National Viral Hepatitis Research Articles

National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care.

Hepatitis C virus (HCV) infection is a major health problem in Egypt as the nation bears the highest prevalence rate worldwide. This necessitated establishing a novel model of care (MOC) to contain the epidemic, deliver patient care and ensure global treatment access. In this review, we describe the process of development of the Egyptian model and future strategies for sustainability. Although the magnitude of the HCV problem was known for many years, the HCV MOC only came into being in 2006 with the establishment of the National Committee for Control of Viral Hepatitis (NCCVH) to set up and implement a national control strategy for the disease and other causes of viral hepatitis. The strategy outlines best practices for patient care delivery by applying a set of service principles through identified clinical streams and patient flow continuums. The Egyptian national viral hepatitis treatment programme is considered one of the most successful and effective public health programmes. To date, more than one million patients were evaluated and more than 850000 received treatment under the umbrella of the programme since 2006. The NCCVH has been successful in establishing a strong infrastructure for controlling viral hepatitis in Egypt. It established a nationwide network of digitally connected viral hepatitis-specialized treatment centres covering the country map to enhance treatment access. Practice guidelines suiting local circumstances were issued and regularly updated and are applied in all affiliated centres. This review illustrates the model and the successful Egyptian experience. It sets an exemplar for states, organizations and policy-makers setting up programmes for care and management of people with hepatitis C.

HCV Health Policy Developments in Response to the National Viral Hepatitis Action Plan: A Brief Update

Hepatitis C virus (HCV) kills 366,000 people worldwide and 17,000 people in the United States each year. In 2011, the U.S. Department of Health and Human Services (HHS) published a national viral hepatitis action plan to control and combat HCV in the United States. This article provides a brief update of HCV health policy developments that have emerged since publication of HHS's national viral hepatitis action plan and concludes with a discussion of the public health impact of these recent HCV health policy developments.

Access to New Medications for Hepatitis C for Medicaid Members: A Retrospective Cohort Study.

