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Alter traveled to Hooper Bay, Alaska, to help start a hepatitis B vaccination program there.

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Sleuthing a Silent Virus

   
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."
   

   
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