A massive effort is under way in the United States to track down those who may have been infected with the hepatitis C virus through blood transfusions in the past.
Under the Department of Health and Human Services' "targeted look back" program, the nation's blood collection agencies have been combing their records to identify all donors prior to July 1992 who were subsequently excluded from donation because they had tested HCV-positive. The July 1992 deadline was selected because routine use of a second-generation screening test for blood collection, which is more sensitive than its predecessor, was introduced in 1990 and began in June of that year.
Similar programs have been conducted in Ireland, New Zealand, and Canada but, says bioethicist Arthur Caplan, Ph.D., of the University of Pennsylvania, Philadelphia, "they are not comparable [to this one] because both have universal systems of health care and thus much better record keeping." Also, unlike the U.S. system, the Irish, New Zealand, and Canadian ones paid for the HCV testing, while most Americans will be on their own financially. "The Veterans Administration and the community clinics will cover their patients," Caplan added.
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There are 6,500 or so U.S. facilities most of them hospitals that administer transfusions. The blood collection agencies are notifying them of all the blood and blood products they were sent, which in retrospect might have been tainted, putting patients at risk.
The transfusion facilities, in turn, are searching their records to pin down which recipients received the potentially contaminated blood. That done, the facilities will try to notify the doctors of these patients who then will notify their patients, assuming that they are still alive. If that is not feasible, the effort will be to try to contact patients directly.
Plans call for the entire notification process to be completed by April 2000. Besides letting people know that they may be at risk, the program will tell them what they can do to determine their actual status, encourage them to do it, and provide other helpful information about HCV. A corollary educational program for health providers has been launched to ready them to shoulder their part of the load.
Tainted transfusions from the pre-July 1992 era account for only about 280,000 to 300,000 of the estimated 4 million or so cases of chronic HCV infection in the U.S. population; a paltry 7% of the total. There are, nonetheless, some high prevalence groups in that 7%.
Cancer survivors, hemodialysis patients, hemophiliacs, and AIDS patients are among them. So are women whose babies were delivered by cesarean section, transplant recipients, and people whose births were premature.
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