Sofosbuvir (SOF)- or simeprevir (SIM)-containing regimens are highly effective for treating chronic hepatitis C virus (HCV) infection. These regimens, however, are expensive. Most payers have implemented prior authorization (PA) requirements to ensure that patients who can benefit most have priority for these medications. While many Medicaid programs limit access to those with advanced disease or to members who do not have active substance use disorder (SUD), the Massachusetts Medicaid (MassHealth) Primary Care Clinician (PCC) plan does not limit access based on disease severity or presence of SUD. Evaluating PA requests for SOF and/or SIM among MassHealth members will offer a useful example of early uptake among Medicaid members and will identify patient groups who might face barriers to treatment at the provider or patient level. To (a) evaluate the percentage of MassHealth PCC members with HCV who had a PA request, along with the percentage of requests approved, and (b) identify characteristics associated with PA requests for SOF or SIM among Massachusetts Medicaid (MassHealth) members with HCV. This retrospective cohort study used enrollment, medical claims, and PA request data from MassHealth PCC members from December 6, 2012, to July 31, 2014. The sample included members with 1 or more claims with an ICD-9-CM code for HCV during this time who were continuously enrolled from December 6, 2013, to July 31, 2014. Enrollment and medical claims data for the cohort with HCV were linked to a database containing information collected from PA requests. The overall percentage of members with HCV and a PA request for SOF and/or SIM between December 6, 2013, and July 31, 2014, and the percentage of requests approved were calculated. Chi-square statistics were used to compare demographic and clinical characteristics among members with HCV who did and did not have a request. Logistic regression was used to estimate the strength of associations between patient characteristics and a PA treatment request, adjusting for clinical and demographic variables. Of 6,849 members identified with HCV, 346 (5.1%) had a PA request for SOF and/or SIM submitted to MassHealth. Compared with members with HCV who did not have a PA request for SOF or SIM, those with a PA request for these new treatments were more likely to be male (P = 0.01), older (P < 0.001), white race (P = 0.04), have standard MassHealth insurance (P = 0.01), and less likely to be homeless (P < 0.001). Members with a PA request were also more likely to have been treated for HCV in the past year and have advanced disease (hepatic decompensation, cirrhosis, or liver transplant) but less likely to have SUD (P < 0.001 for each). Ninety percent of requests for SOF or SIM were approved; few demographic or clinical characteristics were associated with approval. In adjusted analyses, predictors of PA request were aged 50-64 years (odds ratio (OR) = 2.0, 95% CI = 1.1-3.7 vs. aged < 30 years); hepatic decompensation (OR = 1.6, 95% CI = 1.2-2.3); cirrhosis (OR = 3.0, 95% CI = 2.2-4.1); liver transplant (OR = 3.0, 95% CI = 1.4-6.5); substance use (OR = 0.6, 95% CI = 0.5-0.8); recent HCV treatment (OR = 1.6, 95% CI = 1.0-2.6); comorbidity (OR = 0.95, 95% CI = 0.91-0.98) for 1-unit increase in Diagnostic Cost Group score; and care at a hospital outpatient department (OR = 2.0, 95% CI = 1.2-3.2 vs. group practice). Antiviral treatment with SOF and/or SIM was requested for a relatively small proportion of MassHealth members with HCV, with nearly all approved. Prescriber prioritization or patient barriers to care, rather than the PA process, determined access to treatment in this Medicaid population. Support may be needed to ensure patients with SUD benefit from advances in HCV treatment. No outside funding supported this research. Internal funding was provided by the Commonwealth of Massachusetts. Lavitas has received compensation from University of Tennessee Advanced Studies in Medicine for development of CPE activity. Graham has consulted for the National Viral Hepatitis Roundtable and the Department of Health and Human Services, has received payment from Medscape for CME development, and is employed by Trek Therapeutics. Jeffrey has received payment for guest lectures at Boston University and Harvard University. Study concept and design were primarily contributed by Clark and Clements, along with Graham, Lenz, and Jeffrey. Kunte collected the data, which were interpreted by Graham, Lenz, and Jeffrey, with assistance from Lavitas, Clark, and Clements. The manuscript was written primarily by Clements, along with O'Connell and assisted by Graham, and revised by all the authors.

Efforts at the Frontlines: Implementing a Hepatitis C Testing and Linkage-to-Care Program at the Local Public Health Level.

The national Viral Hepatitis Action Plan recommends strengthening partnerships among health departments, community-based organizations, and health-care providers for hepatitis services. We implemented a hepatitis C virus (HCV) testing and linkage-to-care program through a local health department using similar strategies reported for HIV care. The Durham County Department of Public Health received federal funding to conduct HCV testing and linkage to care in Durham, North Carolina. HCV antibody testing with reflex RNA was offered through a sexually transmitted disease clinic, a county jail, community testing sites (including a residential substance abuse recovery program), and a homeless clinic. People with evidence of HCV infection were linked to care through an HCV bridge counselor who provided education, incentives, and transportation, and scheduled appointments with HCV specialists at nearby academic centers and on-site clinics. From December 2012 through February 2014, we conducted 2,004 HCV tests, of which 326 (16.3%) were HCV antibody positive and 241 (12.0%) had detectable HCV RNA. Among the 241 people with HCV infection, 178 (73.9%) were men, and 133 (55.2%) were born between 1945 and 1965. Of 241 people with chronic HCV infection, 150 (62.2%) reported ever injecting drugs, eight (2.5%) were coinfected with HIV, and 123 (51.0%) were linked to care. At the local public health level, HCV testing and linkage to care can be facilitated with additional funding and by leveraging existing programs and provider networks to deliver a coordinated system of care.

