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HEPATITIS C THE NEW SILENT EPIDEMIC

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F. Edward Yazbak MD

 

On December 13, 2001, I published “Autism 2001: The Silent Epidemic”.

It was the third yearly investigation I had published and to my knowledge, the first time anyone had ever described Autism as a “Silent Epidemic.”

/DailyNews/December2001/Autism2001SilentEpdemic.htm

It is with sadness and trepidation that I use again, some 14 + years later, the same term to describe the latest significant and possibly inadvertently created iatrogenic epidemic.

The May 2016 issue of The American Journal of Managed Care was a Special Issue totally devoted to Hepatitis C Viral Infections.

Featured were:

  • Four Clinical Reports
  • Two Commentaries
  • One Editorial
  • Four Policy Statements

http://www.ajmc.com/journals/issue/2016/2016-5-vol22-SP

According to M. Caffrey who reviewed the publication on May 4, 2016, the CDC has reported that:

  • Some 20,000 individuals died from hepatitis C virus (HCV) infection and complications in 2014, more than in any other prior year
  • Because of poor reporting, it is likely that the death toll from the HCV infections was actually higher
  • Estimated cases of HCV disease doubled between 2010 and 2014
  • HCV infections - related complications had become the top cause of death among all 60 listed infectious diseases, including HIV and tuberculosis.

http://www.ajmc.com/focus-of-the-week/0516/deaths-from-hepatitis-c-virus-hit-all-time-high-cdc-reports

It is likely that most of us in the United States were bombarded with more reports about two cases of Ebola, a couple of hundred cases of measles and Zero case of Zika microcephaly in the last 3 years than about the thousands of cases of Hepatitis C that, for reasons unknown, seemed to receive as much attention from the media as the autism disaster we have been battling for years.  

Nationwide, discussion of HCV disease has been mostly focused on new therapies, their availability and their exorbitant run-away prices but not on what really caused the spectacular increase in the number of patients with the disease. The focus of this presentation is the discussion of what may have suddenly caused this second “Silent Epidemic.”          

***

We are presently being repeatedly warned about shingles and how 1 out 3 individuals will suffer from that painful disease. The message from Merck is that if you had chickenpox, the virus remains dormant in your body for years before it shows up as a very ugly and painful rash. This is usually followed by a gentle admonition to see your doctor or your pharmacist to discuss the available vaccine.

The TV commercial does not mention that shingles was previously less common because after recovering from chickenpox, individuals who were constantly re-exposed to the disease in the community received frequent and substantial boosting of their own good and strong cellular mediated Varicella – Zoster Virus (VZV) immunity, thus preventing shingles except rarely in older individuals.

In the past, pediatricians were convinced and told parents that chickenpox provided “lifetime immunity”. What many did not realize was that the life-long immunity was not only the result of the acute illness but also of the constant boosting of that immunity through recurrent exposures.

This all changed when VARIVAX ®, a chickenpox vaccine was developed, approved in 1995 and administered to every child in the United States, quickly preventing chickenpox nationwide and in all likelihood contributing to the increased shingles incidence in spectacular fashion. That in turn created a need for a shingles vaccine and ZOSTAVAX®, a concentrated chickenpox vaccine, was promptly developed. The vaccine was licensed in May 2006 and vigorously marketed. The vaccine’s overall efficacy in preventing shingles has been ~ 51%. https://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf

For a more comprehensive review of the subject, please see: /20110113ChickenpoxVaccineYazbakFE

***

PREVNAR-7® by Pfizer (PCV-7), the first pediatric pneumococcal conjugate vaccine was licensed in the United States in 2000. It includes the purified capsular polysaccharide of seven serotypes of S. pneumoniae (4, 9V, 14, 19F, 23F, 18C, and 6B) conjugated to a nontoxic variant of diphtheria toxin known as CRM197. These serotypes were the most commonly identified strains causing invasive disease before the vaccine was introduced.

According to the CDC Pink Book, serotype 19A, that was not included in PCV-7, was already accounting for 43% of invasive cases by 2008, prompting the development and licensing by 2010 of a 13-valent pneumococcal conjugate vaccine, PREVNAR-13® (PCV-13) that contained the 7 serotypes in PCV7 plus serotypes 1, 3, 5, 6A, 7F and 19A similarly conjugated to CRM197.

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pneumo.pdf

Although a switch of prevailing strains was expected in 2000, it was never mentioned when PCV-7 was launched.

