Hepatitis B and C serious public health issue in US
9 March 2010
A report by the US Institute of Medicine (IOM) has confirmed
that 3.5 to 5.3 million people (1-2 % of the US 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
The major factor impeding efforts to control HBV and HCV is lack of
knowledge and awareness among healthcare 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
Each year, about 15,000 people in the US 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.
Dr Abigail Mitchell 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 US."
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 National Center for HIV/AIDS,
Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Prevention (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
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 (eg 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."
1. Abigail Mitchell, Heather Colvin, R. Palmer Beasley. Institute
of Medicine Recommendations for the Prevention and Control of
Hepatitis B and C. Hepatology; Published Online: February