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Hepatitis & the US Military

Hepatitis & the US Military

While Americans pause for two minutes of silence at 3 PM local time this Memorial Day to remember and honor those who have died in service to the nation, we at Caregiven will also take time to remember the surviving veterans who faced new struggles after returning home. May is Hepatitis Awareness Month in the United States. We’re shining a light on this dangerous disease, which impacts the lives of so many veterans and their families. 

All 31 days represent an important time to raise awareness, but we want to emphasize May 19th in particular: Hepatitis Testing Day. The importance of getting tested cannot be understated. Proactive testing empowers early treatment and can make a huge difference in the spread of viral hepatitis as we strive to eliminate the disease. 

Memorial Day has been known since the years following the Civil War as a day of honoring and mourning friends, family, and fellow citizens who made the ultimate sacrifice while serving in the United States Armed Forces. Many Americans will observe Memorial Day by visiting cemeteries or memorials, participating in parades, or gathering with family. 

Since those era-defining years in the late 1860s, US Armed Forces have grown immensely — along with the country. The women and men who serve civilians and the country at large have made more emotional, mortal, psychological, and physical sacrifices than can be counted. What sometimes passes beyond our awareness are the daily sacrifices many of our service members continue to make even after they have returned to civilian life. Many veterans who survived deadly combat will go on to lose internal battles with deadly diseases. Our goal this May is to honor those who served as well as highlight a specific issue affecting the veteran population, particularly men. 

According to a 2022 fact sheet from the U.S. Department of Veterans Affairs, an estimated 3 million people in the United States have chronic HCV, and 19,000 die each year from HCV-related liver disease. Veterans enrolled for care at the VA are three times more likely to have an HCV infection than the general U.S. population. The rate of HCV infection for veterans is elevated at 5.4%, while it remains just 1.8% for all citizens.

Worldwide, there are 1.1 million deaths each year from Hepatitis with 9.4 million people being treated for a Chronic Hepatitis C infection. These numbers exist despite nearly half of infants around the globe having access to at least a Hepatitis B vaccine and the World Health Organization’s goal of eliminating Hepatitis as a public health threat by 2030.

Looking ahead to World Hepatitis Day in July, we’re already thinking about the official motto for the day, “Hep Can’t Wait.” We at Caregiven take this message seriously and are happy to help educate people as to reaching that achievable 2030 goal set by the WHO — especially for those who have sacrificed so much to protect the United States by serving in a branch of the military.

5 Types of Hepatitis

First, let’s define hepatitis. 

According to the World Health Organization, hepatitis is an “inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading to a range of health problems, some of which can be fatal." Toxins such as alcohol and certain drugs as well as autoimmune diseases may also cause hepatitis. While hepatitis A, B, and C are commonly known, five different strains of the virus exist at present. The Hepatitis B Organization charts out the different types, their causes, and potential treatments in this blog

An overview on types of Hepatitis viruses:

A — Highly contagious and spread through unsanitary practices (fecal-oral) with cleanliness or contaminated food or water. Vaccine preventable.

B — Transmitted through bodily fluids, dirty needles, unsanitary medical equipment, or from mother-to-baby during childbirth. Vaccine preventable.

C — Also transmitted through bodily fluids, dirty needles, and unsanitary medical equipment. Vaccine preventable but the best protection is to avoid risky behaviors like drug use and unprotected sex.

D — “Hepatitis Delta” only presents with people already infected with Hepatitis B (coinfection). Transmitted through bodily fluids. No specific vaccine but can be prevented with the Hepatitis B vaccine.

E — Spread through unsanitary hygiene practices (fecal-oral transmission) and contaminated water and food, specifically undercooked pork, game meat, and shellfish. No vaccine available in the US (China only at present).

Hepatitis C, Military Veterans, and the Air Gun Vaccinator

Given the higher-than-average rate of Hepatitis C infections in Veterans, particularly those serving during the Vietnam War era (active duty from 1964-1975), studies were conducted to trace the root causes of these infections. Among the sacrifices made by veterans, PTSD ranks high as a trauma not recognized soon enough by our society, and many vets resorted to self-medication through drugs and alcohol. Several studies found that intravenous drug use pre-, during, and post-service contributed to inflated rates of Hep C infections among Vietnam vets. Additionally, advances in medical treatment and rapid evacuation of the wounded during that war led to a greater number of blood transfusions. At the time, screening for the Hep C virus was not yet standard in blood supplies. 

According to a Staff Hepatologist at the VA in Memphis, additional risk factors included:

  • blood/body fluid exposure to health care personnel
  • blood/body exposure to combat personnel
  • contamination of vaccinations/immune globulin
  • exposure through the multidose vaccination process
  • blood exposure through sharing of razors, non-sterile instruments or utensils

Another potential contributing factor, as claimed by a Vietnam veteran in a 2017 op-ed, was through “jet gun” injectors used for mass inoculation of military personnel during the Vietnam war era. A number of veterans have stated that these jet guns were not cleaned between patients and left exposed blood on the device. While the VA stated that viral infection through use of jet guns is “biologically plausible,” but has yet to back up said claim, the WHO stopped using jet guns in their global vaccine program in 1997 — and the Department of Defense followed suit that same year. 

Unfortunately, many vets face the stigma of intravenous drug use as a cause of Hep C and fear getting tested. However, the good news is that a vaccine exists and part of defeating this stigma is to raise awareness, just as we raise up those service members who served in foreign wars.

Why a Hepatitis Awareness Month?

Because we, as a global community and especially those in the medical community, can stop the spread of viral hepatitis in most of its forms. The starting point is to raise awareness. Waiting only results in more infections and potential deaths — which means there is no time to spare. A global health effort driven by world leaders can meet the WHO’s goal of eliminating hepatitis as a public health threat by 2030.

There are many impactful ways to get involved in the effort, such as:

  • Sharing simple online tools designed to locate nearby providers of vaccines and testing
  • Incorporating the Hepatitis Awareness Month logo into your online presence (website, blogs, social media posts, email, etc).
  • Joining the social conversation with the hashtags #HepAware, #HepTestingDay, and #HepatitisAwarenessMonth
  • Using and sharing the CDC’s educational campaign materials

Access more information about these and other solutions on the HHS website and get started. Finally, when it comes to raising awareness for veterans, we should take time this Memorial Day to remember how important it is to stand for those who stood for us.