In 2010, when Pfizer decided to enter the adult market with its new Prevnar 13®, it fully disclosed that:

  • Prevnar 13® is a vaccine approved for adults 50 years of age and older for the prevention of pneumococcal pneumonia and invasive disease caused by 13Streptococcus pneumoniae strains (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F)
  • Prevnar 13® is not 100% effective and will only help protect against the 13 strains included in the vaccine

Merck had preceded Pfizer in the adult market with the introduction of Pneumovax-23® in 1983 for use in persons 50 years of age or older. The vaccine was also recommended for children aged ≥2 years at increased risk for pneumococcal disease.   

I reported on PREVNAR-7, the quick appearance of resistant strains and their significant impact on pediatric illness on May 1, 2006 in Pneumococcus from Penicillin to PREVNAR  /content/pneumococcus-penicillin-prevnar

***

Almost 10 years ago, I examined the issues related to the use of Hepatitis B vaccine and published “The Hepatitis B vaccine: What Went Wrong?  (June 21, 2006)

/content/hepatitis-b-vaccine-what-went-wrong

As usual, my clear warning was ignored.

Interestingly, an astute Russian-speaking Israeli scientist and researcher noticed the seriousness of my report and its implications and published it after translation. http://homeoint.ru/vaccines/malady/yazbak13.htm

The first part of the report related the following known facts about Hepatitis B infection:

  • The incidence of hepatitis B infection in the United States had always been very low: 0.1 to 0.5 percent compared to 5 to 20 percent in the Far East and Africa.
  • In 1991, when the U.S. population was around 248 million, there were 18,003 cases of hepatitis B viral illness - a national incidence of 0.007%
  • The number of U.S. cases of hepatitis B virus (HBV) infections peaked in 1985 and started to decline because of improved precautions before the 1991 infant vaccination program.
  • In 1986, five years before the vaccination program was launched, only 279 cases of HBV infections were reported nationwide in children under 14.
  • In 1996, five years after the initiation of the program, the CDC declared, "Hepatitis B continues to decline in most states, primarily because of a decrease in the number of cases among injecting drug users and, to a lesser extent, among both homosexuals and heterosexuals of both sexes."

In 2006, the CDC claimed at least officially that hepatitis B vaccination of infants and children in the U.S. was necessary because it was ultimately going to decrease the incidence of hepatocellular cancer.

The National Cancer Institute still claims to this day that chronic HBV infection can lead to liver cancer and that HBV vaccination was “the first cancer preventive vaccine.” http://www.cancer.gov/about-cancer/causes-prevention/vaccines-fact-sheet

***

The following is what I wrote ten (10) years ago:  

 “Hepatocellular carcinoma

A 1999 study by El-Serag and Mason, published in the New England Journal of Medicine (NEJM), revealed that the incidence of histologically confirmed hepatocellular carcinoma (HCC) increased between 1976-1980 and 1991-1995 from 1.4 per 100,000 population to 2.4 per 100,000. The incidence among black men was double that of white males. “There was a 41 percent increase in the mortality rate from primary liver cancer and a 46 percent increase in the proportion of hospitalizations attributable to this disease during the periods studied. The incidence increased significantly among younger persons (40 to 60 years old) during the period from 1991 to 1995 as compared with earlier periods.” (3)

* * *

Since 1984, a serious hepatitis B vaccination program has been implemented in Taiwan. A group of researchers from the Pediatrics Department at the National Taiwan University Hospital in Taipei undertook a study examining this effort. 

In June 1997, Chang et al published their findings in the NEJM, reporting that, indeed, the incidence of liver cancer in children had decreased since the vaccine has been in use. “The average annual incidence of hepatocellular carcinoma in children 6 to 14 years of age declined from 0.70 per 100,000 children between 1981 and 1986 to 0.57 between 1986 and 1990, and to 0.36 between 1990 and 1994 (P<0.01). The corresponding rates of mortality from hepatocellular carcinoma also decreased. The incidence of hepatocellular carcinoma in children 6 to 9 years of age declined from 0.52 for those born between 1974 and 1984 to 0.13 for those born between 1984 and 1986 (P<0.001).”   (4)

In a subsequent publication, just three years later, in the Journal of the American Medical Association (JAMA), Chang, Shau, Chen and others from the Taiwan Childhood Hepatoma Study Group reported new findings.

