Hepatitis likely did not stay in Vegas

Anyone who was treated at the Endoscopy Center of Southern Nevada between March 2004 and January should be tested for hepatitis and HIV, says a Hawaii infectious disease specialist.

"The flight from Honolulu to Las Vegas is almost continual," said Dr. Alan Tice, expressing concern that some islanders or family living in Las Vegas might have had procedures at the clinic.

An investigation began in January when an unusual number of hepatitis C cases were traced to the clinic, which had been reusing syringes and vials of medicine for about four years.

About 40,000 people who received anesthesia at the center during that time could have been exposed to hepatitis C and other viruses, Nevada health officials said.

They could include Hawaii residents or others with Hawaii ties, said Tice, a professor at the University of Hawaii John A. Burns School of Medicine. "A huge community of Hawaiians live there."

Hepatitis C affects about one in 50 Americans, and most do not know they have it, said Tice. "They don't come down with an expression of the disease, and it causes cancer and cirrhosis (of the liver) 20 to 50 years later. It is a silent epidemic."

Tice has a private practice and works with the Hepatitis Support Network of Hawaii on outreach efforts to educate, test and treat people with hepatitis.

"What I deal with are people who figure out they have it early, and I can do something about it, which I love," he said. "Or they come when the iceberg surfaces and they're ready to die, and there is nothing I can do about it and I hate that."

Hepatitis A is transmitted orally through bad food and water, while hepatitis B and C are potentially fatal blood-borne viruses.

There are effective vaccines for hepatitis A and B but none for hepatitis C. There are also some "new miracle drugs" for hepatitis B as a spinoff from HIV research, Tice said.

Treatment for hepatitis C takes almost a year "of people not feeling well" from the toxic drugs, he said. "Yet the success rate is good."

Hepatitis B is more easily transferred among household members than hepatitis C, and homeless people are particularly susceptible through sharing of toothbrushes or razors, Tice said.

Hawaii has the highest rate of liver cancer per capita in the nation, largely because of people coming here from Pacific islands or countries who were never vaccinated and have the virus without knowing it, he said.

Risk factors for the B and C viruses include injection drugs, even 20 to 50 years ago, and use of unsterilized needles and instruments for medical and dental work, tattoos and body-piercing, Tice said. He urges anyone with those risk factors to get tested.

He said about 600 people have been screened for hepatitis B and C through the Hepatitis Support Network's outreach efforts at health fairs, churches and other events. "We found a lot of people who had no idea they had an infection," about 10 percent, he said. "Now we're evaluating and treating them."

Tice said the dangerous practices uncovered in the Endoscopy Center of Southern Nevada underscore "the value and importance of infection control. People are often unwilling to pay for it because it may not make a difference this month. ... But down the road, we will see the consequences in 20 to 30 years from what happened in that clinic.

"It's like Chernobyl, if you will," he said, referring to the 1986 nuclear accident in Ukraine, then part of the Soviet Union.