Hepatitis C Weekly News

West Virginia Collegiate Recovery Network partners with CHESS Health on hepatitis C digital initiative
“The Live(r) Hep C Free program, an initiative of the West Virginia Collegiate Recovery Network (WVCRN) housed within the Marshall University Research Corporation, is partnering with CHESS Health to deploy its digital contingency management platform that uses a series of reinforcements and rewards for meeting treatment goals”

Hearts From Donors Infected with Hepatitis C Are Safe for Transplant, Study Shows
“A new study by Cleveland Clinic researchers confirms that hearts from hepatitis C-positive donors are safe to use for transplants long-term. The study, which followed patients over a four-year period, found no differences in mortality between patients who received healthy and infected hearts. Cardiac events and other adverse outcomes were also similar.”

Hepatitis C and mental health: Using peer support to fight stigma
“Hepatitis C (HCV) is a blood-borne virus that is most commonly acquired by people who inject drugs. If left untreated, HCV can cause cirrhosis of the liver, liver failure and liver cancer. Unfortunately, due to its most common transmission routes (the sharing of unsterile injecting equipment), hepatitis C is also a stigmatised disease. As such, people who use drugs with a HCV diagnosis face multi-layered stigma, often seen as instruments of contagion, rather than those deserving of care.”

Older age, not comorbidity, linked to worse survival in hepatocellular carcinoma
“Receipt of curative treatment was associated with high comorbidity but not older age. Older age was associated with worse survival in early-stage disease and among treated patients.”

Lawmakers Set To Unveil Subscription Model For Hep C Treatment That Saves $6 Billion
“A bipartisan Senate duo will soon unveil a bill to create a national subscription-type model for hepatitis C treatment that would save over $6 billion. While the lawmakers had hoped it would be folded into a lame-duck package, the bill will likely be used as a payfor in the next Congress. Sen. Chris Van Hollen (D-MD) told Inside Health Policy Thursday (Dec. 12) the details of the bill are “pretty much wrapped up now” and the bill saves over…”

Immunodeficiency, Injection Drug Use Linked to Failed HCV Treatment in People with HIV
“Key Takeaways – Direct-acting antivirals achieve a 95% success rate in treating HCV among HIV patients, but 5% experience unsuccessful treatment. Lower CD4+ cell counts, HCV genotype 4, and recent injection drug use are linked to higher odds of unsuccessful treatment.”

Though some are finding resilience after hepatitis C cure, others still put testing off
“LEWISTON — Looking back, Rosie Boyce does not recall experiencing many symptoms from her hepatitis C infections. With her body clearing it once on its own in 2009, she was surprised to learn she had become infected again years later when she was tested in 2015.”

Hepatitis C in Australia has more than halved in less than a decade, says report
“In 2023, there were an estimated 68,890 people living with hepatitis C in Australia, down 58% from 162,590 at the end of 2015, according to a new report released by the Kirby Institute at UNSW Sydney.”

Prison needle exchanges in Canada save an estimated $2 in infection-treatment costs for every $1 spent
“Every dollar spent on Canada’s Prison Needle Exchange Programs (PNEPs) saves an estimated $2 in treatment costs for hepatitis C and injection-related infections, supporting their expansion to all 43 federal prisons, Canadian and Australian researchers report today in CMAJ.”

Free hepatitis C, HIV and syphilis testing for the month of December
“Southeastern Idaho Public Health will be offering free rapid hepatitis C, HIV and syphilis testing to individuals throughout the month of December in all their county locations. Testing only takes a few minutes, and you can get results before you leave. Visit siphidaho.org to locate a clinic near you. Same-day appointments are available. There is only one way to know — get tested.”

Atea plans Phase 3 study for hepatitis C drug after mid-stage results
“In the Phase 2 study, patients received a combination of bemnifosbuvir and ruzasvir for eight weeks, without any reports of serious side effects or treatment discontinuations. Twelve weeks later, researchers measured the effects the drugs had in fighting hepatitis C. Overall, 98% of patients who adhered to the treatment regimen had a sustained virologic response at the 12-week checkpoint. That rate went up to 99% among patients who weren’t suffering from cirrhosis. And Atea said the drugs showed success even among patients who didn’t take all the pills as directed, suggesting a “robust potency” for the treatment.””