The purpose of the follow-up investigation was to evaluate the association between the hepatitis B vaccination program and the incidence of childhood HCC by sex. The study period extended from 1981 to 1996. All children aged 6 to 14 years diagnosed with HCC were included — 201 boys and 70 girls in all.

According to the authors, “The boy-girl incidence ratio decreased steadily from 4.5 in 1981-1984 (before the program's introduction) to 1.9 in 1990-1996 (six to 12 years after the vaccination program was launched). The incidence of HCC in boys born after 1984 was significantly reduced in comparison with those born before 1978 (relative risk [RR], 0.72; P = .002). No significant decrease in HCC incidence was observed in girls born in the same periods (RR, 0.77; P = .20). The incidence of HCC in boys remained stable with increasing age, while an increase of HCC incidence with age in girls was observed. These age and sex effects remained the same regardless of birth before or after the vaccination program.”

The authors concluded, “Our results suggest that boys may benefit more from HBV vaccination than girls in the prevention of HCC.” (5)

As stated, the conclusion suggests that the girls were protected by the vaccine but the boys were even better protected when it came to HCC. Yet according to the authors, “No significant decrease in HCC incidence was observed in girls born in the same periods.” Clearly, therefore, the girls did not seem to benefit from the vaccine. 

There seems to be further significant concern with the statement, “The incidence of HCC in boys remained stable with increasing age, while an increase of HCC incidence with age in girls was observed.” This carefully worded message suggests that vaccinated girls actually had an increased incidence of HCC as they got older. That is certainly not a desirable outcome … anywhere.

All vaccines have risks. To expose millions to a vaccine that does not work is inappropriate. To expose them to a vaccine that actually may increase cancer seems outrageous.

* * *

Fast forward to June 8, 2006

The Taipei Times pre-empts other news sources and publishes a disturbing report entitled “Study shows hepatitis C may be the cancer culprit.”

The report stated “A new study conducted in Taiwan suggests that the hepatitis C virus is the true culprit behind the nation's rising rates of hepatocellular carcinoma (a common type of liver cancer), debunking theories that the hepatitis B virus was mostly to blame.”

The study in question, “Secular trends and geographic variations of hepatitis B and hepatitis C virus-associated hepatocellular carcinoma in Taiwanis due to be published soon in the International Journal of Cancer. It was conducted by three groups at three locations: the Chang Gung Memorial Hospital in Kaohsiung, the National Taiwan University Hospital in Taipei and the Changhua Christian Hospital in Changhua City.

A total of 18,423 HCC cases over 20 years (1981-2001) were reviewed. The researchers reported that while the overall mortality rate in patients with liver cancer caused by hepatitis B had dropped, the number of deaths related to the cancer caused by hepatitis C had increased by 66 percent in Taiwanese males and by 100 percent among Taiwanese females. (6)

The above has to be the most alarming health news report of 2006. Here we are worrying about a non-existing bird flu pandemic and a few hundred cases of measles or mumps here and there and not realizing that the Far East was looking at a cataclysmic health development.

According to the World Health Organization web site: “Hepatitis C has been compared to a “viral time bomb”… about 180 million people, some three percent of the world's population, are infected with hepatitis C virus, 130 million of whom are chronic HCV carriers at risk of developing liver cirrhosis and/or liver cancer. It is estimated that three to four million persons are newly infected each year, 70 percent of whom will develop chronic hepatitis. HCV is responsible for 50-76 percent of all liver cancer cases, and two thirds of all liver transplants in the developed world.

Current estimates are that 3.9 million Americans are chronically infected with HCV, with prevalence rates as high as 8-10 percent in African Americans. Injectable drug use remains the main route of transmission, accounting for nearly 90 percent of new HCV infections. Sexual transmission is thought to be relatively infrequent.

Mother-to-child HCV transmission has been widely documented. The risk of perinatal infection ranges from 3-15 percent in different populations. Transmission is believed to occur in utero, as a consequence of a high viral load in the mother.” (7)

To date, there is no hepatitis C vaccine. It is likely that when one is developed, it will cause more reactions and cost quite a bit more.

Whether the latest “cancer vaccine” the human papilloma virus vaccine, will result in more problems than it will solve remains to be seen. Stay tuned.” [End of Quote]

The quoted references (3-7) were:

H.B. El-Serag, A.C. Mason. "Rising incidence of hepatocellular carcinoma in the United States." N Engl J Med. 1997 Jun 26; 336(26): 1855-9.

