Digestive Diseases News Summer 2010
Institute of Medicine Calls for National Hepatitis B and C Awareness Strategy
Reducing the enormous health burden of chronic infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) will require a substantial increase in public resources, according to the Institute of Medicine (IOM). The IOM report Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C was released January 11, 2010. The report calls for stepped-up efforts to increase awareness among health care providers, the general public, and at-risk populations of the risks and prevalence of HBV and HCV infections.
Four million Americans are living with chronic HBV and HCV infection. Because symptoms rarely appear until viral hepatitis has caused liver damage—10 years or more in the case of HCV— two out of three people with the virus do not know they are infected. Each year, about 15,000 deaths are caused by HBV- or HCV-associated liver cancer or end-stage liver disease, according to data from the Centers for Disease Control and Prevention (CDC). Hepatitis B or C infection is the cause of about half of liver transplantations in the United States, and researchers estimate that 150,000 people in the United States will die in the next decade from end-stage liver disease and liver cancer resulting from viral hepatitis infections.
The IOM was asked by the CDC in conjunction with the U.S. Department of Health and Human Services Office of Minority Health, the U.S. Department of Veterans Affairs, and the National Viral Hepatitis Roundtable to “determine ways to reduce new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis.”
The report cited three principal shortcomings:
- a lack of knowledge and awareness about chronic viral hepatitis on the part of health care and social service providers
- a lack of knowledge and awareness about chronic viral hepatitis among at-risk populations, members of the public, and policy makers
- insufficient understanding about the extent and seriousness of this public health problem; therefore inadequate public resources are being allocated to prevention, control, and surveillance programs
As a result of these shortcomings, the report’s authors observed the following:
- Inadequate disease surveillance systems underreport acute and chronic infections, so the full extent of the problem is unknown.
- At-risk people do not know they are at risk or how to prevent becoming infected.
- At-risk people may not have access to preventive services.
- Chronically infected people do not know they are infected.
- Many health care providers do not screen people for risk factors or do not know how to manage infected people.
- Infected people often have inadequate access to testing, social support, and medical management services.
The IOM report offered recommendations for improvement in four key areas:
- The CDC should conduct a comprehensive evaluation of the national HBV and HCV public health surveillance system.
- The CDC should develop specific, cooperative viral hepatitis agreements with all state and territorial health departments to support core surveillance for acute and chronic HBV and HCV infection.
- The CDC should support and conduct targeted active surveillance, including serologic testing, to monitor incidence and prevalence of HBV and HCV infections in populations not fully captured by core surveillance.
Knowledge and Awareness about Chronic Hepatitis B and Hepatitis C
- The CDC should work with key stakeholders—other federal agencies, state and local governments, professional organizations, health care organizations, and educational institutions—to develop HBV and HCV educational programs for health care and social service providers.
- The CDC should work with key stakeholders to develop, coordinate, and evaluate innovative and effective outreach and education programs to target at-risk populations and increase awareness in the general population about HBV and HCV.
- All infants weighing at least 2,000 grams and born to HBV surface antigen-positive women should receive single-antigen HBV vaccine and HBV immune globulin in the delivery room as soon as they are stable and washed. The recommendations of the Advisory Committee on Immunization Practices should remain in effect for all other infants.
- All states should mandate that the HBV vaccine series be completed or in progress as a requirement for school attendance.
- Additional federal and state resources should be devoted to increasing HBV vaccination of at-risk adults.
- States should be encouraged to expand immunization information systems to include adolescents and adults.
- Private and public insurance coverage for HBV vaccination should be expanded.
- The Federal Government should work to ensure an adequate, accessible, and sustainable HBV vaccine supply.
- Studies to develop a vaccine to prevent chronic HCV infection should continue.
Viral Hepatitis Services
- Federally funded health insurance programs—such as Medicare, Medicaid, and the Federal Employees Health Benefits Program—should incorporate guidelines for risk factor screening for HBV and HCV as a required core component of preventive care so that at-risk people receive serologic testing for HBV and HCV and chronically infected patients receive appropriate medical management.
- The CDC, in conjunction with other federal agencies and state agencies, should provide resources for the expansion of community-based programs that provide HBV screening, testing, and vaccination services that target foreign-born populations.
Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C is available through the National Academies Press at www.nap.edu/catalog.php?record_id=12793.
For more information about hepatitis B, hepatitis C, and other kinds of hepatitis, visit the National Digestive Diseases Information Clearinghouse at www.digestive.niddk.nih.gov.
NIH Publication No. 10–4552