Priorities in planning person-centred hepatitis B and C testing services: operational guide
“This operational guide on viral hepatitis testing services provides support to countries in developing policies and practices that define a strategic mix of hepatitis B and C testing approaches, that are tailored to their unique situation and priorities, ensuring an impactful national response to the hepatitis epidemic. It introduces a five-step framework for planning person-centred hepatitis B and C testing approaches, emphasizing a strategic mix of testing approaches, mobilization and demand creation, and streamlined linkage to care. It highlights as well the importance of community leadership, health systems integration and quality assurance.”

Broadly effective vaccine design offers new hope in the fight against hepatitis C
‘The development of an effective vaccine against the hepatitis C virus (HCV) has posed a significant challenge for decades due to the high genetic diversity of the virus. A research team has now achieved promising results. Using epitope-focused immunogens, they were able to induce broadly neutralizing antibodies (bnAbs) in laboratory models for the first time.”

Hepatitis C and Homelessness: Assessing Risk Factors
“A study conducted in Madrid, Spain, found a high prevalence of HCV among people experiencing homelessness. Of the 2,709 PEH screened, 47.4% of those with HCV antibodies tested positive for active HCV (HCV-RNA).”

Hepatitis C initiative saves Egypt about EGP 16bn in medical costs: Health Minister
“Khaled Abdel Ghaffar, Deputy Prime Minister and Minister of Health and Population, has reviewed the Ministry of Health and Population’s efforts to implement evidence-based interventions and initiatives. He highlighted the significant success of the Presidential Initiative to Eliminate Hepatitis C, which screened over 63 million citizens and treated more than 4 million patients.”

Anger as some infected blood payouts put on hold
“Some victims of the infected blood scandal have been told interim compensation payments of £100,000 due to be made before Christmas have been put on hold. It is thought at least 10 bereaved families have received letters saying applications approved this month cannot now proceed until they submit new paperwork.”

Music and a Cure for Hepatitis-C
“After 10 years, of not being able to play, Gavin West is finally able to pick up his guitar again. Though his fight with hepatitis C led him down some dark paths, West feels like his experience has enriched his music. He hopes to use his voice and music to help others.”

Comparison of different noninvasive scores for assessing hepatic fibrosis in a cohort of chronic hepatitis C patients
“The continuous search for simple, noninvasive methods for assessing liver fibrosis remains very important to help risk-stratify and follow-up patients with chronic hepatitis C virus (HCV). This study aimed to evaluate the diagnostic performance and accuracy of six serological noninvasive scores for the assessment of liver fibrosis in comparison to liver histopathology.”

Telehealth significantly boosts treatment success for hepatitis C in rural patients
“New research reveals a dramatic improvement in diagnosing and curing people living with hepatitis C in rural communities, using both telemedicine and support from peers with lived experience in drug use. The study, published today in the journal Clinical Infectious Diseases, outlines the results of a randomized controlled trial led by Oregon Health & Science University in seven rural counties in Oregon. The study enlisted people with lived experience in substance use to meet individuals who use drugs, test them for hepatitis C, and then offer them treatment through telehealth or referral to a physical clinic.”

Liver cancer rates are increasing rapidly: Mayo Clinic expert discusses the common, often preventable culprit
“Liver cancer is the sixth most common cancer in the world. While it’s less common in the U.S. than globally, the incidence is increasing at an alarming rate. Since 1980, liver cancer cases in the country have more than tripled, and liver cancer deaths have nearly doubled, according to the National Cancer Institute.”

Health Department Releases 2023 Hepatitis A, B, and C Annual Report, Highlights Progress Toward Eliminating Viral Hepatitis
“The number of people newly reported with chronic hepatitis C in 2023 in New York City decreased by 11% from 2022 and 67% from 2014, showing steady gains towards eliminating this preventable and treatable illness. However, there were increases in the numbers of people newly reported with chronic hepatitis B and people with hepatitis A in New York City compared with 2022. Inequities by gender, race and ethnicity, age, and neighborhood poverty level persist among people reported with hepatitis A and people newly reported with chronic hepatitis B and C in New York City.”

Telemedicine Expands Access to HCV Treatment for Underserved Populations
“Telemedicine has become a valuable tool in expanding access to hepatitis C virus (HCV) treatment, particularly for underserved populations, according to study results published in the Journal of Viral Hepatitis.”

