A recent report by the Institute of Medicine (IOM) confirmed that 3.5 to 5.3 million people (1-2 % of the U.S. population) have chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Despite efforts by federal, state and local government agencies to control and prevent these diseases, they remain a serious public health concern. The major factor impeding efforts to control HBV and HCV is lack of knowledge and awareness among health care providers, social service professionals, members of the public, and policy-makers. The full IOM report is now available online and published in Hepatology, a journal of the American Association for the Study of Liver Diseases (AASLD).
Each year, about 15,000 people in the U.S. die from liver cancer or liver disease related to HBV or HCV. Past studies indicate up to 1.4 million people have chronic HBV infections and up to 3.9 million individuals are infected with chronic HCV. Approximately 65% and 75% of the infected population are unaware they are infected with HBV and HCV, respectively.
Abigail Mitchell, Ph.D. from The National Academies and study director for the IOM report said, "The lack of public and provider awareness has contributed to the limited resources to control and prevent HBV and HCV infections in the U.S." According to the report there are three to five times more people living with chronic viral hepatitis infections than with HIV infection, but just 2% of the CDC NCHHSTP fiscal year 2008 budget was allocated for viral hepatitis while 69% was allocated for HIV/AIDS.
"Better disease surveillance, improved provider and community education, and integrated, enhanced and accessible viral hepatitis services are needed to combat the spread of these diseases," suggested Dr. Mitchell. The report recommended that 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. For prevention purposes education of the benefits of hepatitis B vaccination should be made clear and the report indicates that all states should mandate that the hepatitis B vaccine series be completed or in progress as a requirement for school attendance.
The IOM report also focused on improvement to viral hepatitis services through a comprehensive five component approach: outreach and awareness; prevention of new infections; identification of infected people; social and peer support; and medical management of infected people. In addition to the general population, the report suggests targeting foreign-born individuals from HBV-endemic countries, illicit-drug users, pregnant women, incarcerated populations, community health centers, and facilities that treat "at-risk" individuals (e.g. HIV clinics and shelters) with comprehensive hepatitis services which would have the greatest impact in reducing HBV and HCV infections.
"Implementations of our recommendations would lead to reduction in new HBV and HCV infections, fewer medical complications and deaths related to chronic viral hepatitis, as well as lower total health costs," concludes Dr. Mitchell.
Dr. Arun Sanyal, President of the AASLD said, "This report represents an important first step in the effort to eradicate hepatitis B and C. The AASLD and its membership will continue to remain the vanguard in the development of new knowledge and educational programs on viral hepatitis that will help which will advance the recommendations of the IOM."
"Institute of Medicine Recommendations for the Prevention and Control of Hepatitis B and C." Abigail Mitchell, Heather Colvin, R. Palmer Beasley. Hepatology; Published Online: February 22, 2010 (DOI:10.1002/hep.23561)