Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C

Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C - Report from the Institute of Medicine (IOM)
pdf of full report attached


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"Deaths related to hepatitis C have increased, with the highest number occurring among middle-aged men, non-Hispanic blacks, and American Indians."...."negative perceptions about illicit-drug users, who make up the greatest percentage of those with hepatitis C, can affect the care they receive or their willingness to seek care."....."The committee recommended....improve identification of infected individuals, social and peer support to reduce the stigma of infection, and medical management of those with chronic hepatitis B or C".

"They're the overlooked viruses: Hepatitis B and C together infect three to five times more Americans than the AIDS virus does, and most don't know it. In the next 10 years, these two liver-damaging infections will kill about 150,000 people in the U.S. alone, says a new report Monday from the prestigious Institute of Medicine. 'We have allowed gaps in screening, prevention and treatment to go unchecked,'' said report chairman R. Palmer Beasley of the University of Texas, Houston."

from Jules: "70-90% of people who contracted HIV through injection drug use also have hepatitis C, called HCV/HIV coinfection, this is over 300,000 people. The leading cause of death & hospitalization in HIV in the USA is HCV/HIV coinfection. Current treatment is hard to tolerate but new improved orally administered therapies are in development & promise to make HCV much more treatable with higher 'cure' rates. The Ryan White Care Act contains important HCV language & provides a way to secure funding for HCV/HIV coinfection community-based programs"

-- Ryan White Care Act Hepatitis C & B Language (click here for details)

Released:
January 11, 2010
Up to 5.3 million people-2 percent of the U.S. population-are living with chronic hepatitis B or hepatitis C. These diseases are more common than HIV/AIDS in the U.S. Yet, because hepatitis B and hepatitis C often present no symptoms, most people who have them are unaware until they develop liver cancer or liver disease many years later.

A new IOM study finds that these diseases are not widely recognized as serious public health problems, and as a result, that viral hepatitis prevention, control, and surveillance programs have inadequate resources. The report concludes that the current approach to the prevention and control of chronic hepatitis B and hepatitis C is not working. As a remedy, the IOM recommends increased knowledge and awareness about chronic viral hepatitis among health care providers, social service providers, and the public; improved surveillance for hepatitis B and hepatitis C; and better integration of viral hepatitis services.

Among the key findings by the IOM are that one in fifty Americans has viral hepatitis and the majority of such individuals remain unaware of their disease. While some populations are disproportionately affected, individuals from all segments of society can get the disease. A relative lack of funding for disease surveillance and educational efforts is a major barrier towards eradication of hepatitis B and C.

Summary Brief From IOM: Hepatitis and Liver Cancer-
REPORT BRIEF JANUARY 2010. For more information visit
www.iom.edu/ ...

AASLD Applauds Landmark IOM Study
That Shows the Path to Eradicate Hepatitis B and C

ALEXANDRIA, Va., Jan. 11 /PRNewswire-USNewswire/ -- The American Association for the Study of Liver Disease (AASLD) today reacted favorably to the release by they Institute of Medicine (IOM) of the report of "Hepatitis and Liver Cancer: A National

IOM Press Release
FOR IMMEDIATE RELEASE

IOM REPORT RECOMMENDS STEPS TO REDUCE THREATS POSED BY HEPATITIS B AND C, WHICH DISPROPORTIONATELY AFFECT MINORITIES

Contacts: Christine Stencel, Senior Media Relations Officer Luwam Yeibio, Media Relations Assistant Office of News and Public Information 202-334-2138; e-mail

WASHINGTON -- Stepped-up vaccination requirements, a boost in resources for prevention and treatment, and a public awareness campaign similar to the effort that dispelled the stigma of HIV/AIDS are needed to curb the health threats posed by hepatitis B and hepatitis C, says a new report from the Institute of Medicine.

