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June 16. 2012 11:35PM
In NH, doctors don’t have to report outbreaks of hepatitis C
New Hampshire is the only state in the country that does not require physicians to report cases of hepatitis C.
Dr. Jose Montero, the state’s public health director, said adding the virus to the state’s list of reportable diseases would not necessarily make it easier to identify patients. That’s because only eight in 10 people who have the virus develop symptoms, he said.
And most of the remaining 20 percent of individuals who do develop acute illness are drug users and “may not be part of the regular health care system,” Montero said.
So while about 850 new cases of hepatitis C are reported nationwide each year, Montero said, medical experts believe there are actually as many as 15,000 new infections annually.
“Most patients are missed,” Montero said. “That’s why the value of having it reportable is highly debatable.”
However, Colorado’s state epidemiologist told the New Hampshire Sunday News that her state’s reporting requirements for hepatitis C allowed public health officials to quickly identify the source of an outbreak of the disease among patients of a Denver hospital three years ago.
Dr. Lisa Miller said public health officials in Colorado interview anyone diagnosed with acute hepatitis C. So when two cases of the illness showed up in the spring of 2009, her department was able to quickly determine the patients had no risk factors for the illness, such as injection drug use.
“And they had both had a surgical procedure at the same facility in a time frame that made sense with their infection,” she said. “That was really our first clue.”
State health officials checked their records of previous cases to see whether any involved employees at Rose Medical Center in Denver and found one: a surgical technician. “And we also learned that this employee had recently been let go because they had suspected drug use,” Miller said. “It all sort of fell into place.”
They tracked down the woman, who had gotten a job at another hospital 60 miles away. She eventually admitted she had been stealing pre-filled syringes of fentanyl from hospital carts in procedure rooms and replacing them with contaminated syringes filled with saline, Miller said.
“So not only were people getting exposed to this virus, they were also not getting their narcotic,” she said.
Eighteen hepatitis C cases were identified and six more were suspected but could not be confirmed with testing, according to Miller. More than 6,000 patients were tested for the virus. No cases were identified from the second hospital where the woman worked.
Prison sentence
The 27-year-old surgical technician pleaded guilty to several counts of tampering with a consumer product and is serving 30 years in federal prison.
In Colorado, it was the hospitals, not the state, that notified anyone who might have been exposed and tested them for the virus, Miller said.
“They took on dealing with the patients, which was probably even more difficult than us dealing with the patients, because they had to take some responsibility,” she said. “It was really the facilities who needed to deal with that feeling of mistrust from their patients.”
There are vital lessons to be learned from what Colorado went through, Miller said. Chiefly, “narcotics cannot be left unattended, even in an operating room that is considered secure, because it’s really not secure.”
“You need to keep them under lock and key unless they’re under the direct control of an anesthesiologist or another clinician involved in the immediate administration of the drug.”
After the outbreak, Colorado passed a law requiring surgical technicians to be licensed. Disciplinary actions are now reported in a database, and employers must check that database before hiring someone, Miller said.
New Hampshire does not require surgical technicians to be licensed, Montero said.
In the end, Miller said, it was Colorado’s surveillance of hepatitis C cases that helped investigators solve the case. Without that, she said, “I don’t know how long this person would have been able to continue working and exposing people.”
“Sometimes people think about surveillance and think it is just counting things and why does it matter,” she said. “It does matter because we can understand situations like this.”
Fatality
In Florida, it took a three-year investigation by the CDC, the Department of Health and the Mayo Clinic to figure out the cause of a hepatitis C outbreak at that hospital.
Five patients were infected with the virus between 2006 and 2008 when a radiology technician stole syringes of fentanyl and refilled the contaminated syringes with saline, according to court records.
One patient, who underwent a liver transplant in 2006, died four years later from complications related to hepatitis C, “never knowing how he got it,” according to the U.S. Attorney’s Office in Florida.
The epidemiologists traced three cases of the disease to the Mayo Clinic, where they interviewed 21 employees and requested blood tests.
The 49-year-old technician was arrested in May, 2011, and last month pleaded guilty to 10 federal charges. He faces a maximum penalty of life in federal prison and will be sentenced in September, according to the U.S. Attorney’s Office.
Ashley Carr, deputy press secretary at Florida’s Department of Health, said the CDC is poised to recommend that all baby boomers — anyone born between 1945 and 1965 — be screened for the hepatitis C virus.
