THOUGH it doesn’t command the research dollars that AIDS does, the epidemic of hepatitis C has quietly infected nearly four million Americans. The blood-borne virus, for which there exists no vaccine, often incubates for decades before symptoms of chronic (and potentially fatal) liver disease appear. Battling those obstacles, Dr. Miriam Alter, Nu’71, has been at the forefront of trying to control its spread. Alter is chief of the epidemiology section of the Hepatitis Branch of the Centers for Disease Control and Prevention and has also served as a consultant for the World Health Organization on the control of viral hepatitis.
The
CDC recently released new guidelines to prevent the spread of hepatitis
C, or HCV. It recommends, for instance, HCV testing for IV-drug users
and health-care workers who have been stuck with needles containing HCV-positive
blood, but not for pregnant women or health-care workers in general, because
the percentage of infection is low in these populations, Alter explains.
After graduating from Penn’s School of Nursing, Alter
earned her doctorate in epidemiology at the Johns Hopkins University School
of Hygiene and Public Health, doing hepatitis research for her thesis
in part because there was better government support for research in this
area than for other infectious diseases. “I got so interested that
I decided I wanted to stay in the hepatitis field.”
She began her work at the CDC as an epidemic intelligence
officer investigating hepatitis outbreaks to first determine their source
and then decide how they could be controlled. Her detective work has led
her to some interesting places and people. Alter’s second day on the job
at the CDC, for instance, she flew to Las Vegas to check on rumors of
a hepatitis B outbreak in the “call girl” network there. It
turned out not to be true, but in the process of collecting data, she
interviewed a knowledgable pimp on the subject. More recently, her staff
investigated the outbreak of hepatitis A among Michigan schoolchildren,
which was linked to frozen strawberries provided in school lunches.
Alter’s own ongoing research focuses on hepatitis C,
which unlike hepatitis A and B, cannot yet be vaccinated against. Soon
after joining the CDC, Alter designed a study to examine the long-term
consequences of what was then known as “non-A, non-B hepatitis.”
She’s still following the same patients today. “That study actually
provided the information needed when hepatitis C was first identified
to show in fact that this virus was responsible for this disease. We were
the first to demonstrate that most individuals who got the disease became
chronically infected.”
Research so far has not been able to determine whether
HCV is sexually transmitted or pinpoint the risk an infected individual
has for developing liver disease down the line. But Alter expects research
funding to increase along with public awareness. “Hepatitis C is
a major problem in the U.S. and there are a lot of unanswered questions.”