Trends in Hepatocellular Carcinoma Mortality Rates in the US and Projections Through 2040
“Findings  In this cross-sectional study of 188 280 HCC-related deaths, ASMRs increased from 2006 to 2022 and were projected to continue rising until 2040, primarily due to increased deaths from alcohol-associated liver disease (ALD) and metabolic dysfunction–associated steatotic liver disease (MASLD); deaths from viral hepatitis were under control and were projected to decrease. Large disparities were observed in HCC-related ASMRs by age, sex, and race and ethnicity.”

A Clinical Algorithm for Screening Compensated Advanced Chronic Liver Disease Utilizing Ultrasonography, Platelet Count, and Albumin Levels, With Transient Elastography as Reference
“Conclusions: USG alone has limited reliability in diagnosing cACLD but is valuable for ruling out advanced fibrosis in asymptomatic patients due to its high NPV. Adding platelet and albumin levels improves diagnostic accuracy, though TE remains essential for definitive diagnosis. This approach may streamline screening and optimize resource use, particularly in settings with limited TE access. USG combined with platelet count and serum albumin offers a cost-effective, accessible, and practical solution for the initial assessment of cACLD. Further studies are needed to validate these findings in broader populations.”

Investigational Combination Hepatitis C Therapy Demonstrates a 97% Sustained Virologic Response
“At the ongoing The Liver Meeting in San Diego, Atea Pharmaceuticals has presented posters about the company’s investigational antiviral combination of bemnifosbuvir and ruzasvir, which is being studied for potential hepatitis C virus (HCV) treatment. In one of the posters, the combination therapy achieved a 97% sustained virologic response at 12 weeks post-treatment (SVR12) in a phase 2 lead-in cohort. According to the investigators, the analysis supports a short 8-week treatment with bemnifosbuvir and ruzasvir for chronic HCV.”

Scientists Fear What’s Next for Public Health if RFK Jr. Is Allowed To ’Go Wild’
“Many scientists at the federal health agencies await the second Donald Trump administration with dread as well as uncertainty over how the president-elect will reconcile starkly different philosophies among the leaders of his team. Trump announced Thursday he’ll nominate Robert F. Kennedy Jr. to be secretary of the Health and Human Services Department, after saying during his campaign he’d let the anti-vaccine activist “go wild” on medicines, food, and health.”

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Global launch of The Lancet Gastroenterology & Hepatology Commission on viral hepatitis

Study Finds Most Children with Hep C have Developmental Disorder, Learning Difficulty
“Key Takeaways: A study found 62% of children with chronic HCV had neurodevelopmental disorders, with ADHD being the most common. Rising HCV-positive pregnancies, primarily due to vertical transmission, contribute to increased chronic HCV in children.”

Research shows low vaccination rates for hepatitis A and B in men who have sex with men
“Research analyzing European survey data from 113,884 men who have sex with men (MSM) and published in Eurosurveillance indicates that while most MSM have a basic understanding of viral hepatitis, only 44% report having been vaccinated against both hepatitis A and B. The data highlight notable immunisation gaps despite available vaccination and recommendations. Strong public health support and creating an open environment that enables MSM to follow recommendations will be crucial to reduce outbreaks among MSM and eliminate hepatitis B.”

Study finds high hepatitis C rates among opioid overdose patients
“New research from the University of Missouri School of Medicine indicates that accidental opioid overdose patients in central Missouri have high rates of hepatitis C infections, despite only 40% of patients having a history of testing.”

Effectiveness of sofosbuvir-based treatments for patients with hepatitis C virus genotype 6 infection: a real-world study from East China
“Conclusions: SOF-based treatments achieved high virological and biochemical response rates in patients with HCV GT 6 infection.”

Hepatitis C Reinfection Rates Drop for Drug Users Over Time
“Hepatitis C virus (HCV) reinfection rates among people who inject drugs are high immediately after treatment in community settings, particularly among those reporting recent injection drug use and sharing of injection paraphernalia, but they decrease significantly over time.”

Survey Highlights Critical Role of Pharmacists in HCV Management
“Key Takeaways: Pharmacists are integral to HCV management, involved in screening, treatment evaluation, and patient education across various healthcare settings. The survey found pharmacists often independently select HCV treatment regimens and provide on-treatment or post-treatment monitoring.”