Shawne Wickham may be reached at swickham@unionleader.com.
Dr. Jose Montero, the state’s public health director, said adding the virus to the state’s list of reportable diseases would not necessarily make it easier to identify patients. That’s because only eight in 10 people who have the virus develop symptoms, he said.
And most of the remaining 20 percent of individuals who do develop acute illness are drug users and “may not be part of the regular health care system,” Montero said.
So while about 850 new cases of hepatitis C are reported nationwide each year, Montero said, medical experts believe there are actually as many as 15,000 new infections annually.
“Most patients are missed,” Montero said. “That’s why the value of having it reportable is highly debatable.”
However, Colorado’s state epidemiologist told the New Hampshire Sunday News that her state’s reporting requirements for hepatitis C allowed public health officials to quickly identify the source of an outbreak of the disease among patients of a Denver hospital three years ago.
Dr. Lisa Miller said public health officials in Colorado interview anyone diagnosed with acute hepatitis C. So when two cases of the illness showed up in the spring of 2009, her department was able to quickly determine the patients had no risk factors for the illness, such as injection drug use.
“And they had both had a surgical procedure at the same facility in a time frame that made sense with their infection,” she said. “That was really our first clue.”
State health officials checked their records of previous cases to see whether any involved employees at Rose Medical Center in Denver and found one: a surgical technician. “And we also learned that this employee had recently been let go because they had suspected drug use,” Miller said. “It all sort of fell into place.”
They tracked down the woman, who had gotten a job at another hospital 60 miles away. She eventually admitted she had been stealing pre-filled syringes of fentanyl from hospital carts in procedure rooms and replacing them with contaminated syringes filled with saline, Miller said.
“So not only were people getting exposed to this virus, they were also not getting their narcotic,” she said.
Eighteen hepatitis C cases were identified and six more were suspected but could not be confirmed with testing, according to Miller. More than 6,000 patients were tested for the virus. No cases were identified from the second hospital where the woman worked.
Prison sentence
The 27-year-old surgical technician pleaded guilty to several counts of tampering with a consumer product and is serving 30 years in federal prison.
In Colorado, it was the hospitals, not the state, that notified anyone who might have been exposed and tested them for the virus, Miller said.
“They took on dealing with the patients, which was probably even more difficult than us dealing with the patients, because they had to take some responsibility,” she said. “It was really the facilities who needed to deal with that feeling of mistrust from their patients.”
There are vital lessons to be learned from what Colorado went through, Miller said. Chiefly, “narcotics cannot be left unattended, even in an operating room that is considered secure, because it’s really not secure.”
“You need to keep them under lock and key unless they’re under the direct control of an anesthesiologist or another clinician involved in the immediate administration of the drug.”
After the outbreak, Colorado passed a law requiring surgical technicians to be licensed. Disciplinary actions are now reported in a database, and employers must check that database before hiring someone, Miller said.
New Hampshire does not require surgical technicians to be licensed, Montero said.
In the end, Miller said, it was Colorado’s surveillance of hepatitis C cases that helped investigators solve the case. Without that, she said, “I don’t know how long this person would have been able to continue working and exposing people.”
“Sometimes people think about surveillance and think it is just counting things and why does it matter,” she said. “It does matter because we can understand situations like this.”
Fatality
In Florida, it took a three-year investigation by the CDC, the Department of Health and the Mayo Clinic to figure out the cause of a hepatitis C outbreak at that hospital.
Five patients were infected with the virus between 2006 and 2008 when a radiology technician stole syringes of fentanyl and refilled the contaminated syringes with saline, according to court records.
One patient, who underwent a liver transplant in 2006, died four years later from complications related to hepatitis C, “never knowing how he got it,” according to the U.S. Attorney’s Office in Florida.
The epidemiologists traced three cases of the disease to the Mayo Clinic, where they interviewed 21 employees and requested blood tests.
The 49-year-old technician was arrested in May, 2011, and last month pleaded guilty to 10 federal charges. He faces a maximum penalty of life in federal prison and will be sentenced in September, according to the U.S. Attorney’s Office.
Ashley Carr, deputy press secretary at Florida’s Department of Health, said the CDC is poised to recommend that all baby boomers — anyone born between 1945 and 1965 — be screened for the hepatitis C virus.
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Shawne Wickham may be reached at swickham@unionleader.com.
