Billboard Campaign Spotlights Growing Hepatitis C Epidemic

The pairs of yellow eyes in indigo faces staring from billboards around town know something you may not: Ignorance of hepatitis C can kill.

"We are fighting a major epidemic, and most people don't know about it," said Alan Brownstein, president of the American Liver Foundation.

The New Jersey-based foundation's eerie, eye-catching billboards, including six in Seattle and Tacoma, have more people talking about the new and largely incurable virus. Calls to the foundation hotline number posted on the billboards hit a monthly record - 19,206 - last month, including 124 from this state. The public-awareness campaign was paid for by pharmaceutical companies.

An estimated 3.9 million Americans have hepatitis C - 1.8 percent of the population - but the vast majority, up to 90 percent, don't know they have the blood-borne virus, which was not identified until 1989.

The estimate was projected from the results of a national blood sampling survey, said Eric Mast, who heads the hepatitis C surveillance unit for the national Centers for Disease Control and Prevention in Atlanta.

Among African Americans, the infection rate is 3.2 percent - double the overall average - among Mexican Americans, it's 2.1 percent, and among Caucasians, 1.5 percent, according to a recent National Institutes of Health report.

Rate declining

The rate of new infection appears to be declining since blood banks began screening for hepatitis C in 1990, Mast said. The health threat is greatest for the estimated 3.9 million who already have it, most of whom are unaware they were exposed to the previously mysterious virus.

Some of these people had blood transfusions before 1990; about a half shared needles or straws to inject or snort drugs.

On the billboards, bold type urges people to: "Get hip. Get tested. Get treated." Here's why:

-- Between 8,000 and 10,000 people are expected to die from complications of chronic hepatitis C this year. If the death rate triples over the next 10 to 20 years, as postulated in last March's National Institutes for Health hepatitis C consensus panel findings, more people could die annually from complications of hepatitis C than from AIDS.

The CDC recorded 31,256 AIDS deaths in 1995 and expects that rate to continue to fall.

-- Hepatitis C is the most chronic and insidious form of the hepatitis virus - largely because in about 70 percent of the cases liver damage can progress without symptoms for months or years.

-- Hepatitis C is the leading reason for liver transplants nationwide. Twenty percent of cases lead to liver cirrhosis (severe liver scarring) and 5 percent to liver cancer within 20 to 30 years of infection - both currently fatal conditions.

-- The blood-borne virus can exist undetected for decades. The extreme fatigue, vague abdominal pain and worsening symptoms can also persist undiagnosed for years.

-- Lifestyle changes - such as avoiding alcohol, since the liver processes alcohol toxins - could prolong the length and quality of life for people with hepatitis C.

-- Baseball great Mickey Mantle, who died of liver cancer in 1995, is believed to have contracted hepatitis C during a blood transfusion for a knee operation. Country singer Naomi Judd retired midcareer because of hepatitis C symptoms, the foundation reported.

On the heels of the liver-foundation campaign, a federal Department of Health and Human Services committee will decide next month whether to launch an awareness campaign directed at physicians through the CDC and the Food and Drug Administration, which regulates the nation's blood supply.

For decades, public-health professionals knew a virus existed that was not hepatitis A or B, said Dr. David Gretch, a University of Washington virologist and national hepatitis C expert. But researchers were not able to identify it genetically as hepatitis C until 1989. Interferon, a drug used to treat leukemia, eradicates the virus in 15 percent to 20 percent of the cases.

In September, the National Institutes of Health chose the University of Washington as one of four Hepatitis C Collaborative Research Centers nationwide to conduct and exchange experiments on treatment and research for a cure, said Dr. Nelson Fausto, UW center director and medical-school pathology-department chairman. Dr. Mark Kay, a hepatologist, and Gretch also are members of the UW research team.

Funding increased

The NIH boosted funding for hepatitis C from $1 million in 1995 to $8.4 million last year for the four centers, Brownstein said. The other centers are at Stanford University, the University of Southern California and the University of North Carolina.

The urgency among researchers is palpable.

"In reality, hepatitis C is a public-health problem of a major magnitude, and it has not been studied in the detail that it has deserved," Fausto said. "I think this represents a new emphasis by the NIH."

Hepatitis C is a lifelong, chronic condition for 85 percent of those infected. In contrast, only 10 percent of people infected with hepatitis B, also blood-borne, develop a chronic form of the disease.

Hepatitis C is rarely transmitted sexually - in less than 10 percent of cases - unlike hepatitis B, which has a high rate of sexual transmission. There is a vaccine for hepatitis A and B but not for C. Researchers have been stymied in developing a hepatitis C vaccine because the virus continues to mutate - an obstacle similar to the one HIV-AIDS vaccine researchers face.

Neither hepatitis B nor C is believed to be transmitted through casual contact. Hepatitis A, more familiar and less serious, differs from the blood-borne B and C because its transmission is fecal-oral and can be spread through casual contact, such as an infected person who uses the bathroom and prepares food with unwashed hands.

Until a vaccine is discovered, public awareness is the best defense, Brownstein said.

On Denny Way as it crosses Westlake Avenue, passers-by encounter the billboard eyes silently inquiring about hepatitis C. Had they ever shared an intravenous drug needle? Even once? Estimates are that 80 percent to 90 percent of intravenous drug users have hepatitis C, Gretch said.

Had they ever shared straws while snorting cocaine? Nasal blood could transmit the virus as well. Had a blood transfusion before 1990? Been a health-care worker exposed to blood? Shared a razor or toothbrush with an infected person? Had body piercing or tattooing with needles not properly disinfected?

The liver foundation knew the ad would get looks, Brownstein said. Some people with hepatitis find the ads offensive because the eyes appear jaundiced, alien or sinister. The artist at Ruder-Finn, the New York public-relations agency that designed the ad, was not familiar with jaundice, the eye-yellowing symptom of liver disease, Brownstein said. Instead, he was drawn to the attention-getting quality of yellow on blue.

However, the majority have agreed with hepatitis C patients in five focus groups the foundation set up nationwide to review proposals before selecting the ad image. They all chose the yellow-eye ad as the one "that would most engage the viewer," Brownstein said.

The American Liver Foundation's toll-free hotline number is 888-4HEP-USA. Links to related hepatitis Web sites are on The Seattle Times Today's News Web site at: http://www.seattletimes.com