Emergency Department HCV Screening May Reduce Potential Hepatic Complications, Lower Costs
“Key Takeaways: Emergency department-based HCV screenings are cost-effective, reducing hepatic complications and long-term treatment costs. The study used a decision-analytic Markov model with a 30-year time horizon to simulate HCV screening and progression.”

Severance Hospital’s AI software identifies high-risk patients after cure of chronic hepatitis C
“Researchers at Severance Hospital have developed an artificial intelligence (AI) system capable of identifying high-risk patients who may develop severe complications, such as hepatocellular carcinoma, following the successful treatment of chronic hepatitis C.”

Targeting a specific gene could be key to treating hepatitis B, C and D
“Chronic viral hepatitis is the long-term inflammation of the liver. It is caused by hepatitis B, C or D virus particles. Even though these viruses replicate differently, they all use the endoplasmic reticulum-Golgi pathway for replication, where the TM5SF2 gene is located.”

Efficacy of 8-week daclatasvir-sofosbuvir regimen in chronic hepatitis C: a systematic review and meta-analysis
“The high rates of the sustained virologic response 12 weeks after treatment (SVR12) in real world settings provoked the adoption of shortened courses of the costly direct-acting antivirals (DAAs) regimens. This study provides, to our knowledge, the first systematic review and meta-analysis for the efficacy of the shortened 8-week course of sofosbuvir (SOF) plus daclatasvir (DCV), the most accessible DAAs in the low-middle income countries (LMICs).”

35 Health Advocacy Groups Urge the Supreme Court to Protect Preventive Care
“[On October 21] 35 organizations, representing millions of patients with serious health conditions and thousands of health care professionals, filed an amicus curiae, or “friend-of-the-court,” brief in the case of Braidwood v. Becerra at the U.S. Supreme Court. The amicus brief supports the government’s petition for certiorari in the case, providing extensive scientific data demonstrating that preventive services save lives and are cost-effective. At the crux of the case is a provision of the Affordable Care Act (ACA) that requires most insurers cover preventive services recommended by the United States Preventive Services Task Force (USPSTF) without cost-sharing by patients.”

Minicircle-based vaccine induces potent T-cell and antibody responses against hepatitis C virus
“An effective vaccine against hepatitis C virus (HCV) should elicit both humoral and cellular immune responses.”

Use of Hepatitis C Viremic Donors to Expand the Pediatric Donor Pool
“The use of hepatitis C virus (HCV)-positive donors in organ transplantation has become increasingly viable due to advancements in direct-acting antiviral (DAA) therapies, which offer high cure rates. This review aims to evaluate the current practices, benefits, and challenges of utilizing HCV-positive donors for organ transplantation.”

HCV Prevalence Is Linked to Age, Drug Use Patterns in Men Who Have Sex With Men
“Among HIV-negative men who have sex with men who reported non-injection drug use, those who were aged 42 and older and used multiple drugs had a greater likelihood of hepatitis C infection.”

A Large-Scale Screening of Hepatitis C Among Men Who Have Sex With Men in the Community Using Saliva Point-of-Care Testing
“Conclusion: The point-of-care strategy on the street using a quick oral self-test at massive MSM events is feasible, well-accepted, and quick, and may be a useful strategy to reach other populations at risk of HCV infection”

Phil Lesh, founding member of the Grateful Dead and influential bassist, dies at 84
“”Phil Lesh, bassist and founding member of The Grateful Dead, passed peacefully this morning. He was surrounded by his family and full of love. Phil brought immense joy to everyone around him and leaves behind a legacy of music and love,” the Instagram statement reads in part.”

Ohio State study finds donor livers are underutilized; more lives can be saved with hepatitis C-positive livers
“New research from The Ohio State University Wexner Medical Center Comprehensive Transplant Center finds transplant centers can safely raise the number of liver transplants by increasing the use of livers from hepatitis C-positive donors or from donation after circulatory death. The study, published in the journal Transplantation, found short-term patient outcomes aren’t compromised by using livers from these donor groups.”

Digestive Health Specialist of St. Joseph spreading awareness during Liver Disease Awareness Month
“(ST. JOSEPH, Mo.) While most people think of October as Breast Cancer Awareness Month, October also marks Liver Disease Awareness Month as well. With liver disease increasing instead of decreasing, Digestive Health Specialist of St. Joseph is spreading awareness about why it’s important to get routine screenings and making sure that your liver health is in order.”

