Earlier this week, Local 22, the Fire Department union, released the results of hepatitis C tests for about half of the 4,000 retired and active firefighters it represents. About 130 - 6 percent - tested positive for hepatitis C.
Union president George Casey contends the firefighters got the disease on the job, often in the days before rescue workers took precautions against blood-borne illnesses. "Most of the guys that are showing up are guys that worked the squads 10 years ago," he said.
"We never had gloves and glasses."
Casey wants the city to recognize hepatitis C as a work-related injury, which would qualify infected firefighters for extra financial help. He began talking about the issue, he said, because the cost of drugs for firefighters with the disease is causing financial problems for the union.
Overall, about 1.8 percent of Americans have been infected with hepatitis C, but the prevalence varies considerably by sex, age and race. The rate is highest among 30- to 39-year-olds: 3.9 percent. In that age group, 6 percent of blacks and 3.2 percent of whites have the disease, according to a study published this year in the New England Journal of Medicine. Men are about twice as likely as women to have hepatitis C.
Gregory Armstrong, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention, said studies show only about 1 percent of health-care workers test positive for the disease. Studies of health-care workers who contract hepatitis B, which spreads much more easily than hepatitis C, show that "often, their exposures are related to nonoccupational exposures," he said.
Other risk factors include injected drug use, multiple sex partners, and having gotten a blood transfusion before July 1992.
Armstrong and others who study hepatitis C were unaware of studies examining the prevalence in rescue workers or firefighters.
A study released earlier this year found that veterans, another group with significant exposure to blood, do seem to have an unusually high rate of the disease. According to the study, 18 percent of veterans undergoing blood tests at the San Francisco Veterans Affairs Hospital tested positive for hepatitis C.
Kenneth Rothstein, a liver specialist and associate director of the Center for Liver Disease at Albert Einstein Medical Center, is treating 25 of the infected Philadelphia firefighters and said they seem to have no risk factors other than their rescue work.
"In talking to these guys and talking about their exposure, it seems that they've been exposed to blood. They've been exposed to blood all the time," he said. "Until the mid '80s, they never used precautions."
The fire commissioner said he did not have enough information to make "blanket" statements about how the firefighters contracted the disease or whether it should be considered work-related. "I don't think we have a real good picture yet," Hairston said.
He added that he empathized with the firefighters and their families. "I've got people that are scared over this," he said.
State Rep. Curtis Thomas (D., Phila.) has proposed legislation that would include hepatitis C among work-related injuries for all emergency personnel. The House Health and Human Services Committee, he said, is investigating the firefighters' plight and what can be done about it. And he is calling on Philadelphia lawmakers to participate in an event next month to raise money for infected firefighters and the union.
"I think that the burden really is on the city to show that it's not a work-related injury," he said.
An estimated four million Americans have been infected with hepatitis C, an infection of the liver caused by the hepatitis C virus. About 2.7 million of them are chronically infected. People may not have symptoms for many years after contracting the virus.
When symptoms do occur, they include jaundice, fatigue, abdominal pain, loss of appetite, nausea, and vomiting. But people can have significant liver disease without symptoms, said Rothstein, the liver specialist.
While there's no cure for the disease, a combination of interferon-based drugs can put 30 to 40 percent of patients into remission. Rothstein said new, more-effective drugs would be available soon.