Report: Too Little Surveillance, Treatment for US Patients With Hepatitis B and C

Abstract

CHRONIC HEPATITIS B VIRUS (HBV) and hepatitis C virus (HCV) infections are 3 to 5 times more common than HIV/AIDS infections in the United States, yet few public health resources are devoted to identifying those at risk and ensuring they get proper care, according to a report by the Institute of Medicine (IOM). Partly as a result of the lack of resources invested in this area, about 150 000 individuals living with chronic HBV or HCV infection are expected to die of liver complications over the next 10 years. But according to the new report, many of these deaths could be prevented if US public health officials mounted a more effective response, if physicians and other caregivers followed recommended screening and treatment protocols, and if the public were better educated about these conditions and their treatment. The report, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C (http://www .iom.edu/Reports/2010/Hepatitis-and -Liver-Cancer-A-National-Strategy -for-Prevention-and-Control-of -Hepatitis-B-and-C.aspx), was commissioned by the US Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services Office of Minority Health, the Department of Veterans Affairs, and the National Viral Hepatitis Roundtable, a coalition of public, private and nonprofit organizations. Although 3.5 million to 5.3 million US individuals, about 1% to 2% of the population, have a chronic HBV or HCV infection, most are unaware that they are infected until they develop such complications as cirrhosis or liver cancer, according to the report. Preventive efforts can reduce the rate of infection and treatment of those infected and can prevent such complications. But there is no national strategy for reducing the burden of viral hepatitis, said R. Palmer Beasley, MD, dean emeritus of the University of Texas School of Public Health and chair of the IOM committee that drafted the report. Beasley said, however, that education campaigns, better integration of viral hepatitis services in public health and medical care, and efforts to boost prevention and harm reduction efforts could substantially reduce the burden of chronic viral hepatitis and improve the lives of affected individuals. One of the reasons the public may be so poorly informed about the prevalence and impact of viral hepatitis infections is that a lack of funding has resulted in inadequate surveillance for these disorders. The report notes that although deaths related to chronic HCV infection may soon outpace deaths due to HIV, only 2% of the about $1 billion budget of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention is allotted for hepatitis vs 69% allocated for HIV, 15% for sexually transmitted diseases, and 14% for tuberculosis. This sparse funding at the federal level also translates into limited resources for hepatitis surveillance and interventions at state and local public health departments. Daniel R. Church, MPH, epidemiologist and Adult Viral Hepatitis Coordinator for the Massachusetts Department of Health in Jamaica Plain, explained that the CDC currently allocates $90 000 on average to each state and large city for viral hepatitis activities. This usually ends up paying for just 1 staff position and leaves no funding for surveillance activities and services. So despite the fact that local and state health departments receive many reports of newly diagnosed cases of HCV, they may not have the resources necessary to act on the information. Many of the groups that are most affected by viral hepatitis—immigrants,