Chicago Marathon Runner Finishes Race Cancer-Free and With New Liver
“One year after delaying a liver transplant to run the 2023 Chicago Marathon, Batbayar Tserendorj has a new liver, is cancer-free and completed the 2024 race, according to Northwestern Medicine (NM). Last year, Tserendorj then age 60, was living with liver cancer and on the waiting list for a new liver. He had been diagnosed with liver cancer in early 2023, likely caused by chronic hepatitis B and D infections, according to Northwestern Medicine.”

Endoscopies at Vanderbilt exposed patients to HIV, hepatitis C
“Nashville-based Vanderbilt Health is notifying patients that they may have been exposed to hepatitis B, hepatitis C and HIV as a result of botched endoscopy procedures performed at a clinic located on the hospital’s main campus.”

Coincidence of HCV and chronic kidney disease-a systematic review and meta-analysis
“Conclusions – We found a strong correlation between HCV infection and a higher risk of chronic renal disease in general global population.”

UB researchers advocate for continuing fewer rules for telemedicine
“During the COVID-19 pandemic, the federal government loosened regulations that govern the use of telemedicine for patients, which are set to expire on Dec 31. With a few months to go, an extension is possible. Some UB researchers and clinicians believe that returning to pre-pandemic restrictions would have a profoundly negative impact on health care.”

Study Identifies Risk Factors for Liver Enzyme Elevation Following Hepatitis C Virologic Cure
“Key Takeaways – Higher pretreatment ALT and cirrhosis increase liver enzyme elevation risk in HCV patients post-virologic response. Male sex is linked to reduced odds of liver enzyme elevation after HCV treatment.”

With October Being Liver Awareness Month, an Opportunity to Acknowledge This Essential Organ
“It is time to celebrate researchers’ amazing identification of our the body’s big secret—liver cells! These silent miraculous unrecognized liver cells have been hiding inside our noncomplaining, liver.”

Pharmacy-Based Services Combat SUD, HIV, STI Syndemic-Related Harms
“Pharmacies can play a crucial role in access to care by providing harm reduction, sexually transmitted infection (STI), and hepatitis C virus (HCV) services, according to a new study published in the Journal of the American Pharmacists Association. The findings show that by offering patient incentives, pharmacies can increase testing and detection of infectious diseases among individuals who might not otherwise seek care.”

HCV Transmission: What Are the Trends in HCV Without Injection Drug Use?
“Hepatitis C virus (HCV) infection among individuals without a history of injection drug use (IDU) is “sizeable” despite the higher HCV rates among those with a history of IDU, according to study findings published in Liver International. The primary mode of HCV transmission is through IDU. However, transmission can occur in the absence of IDU, through sexual contact, household contact, occupational exposure, and dialysis or transfusion, among other means.”

HCV Linked to Increased Risk of Peripheral Artery Disease in Hemodialysis Patients
“Key Takeaways – HCV infection in ESRD patients on hemodialysis is linked to increased PAD risk, indicated by elevated baPWV levels. Higher HCV viral loads and genotype 1 are significantly associated with increased PAD risk in these patients.”

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First-Hand Insights into Treating Hepatitis C in Pregnancy
“At IDWeek, the session “Should HCV Be Treated in Pregnant Persons?” featured Catherine Chappell, MD, MSc, assistant professor at the University of Pittsburgh. Chappell, an obstetrician-gynecologist with training in reproductive infectious disease, family planning, and addiction medicine, discussed ongoing studies on direct-acting antivirals for treating hepatitis C in pregnancy.”

DOH Report Finds Earlier Death Associated with Hepatitis C
“HONOLULU – As part of Liver Cancer Awareness Month in October, the Hawai‘i Department of Health (DOH) has released a report that found hepatitis C was associated with death at an earlier age in Hawaiʻi. “Premature Deaths and Disparities Associated with Hepatitis C: The Hawaiʻi Hepatitis C Mortality Report,” analyzed mortality data from 2000 to 2021 to understand the burden of hepatitis C infections on local communities. The findings will guide efforts to improve liver health and reduce preventable deaths.

