State health officials say four more cases of hepatitis C involving patients at Exeter Hospital have been identified in addition to the 10 who were previously determined to have the infection.

The N.H. Division of Public Health Services on Saturday morning announced that four more patients match the strain of hepatitis C recently diagnosed in the 10 people who had been treated at the hospital’s cardiac catheterization lab. Of the 14, one is an Exeter Hospital employee. All 14 individuals have been notified.

Exeter Hospital officials said they have reached out via telephone and letter to 879 identified patients who were treated at the hospital’s cardiac catheterization lab and its recovery unit from April 1, 2011, through May 25. Patients are continuing to come in for testing and hospital officials said it is likely that even without further expansions of the screening period testing will continue at least throughout the coming week.

The DPHS informed the hospital that as of Thursday, June 7, 422 - or 97.2 percent - of the blood samples they have completed testing on have been confirmed as negative by the state’s laboratory, meaning they show no signs of hepatitis C.

Dr. Jose Montero, New Hampshire public health director, said officials are working with Exeter Hospital as quickly as possible to determine how the people were infected. The DPHS on Friday said the investigation is ongoing.

The DPHS informed the hospital that it has begun to mail test results to primary-care physicians as of Thursday afternoon. It is likely to take seven to 10 days from the time a patient’s blood is drawn for the primary-care physician to receive information about negative test results.

Exeter Hospital’s Call Center continues to take calls and schedule appointments for identified patients at their earliest convenience. The center is open 7 a.m. to 7 p.m. Monday through Friday, and 7 a.m. to noon on Saturday. Call 580-6124. The drawing station is taking appointments scheduled through the call center from 8 a.m. to 6 p.m. Monday through Friday, and from 7 a.m. to noon on Saturday.

Hepatitis C is a viral infection most commonly transmitted by blood. It causes inflammation of the liver that can lead to chronic health issues.

Exeter Hospital closed its cardiac catheterization laboratory late last month after the four initial patients were determined to have the identical strain of hepatitis C. The lab was reopened June 1 on an emergency basis and resumed full and normal operations Tuesday, June 5.

Following the Exeter outbreak, though not related, the Centers for Disease Control reiterated its recommendation that baby boomers be tested for the infection.

According to the CDC, about 3.2 million people in the country live with hepatitis C and in many cases it goes unreported. More than 2 million baby boomers nationwide are infected with hepatitis C, accounting for more than 75 percent of all American adults living with the virus. Baby boomers are five times more likely to be infected than other adults, according to the CDC.

Montero previously said there’s a 70 percent chance that a baby boomer who used illegal drugs has hepatitis C.

“The baby boomers are an interesting group because many that engaged in drug-related behaviors in their youth never developed symptoms and today they have liver problems,” he said.

CDC officials said one main reason why they are focused on baby boomers is because many were infected before universal precautions and widespread blood screening began in 1992.

Treatment has improved over the years. Newly available therapies can cure up to 75 percent of infections. Montero said there are a number of treatments for various strains of hepatitis C; most include an injection over a series of 24 to 48 weeks.

Hepatitis C

Who should be tested?

Baby boomers: Anyone born between 1945 and 1965

Drug users: Anyone who ever injected illegal drugs

Transfusion recipients: of blood or solid organ transplants before July 1992, or clotting factor concentrates made before 1987

Patients: who have ever received long-term hemodialysis treatment

Persons with known exposures to hepatitis C, such as:

Health care workers: after needle-sticks involving blood from a patient with hepatitis C

Blood or organ recipients: from a donor who later tested positive for hepatitis C

People: living with HIV

People: with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)

Children: born to mothers who have hepatitis C

Acute infection symptoms: Fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray stools, joint pain and jaundice may occur two to six months after exposure. Symptoms can also appear in chronic infections.

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- Information provided by Center for Disease Control

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