Viral Hepatitis Prevention—New Challenges, New Directions

Abstract

In recognition of Hepatitis Awareness Month, this issue of the Journal highlights examples of current research on viral hepatitis. As described in the accompanying editorial, significant changes have occurred in the epidemiology of viral hepatitis, causing leaders in public health, including the Centers for Disease Control and Prevention (CDC), to reassess and establish priorities in line with these changes. Although there are 5 recognized hepatitis viruses worldwide, the most common in the United States are hepatitis A, B, and C, all of which have shown substantial declines in incidence over the past 20 years. Despite these declines, many of those with acute infection have gone on to develop chronic hepatitis B or C, which accounts for substantially greater morbidity and leads to other serious health consequences. In the absence of a vaccine, HCV infection, occurring primarily among those who inject drugs, is prevented largely through behavioral changes. Latka et al. report significant new findings that demonstrate the effectiveness of a behavioral intervention in reducing the lending of used injection equipment among young injection drug users. Rousseau et al. explore racial differences in evaluating and treating chronic HCV infection among veterans. In a very thoughtful analysis, they find that Black veterans are significantly less likely than White veterans to receive antiviral treatment and to undergo selected viral testing and evaluation. They also discuss a number of critical issues regarding HCV infection that must be taken into account when investigating treatment efficacy. In a brief report, Kritz et al. examine how state funding and guidelines affect substance abuse treatment programs that provide infection-related services, including those for HCV. The authors show that available state funding is not always accessed by community-based substance abuse treatment programs, a key component of the service network, especially for preventing HCV infection. Weinbaum et al. report survey results on immunization against hepatitis B virus (HBV) infection among men who have sex with men. Despite finding that a majority of the men who were susceptible to infection had a regular source of health care, most men who have sex with men had not been immunized with the HBV vaccine. The authors further identify several missed opportunities for the provision of immunization services. Lastly, Koya et al. examine trends in HBV vaccine immunization coverage among a sample of high-risk US adults. Although they observe an increase in immunization over time, it is significant only among the youngest of 3 age groups, which the authors conclude suggests a “cohort effect” (successful vaccination of these adults during adolescence) rather than successful targeted immunization efforts among adults. Each of these studies has significant public health implications. Until a vaccine is developed, implementing effective behavioral interventions for the prevention of HCV infection among injection drug users is critical. Treatment options, obstacles to treatment, and disparities in treatment for those who are chronically infected with HCV also require further study. These efforts can be greatly facilitated by increasing state and local public health capacity to track the disease and provide prevention and referral services for those with chronic infection. Finally, findings from the studies that examined HBV infection clearly illustrate the importance of continuing and enhancing efforts to immunize vulnerable populations. All of these areas of investigation align well with the priorities currently identified by CDC for the prevention, control, and treatment of viral hepatitis.