities, but only spent $50 million, a $145 million difference…We believe that management decisions could have contributed to lower than expected screening and treatment expenditures, in addition to the factors VA cited. 104 kb pdf

Viral Hepatitis among US Navy and Marine Corps-1987

Six hundred and twenty-nine cases of viral hepatitis (A, B, and NonA-NonB) were reported among a total of 768,832 United States Navy and Marine Corps personnel during 1984 and 1985 via a passive surveillance system. Cumulative incidence for all three hepatitis types was higher than those reported for the general population at the same time.

 

 

Vets Upset Over Medical Care Funding

Groups representing the nation's military veterans say they are "howling mad" that the Republican leadership in the House of Representatives backpedaled on a promise to approve $1.8 billion for healthcare funding and caused substantial delays in service personnel receiving medical treatment. "We have a situation. The demand (for treatment) has grown enormously and the funding has not kept up for it, and as a result you have the rules being changed and people not being able to get into the system,"

 

 

 

 

 

 

 

 

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