Culture: Impact of war on language (155).
By Sami El-Shahed - The Egyptian Gazette According to Dr Bradford Waters, Professor of Medicine, University of Tennessee, Memphis, 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 C.
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, said Professor Waters who is also Staff Hepatologist, Memphis Veteran Affairs (VA) Medical Centre Associate.
The demographics of hepatitis C in US civilians and VA patients are important. Several epidemiological studies have found hepatitis C to be higher in US males, African-Americans, lower socioeconomic groups and in those Americans in the 40 to 60 year old age groups. In addition to serving primarily males, the VA has historically served large populations of disadvantaged, uninsured and minority veterans.
The VA has had well established programmes for the treatment of ethanol and other substance abuse. These substance abuse programmes have often attracted younger veterans with prior intranasal cocaine and intravenous drug use associated with hepatitis C infection.
As a result of the VA programmes' providing care for the disadvantaged, uninsured and substance abusing veterans, the VA has acquired significant patient populations with high risk for hepatitis C. Many of the highest risk groups for hepatitis C in the US - identified by the Centres for Disease Control: male, poor socioeconomic group, and between the ages of 30-50 (in a 1988-94 study) - have the same demographic criteria met by many Vietnam era veterans seeking care in the VA. Improved screening of VA patients with risk factors for hepatitis C has helped identify increasing numbers of patients with chronic hepatitis C, Dr Waters explained.
A large multi-centre VA study involving twenty six Medical Centres and approximately 5,800 patients was initiated by the San Francisco VA Medical Centre to study demographic factors and treatment response in VA patients.
The role of tattoos in transmission of hepatitis C has been controversial. In this group of Memphis veterans, 30.2% of patients had tattoos. 92.8% of patients reported multiple risk factors for hepatitis C. In analysis of patients with a single risk factor for hepatitis C, intranasal cocaine use, non-combat occupational exposure, surgery, transfusion, intravenous drug abuse (IVDA) and sex with a prostitute were identified, Dr Waters elaborated.
Medical advances during the Vietnam War included rapid evacuation, improved transfusion and high rates of US casualty survival in an era prior to hepatitis C screening of the blood supply. Many Vietnam combat casualties who survived with multiple transfusions would have died on the battlefield in previous conflicts.
Hepatitis C in Vietnam era veterans is an ongoing national problem. Complex challenges remain in the epidemiology and treatment of hepatitis C. Many Vietnam era veterans are now on the front lines of the hepatitis C epidemic. Improved understanding and treatment of these patients will ultimately benefit all Americans with hepatitis C, Dr Waters concluded.
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