Flawed VA Studies on Hepatitis C Risk Factors

Jet Injectors = Jet Infectors

June 4, 2016

The VA often cites VBA Fast Letter 211 (04-13)  when concerns of jet injector transmission arise. “Despite the lack of any scientific evidence to document transmission of HCV with airgun injectors, it is biologically plausible.” This document also purported, “The large majority of HCV infections can be accounted for by known modes of transmission, primarily transfusion of blood products before 1992, and injection drug use.”

Herein the Fast Letter alludes to VA Cooperative Study 488, where 78% of HCV veterans studied were found to have either the risk of blood transfusions or injection drug use.

However, VA Cooperative Study 488, by Dominitz and colleagues (2005), only assessed 52 veterans with HCV antibodies. This small sample of veterans has been used by the VA to guide the public health policy of the 174,000 veterans within VHA(Department of Veterans Affairs, 2014), the estimated 42,000 veterans unknowingly living with Hep C, and the estimated 58% of the veterans in this cohort who do not utilize VHA care. [This percentage comes from a 2014 Congressional Research Report which stated, “As a proportion of the total veteran population, the VA-enrolled veterans have increased from 20% in FY2001 to 42% in FY2014” (Bagalman, 2014)].

In so doing, the VA has attributed the etiological causes for over 287,000 veterans positive with hepatitis C antibodies (Department of Veterans Affairs, 2010) based on a study that only assessed 52 veterans with hepatitis C antibodies. Herein the sample size of the study is only two-thousandths of a percent (0.02%) of the population.

VA Cooperative Study 488 is also grossly outdated. The study sampled veterans in 2001 at which time the Veterans Health Administration (VHA) had roughly 100,000 veterans with hepatitis C in their system. This figure is estimated from Butt and colleagues (2007) who reported by 2003 VHA had 113,927 veterans with HCV in their care. By 2014, the VA reported over 174,000 veterans with HCV within VHA. Therefore, from 2001 to 2014 we can estimate the number of hepatitis C veterans within VHA’s system rose by over 74,000 people, or rather by 74 percent. There is no guarantee that the risk factors for these additional veterans, who were new patients within the VHA system, are reliably represented in that study.
VA Cooperative Study 488 is a unique study that properly assessed the prevalence of hepatitis C antibodies amongst a random sample of veterans. In this study, veterans were randomly selected and then assessed on whether or not they had hepatitis C antibodies. However, this is the limits to this study. Assessing the etiological causes of only 52 veterans with hepatitis C antibodies, as VA Cooperative Study 488 did, is a weak claim in identifying the risk factors for a larger population. This is evidenced based upon the data, which reported spending more than 48 hours in jail posed a greater risk for hepatitis C than military service (which included combat duty and jet injections).

Despite the VA’s denunciation of jet injectors, the administration admitted “It is possible that if transmission of hepatitis C did occur via the use of jet injectors, it happened in isolated circumstances, or on a small scale. Such events would be difficult to detect in a population-based prevalence study like VA Cooperative Study 488” (Department of Veterans Affairs, 2006).

Briggs and colleagues (2001) also conducted a study to assess the prevalence of and risk factors for hepatitis C within a VA Medical Center. The study found 185 veterans, or rather 17.9 percent of the sample, had hepatitis C.  Their study purported,

History of vaccine in combat or vaccination with an air gun [another name for a jet injector] did not correlate with HCV status (data not shown).  However, these questions were added to the questionnaire during the conduct of the study and information was available from only 211 respondents.

The researchers explicitly disclosed that not all of the sampled veterans received the same questionnaire consisting of the question to evaluate for jet injectors.  In fact, the researchers stated only 211 veterans or rather 20.4 percent or rather one-fifth of the sampled population received an updated questionnaire.  Yet regardless of this inconsistency the researchers ultimately denounced an association between hepatitis C and jet injector vaccinations within their study.

Here the VA has relied upon invalidated research to obfuscate the jet injector / hepatitis C nexus. When in fact, validated Research Demonstrates Military Jet Injections Were a Risk Factor for Hepatitis C Veterans.

References:

  • (Bagalman, 2014) Bagalman E. The Number of Veterans That Use VA Health Care Services: A fact sheet. Congressional Research Service. 3 June 2014.
  • (Briggs et al., 2001) Briggs ME, Baker C, Hall R, Gaziano JM, Gagnon D, Bzowej N, and TL Wright. Prevalence and risk factor for hepatitis C virus infection in an urban Veterans Administration medical center. Hepatology 2001, 34:1200-1205.
  • (Butt et al., 2007) Butt AA, Justice AC, Skanderson M, Rigsby MO, Good CB, Kwoh CK. Rate and predictors of treatment prescription for hepatitis C. Gut. 2007;56(3):385-389.
  • (Department of Veterans Affairs, 2006) Department of Veterans Affairs, VA Hepatitis C Prevalence Study Results and VA Hepatitis C Program Actions: Summary. 25 September 2006. Accessed at: https://web.archive.org/web/20070816025640/http://www.hepatitis.va.gov/vahep?page=prtop01-rs-01.
  • (Department of Veterans Affairs, 2010) Department of Veterans Affairs, State of Care for Veterans with Chronic Hepatitis C. November 2010. Accessed at: http://www.hepatitis.va.gov/pdf/HCV-State-of-Care-2010.pdf.
  • (Department of Veterans Affairs, 2014) Department of Veterans Affairs. State of Care for Veterans with Hepatitis C. September 2014. Accessed at: http://www.hepatitis.va.gov/pdf/HCV-State-of-Care-2014.pdf.
  • (Dominitz et al., 2005) Dominitz JA, Boyko EJ, Koepsell TD, Heagerty PJ, Maynard C, Sporleder JL, Stenhouse A, Kling MA, Hrushesky W, Zeilman C, Sontag S, Shah N, Ona F, Anand B, Subik M, Imperiale TF, Nakhle S, Ho SB, Bini EJ, Lockhart B, Ahmad J, Sasaki A, van der Linden B, Toro D, Martinez-Souss J, Huilgol V, Eisen S, Young KA. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology. 2005 Jan;41(1):88-96.

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