Chronic hepatitis B and C cause thousands of cases of liver cancer, liver disease, and death each year -- taking the heaviest toll among Asians, Pacific Islanders, and blacks in the U.S. -- and these infections account for nearly half of the liver transplantations that must be performed annually. Resources and efforts to contain the viruses that cause hepatitis B and C lag behind those directed at other infectious diseases of similar impact to public health, noted the committee that wrote the report.

"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 committee chair R. Palmer Beasley, professor of epidemiology and disease control, University of Texas School of Public Health, Houston. "This report outlines the additional resources and actions needed to reduce the unacceptably high burden of liver disease and cancer associated with these viruses."

An estimated 800,000 to 1.4 million Americans have chronic hepatitis B and between 2.7 million and 3.9 million have chronic hepatitis C. The majority of infected individuals are not aware of their condition until they develop symptoms of liver cancer or liver disease. Few among the populations most at risk -- immigrants from countries where the diseases are endemic, non-Hispanic black men, injection-drug users, and people who had blood transfusions before 1992 -- seek testing or information on how to protect themselves from infection. Moreover, health care and social service providers' knowledge about hepatitis B and C is generally poor, and many fail to follow guidelines for screening patients and providing prevention, treatment, and follow-up services. The report calls for a public awareness initiative along the lines of the effort that succeeded in increasing recognition, prevention, and treatment of HIV/AIDS, which affects three to five times fewer Americans than viral hepatitis. Educational programs and materials that outline risk factors for viral hepatitis and provide information on immunization, prevention, and proper monitoring of infected individuals should be developed and made available to all health professionals and social service providers.

Steps need to be taken to eliminate the stigma associated with viral hepatitis. Negative attitudes about hepatitis B in some cultures may contribute to immigrants' reluctance to seek testing. In China, for example, people with chronic hepatitis B face job and social discrimination. In addition, negative perceptions about illicit-drug users, who make up the greatest percentage of those with hepatitis C, can affect the care they receive or their willingness to seek care.

Although the availability of an effective vaccine against hepatitis B has significantly reduced its spread, some 1,000 infants born to infected mothers develop chronic infections each year, a number that has not declined over the past decade. Moreover, three states -- Alabama, Montana, and South Dakota -- still do not require that children be vaccinated against hepatitis B before entering daycare or school. All full-term newborns whose mothers test positive for hepatitis B should receive the vaccine once they are stable and before leaving the delivery room rather than up to 12 hours after birth as is currently recommended. All states should make hepatitis B vaccination a requirement for school attendance, and health plans need to fully cover the costs associated with the immunization. Particular attention should be given to screening and vaccinating children who were born in countries where hepatitis B circulates widely. Each year, roughly 40,000 to 45,000 people legally emigrate to the United States from countries where hepatitis B is endemic.

Health care and social services related to viral hepatitis are sparse and fragmented among providers and organizations, leading to missed opportunities to prevent the spread of infection and to lessen the impact of chronic infections, the report concludes. The committee recommended several steps to create a more-coordinated approach, including ways to improve identification of infected individuals, social and peer support to reduce the stigma of infection, and medical management of those with chronic hepatitis B or C. These strategies are aimed at not just health professionals in hospitals and doctors' offices, but also individuals and groups that provide services to at-risk populations, including prisons and jails, HIV and STD clinics, shelter-based programs, and mobile health units.

People at greatest risk for hepatitis B include individuals born in East and Southeast Asia, sub-Saharan Africa, and other areas where the virus circulates widely; infants born to women with the disease; and those who have sexual contact or share injection-drug equipment with an infected person. Asians and Pacific Islanders make up 4.5 percent of the U.S. population but account for more than 50 percent of chronic hepatitis B cases. Those at greatest risk for hepatitis C are individuals who received a blood transfusion before 1992 and past or current injection-drug users. The chances of contracting hepatitis C increase with years of drug use and may be as high as 90 percent among long-term users. Deaths related to hepatitis C have increased, with the highest number occurring among middle-aged men, non-Hispanic blacks, and American Indians.

The report was sponsored by the U.S. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services' Office of Minority Health, U.S. Department of Veterans Affairs, and the National Viral Hepatitis Roundtable. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.