Online only: Report calls for national strategy to address hepatitis B and C
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The health threats posed by hepatitis B and C call for a national strategy that includes stepped-up vaccination requirements, a boost in resources for prevention and treatment, and a public awareness campaign similar to ones aimed at dispelling the stigma of HIV/AIDS, according to a recent Institute of Medicine report.

Chronic hepatitis B and C are linked to thousands of cases of liver cancer, liver disease and death each year in the United States, taking the heaviest toll among Asians, Pacific Islanders and blacks. The report said resources aimed at containing the viruses that cause hepatitis lag behind those directed at other infectious diseases with similar public health impacts.

“Although hepatitis B and C are preventable, the rates of infection have not declined over the past several years, underscoring the conclusion that we have allowed gaps in screening, prevention and treatment to go unchecked,” said R. Palmer Beasley, MD, chair of the committee that authored the report and professor of epidemiology and disease control at the University of Texas School of Public Health.

As many as 1.4 million Americans are estimated to have chronic hepatitis B and almost 4 million have chronic hepatitis C — up to 2 percent of the nation’s population. Exact numbers are difficult to pin down because the majority of infected individuals are unaware of their condition until they develop symptoms of liver cancer or liver disease, according to the report.

Another challenge is that few among the most at-risk populations — including immigrants from countries where the diseases are endemic, black men, injection drug users and people who had blood transfusions before 1992 — seek testing or information on how to protect themselves from infection, according to the report. And health care and social services providers’ knowledge about hepatitis B and C is generally poor, with many failing to follow guidelines for screening patients and providing prevention, treatment and follow-up services, it said.

The Centers for Disease Control and Prevention supports the IoM report’s calls for an intensified national response to viral hepatitis, said Kevin Fenton, MD, PhD, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

“The nation must recognize viral hepatitis as a severe health threat that affects millions of Americans,” Fenton said in a Jan. 11 statement. “Yet there is a lack of awareness about this serious public health challenge, not only among the general public, but among health care and social service providers, at-risk populations and policy-makers.”

The report begins with the stark words that “in the next 10 years, about 150,000 people in the United States will die from liver cancer and end-stage liver disease associated with chronic hepatitis B and hepatitis C.” It also stressed the fact that while vaccination has led to a decline in acute hepatitis B infection, there are still 43,000 new infections yearly, including about 1,000 among infants born to mothers with hepatitis B.

Specific recommendations in the report call for increased and improved disease surveillance, education campaigns to improve knowledge among both the general population as well as health care and social services providers, increased immunization efforts and expanded services such as screening among high-risk populations.

The full report, “Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C,” is available at [www.nas.edu](http://www.nas.edu).



*   Copyright The Nation’s Health, American Public Health Association