 M.H. Chang, C.J. Chen, M.S. Lai, H.M. Hsu, T.C. Wu, M.S. Kong, D.C. Liang, W.Y. Shau, D.S. Chen."Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group." N Engl J Med. 1997 Jun 26; 336(26): 1906-7.

 M.H. Chang, W.Y. Shau, C.J. Chen, T.C. Wu, M.S. Kong, D.C. Liang, H.M. Hsu, H.L. Chen, H.Y. Hsu, D.S. Chen. "Hepatitis B Vaccination and Hepatocellular Carcinoma Rates in Boys and Girls." JAMA. 2000; 284: 3040-3042.

 Wang Chang-min. "Study shows hepatitis C may be the cancer culprit." TAIPEI TIMES, June 8, 2006. Available at http://www.taipeitimes.com/News/taiwan/archives/2006/06/08/2003312305

 World Health Organization, Hepatitis C, Initiative for Vaccine Research (IVR): http://www.who.int/immunization/research/en/

*****

Although denied by the CDC, it is still quite likely that the sudden increase in shingles cases in the Unites States was directly or indirectly due to the use of VARIVAX® and the elimination of chickenpox.

It is also very likely that the extensive use of PREVNAR-7 ® resulted in the appearance of new more virulent strains of Streptococcus pneumoniae (pneumococcus) and the need to develop PREVNAR-13®.

Because HBV and HCV are distinct and different viruses, it is hard to argue convincingly that the success of the Hepatitis B vaccination programs and the decrease in HBV chronic infections, directly or indirectly resulted in the substantial increase in the more serious HCV infections and related complications.

Yet, because this temporal association is so striking, it should not be summarily discounted.

So far, the CDC has not made it a priority to investigate this issue and everything else that could be causing the significant increase in HCV chronic infections and complications.

Hopefully, long due honest research will be done and provide answers.

The CDC has a detailed table comparing Hepatitis A, B and C. (2015)  http://www.cdc.gov/hepatitis/Resources/Professionals/PDFs/ABCTable.pdf

The following is a summary of some of the information in that table:

 

 

Hepatitis B

Hepatitis C

US Statistics

 Est. 19,800 new infections in 2013 

Est. 1.2 million people with     chronic HBV infection

Est. 29,700 new infections in 2013  Est.3.2 million people with

chronic HCV infection

Vaccine

Yes

No

Potential Chronic Infection

Among unimmunized persons,  25%–50% of children aged 1–5 yr ,  6%–10% of older children and adults

 75%–85% of newly infected persons develop chronic infection

Severity

-Most persons with acute disease recover with no lasting liver damage;

-Acute illness is rarely fatal

-15%–25% develop chronic liver disease, including cirrhosis, liver failure, or liver cancer

-1,800 persons in the United States die with HBV related liver disease

Acute illness is uncommon.  

- 60%–70% develop chronic liver disease

- 5%–20% develop cirrhosis

- 17,000 persons in the US die with HCV-related liver disease

Treatment

Acute: supportive treatment  Chronic: Monitoring liver disease progression; some patients are treated with antiviral drugs

 Acute: Antivirals & Supportive  Chronic: Monitoring liver disease progression- New direct acting antiviral medications -

 

Even discounting the many serious co-infections that often afflict individuals with chronic HCV infections, the disease itself is clearly much more serious than HBV disease and its complications.

***

A recent PubMed Search for “Hepatitis C” revealed more than fifty (50) publications on the subject in the last 3 months. Strangely, not one of them deserved a mention in news reports totally busy with a few local Zika virus cases and four quarantined measles cases in Mississippi.

Is there a cover-up, again?

If so, could it be that THIS cover-up of the latest silent epidemic of HCV infections is orchestrated by the same people and agencies that growing numbers think are still refusing to thoroughly and honestly investigate all the possible causes of the Autism epidemic or to reveal everything they have actually found? 

No one is suggesting that the epidemic of HCV infections was purposely caused by the introduction of Hepatitis B vaccination.

Similarly, no one has ever suggested that the autism epidemic was due to intentional injury by a vaccine manufacturer.  

Nevertheless, people dying or seeing a dear one dying from liver failure or liver cancer deserve an explanation, very much like the children and adults condemned, by no fault of theirs, to a life of autism deserve at the very least, clear, true and honest answers. 

 

F Edward Yazbak MD, FAAP

Falmouth, Massachusetts  

May 17, 2016