This novel report was the first comprehensive analysis of hepatitis C death data for Hawaiʻi. The most important findings from the report include: People with hepatitis C die at a younger age than the general population. Most (88 percent) Hawaiʻi residents with hepatitis C-related deaths did not reach age 75, which was lower than the U.S. life expectancy in 2021. Many deaths occur before retirement age. Among Hawaiʻi residents with hepatitis C-associated deaths, more than 40 percent died before the average retirement age of 65 years (as compared to 23 percent for all causes of death). Progress is being made. Hepatitis C death rates were lower than the national average from 2017 to 2020, with 2.63 deaths per 100,000 in Hawaiʻi compared to 3.45 per 100,000 in the U.S. in 2020. However, disparities in death rates were observed for male and white residents in Hawaiʻi.

Revealing disparities in hepatitis C care for reproductive-aged women to break cycle of viral transmission
“Most pediatric cases of hepatitis C virus (HCV) infection are perinatal, meaning the virus is transmitted from birthing parent to child during pregnancy or birth, according to the Centers for Disease Control and Prevention. If left untreated, hepatitis C infection can lead to worse outcomes later in life, such as chronic liver disease, liver failure, and liver cancer. Identifying disparities in testing and treating hepatitis C among people of reproductive age with opioid use disorder can improve health outcomes for all birthing parents and children.”

Feasibility and Performance of a Point-of-Care Hepatitis C RNA Assay in a Community Supervision Cohort
“Progress toward hepatitis C virus (HCV) elimination in the US has been stalled by reliance on a multistep diagnostic algorithm to confirm viremia, reducing access to curative treatment.”

New Research Supports Universal HCV Screening Over Risk-Based Testing
“The study found 1.4 million people aged 12-59 with current HCV infection, including over 500,000 without injection drug use history.”

State Spotlight Series: Syndemic Approaches to Substance Use and Infectious Disease
“Governors and their teams are responding to a rapid rise in syphilis and congenital syphilis cases. The National Governors Association Center for Best Practices (NGA Center) is working to support states and territories in implementing a “syndemic” approach to this and other infectious diseases, recognizing that these outbreaks are intertwined with substance use. A syndemic refers to intersecting epidemics that are not only concurrent or sequential, but also have synergistic relationship, with overlapping or interactive risk factors, and often a context of shared social and behavioral risk factors and healthcare access gaps.”

An evolutionary concept analysis: stigma among women living with hepatitis C
“Stigma is a complex social phenomenon that leads to marginalization and influences the course of illness. In the context of hepatitis C virus (HCV), stigma is a well-documented barrier to accessing care, treatment, and cure. In recent years, HCV rates among women have increased, resulting in an urgent need to address stigma and its harmful effects. The purpose of this concept analysis was to investigate stigma in the context of women living with HCV using Rodgers’ evolutionary method.”

Pregnancy Outcomes in Patients With Hepatitis C Virus Infection
“Despite no increased odds of preterm birth or other adverse maternal outcomes in adjusted analyses, maternal HCV infection was associated with twofold increased odds of NICU admission and nearly threefold increased odds of SGA birth weight below the 5th percentile.”

HCV Testing Rates Among Perinatally Exposed Children Are Low, Racially Dependent
“Fewer than half of hepatitis C virus (HCV)-exposed children were tested for HCV, with lower testing rates among Black, Asian/Pacific Islander, and Hispanic/Latinx children. These results were published in the Journal of the Pediatric Infectious Diseases Society.”

‘I was living with hepatitis C without knowing for 20 years’ – why you should get checked
“Getting a tattoo on his right arm led Andrew Eadie to contracting a shocking disease that only revealed itself two decades later when he visited his GP for with a suspected chest infection. The GP referred him to the University Hospital of Wales where concerns were raised about the significant swelling on his stomach.”

DAA Marketing Payments From Manufacturers Linked to Physician Prescribing Patterns
“New research is calling attention to a significant association between pharmaceutical company marketing payments related to direct-acting antivirals (DAAs) and physician prescription patterns for hepatitis C virus (HCV) treatment.”

Breakthrough in Hepatitis C Research Offers Hope for Vaccine Development
“Researchers at the University of Copenhagen have identified a protein complex on the hepatitis C virus that facilitates cell infection, paving the way for potential vaccine development, SciTech Daily revealed yesterday.”

Patients at Washington dental clinic told to get tested for HIV, hepatitis
“People expect the dentist who cares for their teeth to keep their equipment sanitary. In Eastern Washington’s Spokane County, patients at a dental clinic received an alarming letter.”