That estimate is based on the financial impact of a proposed change to the workers' compensation law that would classify hepatitis C as a work-related disease for rescue workers, Trujillo said.
It also takes into consideration that, based on medical estimates, up to 5 percent of the infected firefighters may require liver transplants, he said.
As many as 200 active and retired firefighters are infected with the blood-borne virus that causes hepatitis C. The firefighters contend that the nature of their work - which is more emergency rescue than fighting fires - puts them at risk.
Trujillo said it was difficult to calculate beyond five years the financial burden of the crisis. "Some of the difficulties with this is the medical treatment of hepatitis C is radically changing," Trujillo said. "It's hard enough to make the estimate on what we have right now."
Hepatitis C can cause chronic liver disease or liver failure. Before 1992 and routine screening of blood donations, the hepatitis C virus could be contracted from blood transfusions. Now, among the general population, the two most likely causes of infection are sharing needles for intravenous drug use or sex with multiple partners.
The cost of the crisis is becoming a larger issue as momentum builds in Washington and Harrisburg to help infected firefighters and rescue workers.
Two weeks ago, Congress passed a bill to fund more testing to determine the prevalence of the disease among firefighters. Meanwhile, the Pennsylvania legislature is considering changes to make hepatitis C a presumed occupational disease for rescue workers. The matter could come before the state House for a vote this year, sponsors said.
Under current state law, hepatitis is a work-related disease for nurses, blood processors and "auxiliary workers," a vague health-care category. That means, for example, if emergency-room nurses contract hepatitis C from tainted blood, they are given the benefit of the doubt that the virus was contracted on the job.
But if firefighters make the same claim, they must prove that the infection happened on the job.
Bills in both the state House and Senate would shift the burden of proof in workers' compensation cases from firefighters to municipalities. Now, firefighters must supply the specifics of when, where and how they contracted hepatitis C. As one firefighter explained, being able to pinpoint such information is like getting attacked by a swarm of bees and identifying the one that stung you.
So far, only one infected Philadelphia firefighter has been awarded workers' comp - and that was posthumously, to his widow.
State Rep. Dennis O'Brien (R., Phila.), one of the 54 sponsors of the Pennsylvania bill, said that because hepatitis C already is classified as an occupational risk for some health-care workers, it could make it easier to convince lawmakers to expand the coverage to rescue workers.
Most of the work done by Philadelphia firefighters is not fighting fires. Three out of four calls by local firefighters are for handling emergency rescues - everything from car crashes to unexpected home deliveries of babies.
State Rep. Michael McGeehan (D., Phila.), the bill's prime sponsor, said lawmakers were loath to reopen the 1996 Workers' Compensation Act. But he said the matter was so sensitive that labor unions have promised not to try to pile on other issues to the firefighters' bill.
"Labor unions understand the critical nature of this disease and how it affects firefighters," McGeehan said.
In Philadelphia, the ranks of infected firefighters grow each week. The tally now reaches as many as 150 active and 50 retired firefighters.
It has been a year since the firefighters' union discovered that it had a medical crisis on its hands. But the question of why so many firefighters have the disease remains contested.
At issue is whether firefighters became infected with the hepatitis C virus from accident victims. In a published report on July 28, the U.S. Centers for Disease Control and Prevention said rescue workers were no different from anyone else and had no greater occupational risk of getting infected.
The CDC concluded that the prevalence of hepatitis C among "first responders" - firefighters, emergency medical technicians and paramedics - was in line with the general male population.
The CDC said that for men between the age of 30 and 59, the prevalence of hepatitis C was 5 percent - the same as the infection rate of Philadelphia firefighters, based on the union's tally of active and retired members with the disease.
The CDC did not recommend routine testing for firefighters. The agency also said the hepatitis C virus was not transmitted efficiently from occupational exposures such as needle pricks.
"Among first responders, [hepatitis C virus] infection was associated primarily with nonoccupational factors," the CDC said. Those factors are IV drug use, high-risk sex and blood transfusions before 1992.
In a seven-page rebuttal, Harold Schaitberger, president of the International Association of Fire Fighters, called the report "flawed."
Among his points, he said that in dismissing the occupational risk of firefighters, the CDC relied on surveys of rescue workers in five regions. But in two of those samplings - including the largest in Philadelphia - rescue workers who tested positive were not asked about their on-the-job exposure to tainted blood. He questioned, therefore, how the CDC could make its assertion about the occupational risk.
"We don't get to operate in sterile environment," said Schaitberger in an interview. "We're operating in environments that are out of control."
Frederick Nunes, a liver specialist and associate professor of medicine at the Hospital of the University of Pennsylvania, reviewed the CDC article as well as the union's reply. "Additional studies are necessary to answer the question of whether firefighters acquired hepatitis C from occupational exposure," Nunes said.
"The CDC is making a lot of inferences without the data specifically being collected in the studies they're quoting," he said.
"The key thing is there seems to be a significant number of firefighters who do have hepatitis C and it's important to find out if it was acquired occupationally."
Ken Rothstein, a hepatologist at Albert Einstein Medical Center who is treating 30 local firefighters, questioned the CDC's conclusion that rescue workers were not at a greater occupational risk.
"I don't believe it," Rothstein said. "And the reason I don't believe it is because the overwhelming majority of my firemen with this disease really don't have any other risk factor."
Jennifer Lin's e-mail address is email@example.com