Significant reduction in end-stage liver diseases burden through the national viral hepatitis therapy program in Taiwan

A national viral hepatitis therapy program was launched in Taiwan in October 2003. This study aimed to assess the impact of the program on reduction of end-stage liver disease (ESLD) burden. Profiles of national registries of households, cancers, and death certificates were used to derive incidence and mortality of ESLDs from 2000 to 2011. Age-gender-adjusted incidence and mortality rates of hepatocellular carcinoma (HCC) and chronic liver diseases (CLDs) and cirrhosis of adults ages 30-69 years were compared before and after launching the program using Poisson's regression models. A total of 157,570 and 61,823 patients (15%-25% of those eligible for reimbursed treatment) received therapy for chronic hepatitis B and C, respectively, by 2011. There were 42,526 CLDs and cirrhosis deaths, 47,392 HCC deaths, and 74,832 incident HCC cases occurred in 140,814,448 person-years from 2000 to 2011. Male gender and elder age were associated with a significantly increased risk of CLDs and cirrhosis and HCC. Mortality and incidence rates of ESLDs decreased continuously from 2000 to 2003 (before therapy program) through 2004-2007 to 2008-2011 in all age and gender groups. The age-gender-adjusted rate ratio (95% confidence interval; P value) in 2008-2011 was 0.78 (0.76-0.80; P < 0.001) for CLDs and cirrhosis mortality, 0.76 (0.75-0.78; P < 0.005) for HCC mortality, and 0.86 (0.85-0.88; P < 0.005) for HCC incidence using 2000-2003 as the reference period (rate ratio = 1.0). The national viral hepatitis therapy program has significantly reduced the mortality of CLDs and cirrhosis and incidence and mortality of HCC.

Epidemiology of Hepatitis E Virus in China: Results from the Third National Viral Hepatitis Prevalence Survey, 2005–2006

In China, hepatitis E virus (HEV) is prevalent and causes disease, but its epidemiological profile is not well understood. We used a commercial enzyme-linked immunosorbent assay to detect total antibodies to hepatitis E virus in 15,862 serum samples collected during the Third National Viral Hepatitis Prevalence Survey. The results were analyzed to calculate estimates of HEV seroprevalence and to examine the effects of some putative risk factors. The seroprevalence of HEV in the general Chinese population during the period from 2005 through 2006 was 23.46% (95% confidence interval [CI], 18.41%–28.50%). The farming population, the age group of 15–60 year olds, and those living in the Midwest or Mideast region and in Xinjiang province had the highest seroprevalence estimates. The prevalence of HEV is high in China. The seroprevalence rate of HEV shows an unbalanced distribution among areas with different geographic location and economic development levels. The characteristics of the distribution associated may be due to the route of HEV transmission (via contaminated water or animal reservoirs). Within the same region, the seroprevalence of HEV is generally increased with age.

A national multidisciplinary healthcare network for treatment of hepatitis C in people who inject drugs in Slovenia.

A national multidisciplinary healthcare network for treatment of hepatitis C in people who inject drugs in Slovenia.

Infectious disease burden in Gujarat (2005-2011): comparison of selected infectious disease rates with India.

BackgroundIndia is known to be endemic to numerous infectious diseases. The infectious disease profile of India is changing due to increased human environmental interactions, urbanisation and climate change. There are also predictions of explosive growth in infectious and zoonotic diseases. The Integrated Disease Surveillance Project (IDSP) was implemented in Gujarat in 2004.MethodsWe analysed IDSP data on seven laboratory confirmed infectious diseases from 2005–2011 on temporal and spatial trends and compared this to the National Health Profile (NHP) data for the same period and with other literature. We chose laboratory cases data for Enteric fever, Cholera, Hepatitis, Dengue, Chikungunya, Measles and Diphtheria in the state since well designed vertical programs do not exist for these diseases. Statistical and GIS analysis was done using appropriate software.ResultsOur analysis shows that the existing surveillance system in the state is predominantly reporting urban cases. There are wide variations among reported cases within the state with reports of Enteric fever and Measles being less than half of the national average, while Cholera, Viral Hepatitis and Dengue being nearly double.ConclusionsWe found some limitations in the IDSP system with regard to the number of reporting units and cases in the background of a mixed health system with multiplicity of treatment providers and payment mechanisms. Despite these limitations, IDSP can be strengthened into a comprehensive surveillance system capable of tackling the challenge of reversing the endemicity of these diseases and preventing the emergence of others.

How infected is Gujarat: Comparison of selected infectious disease rates with India

Background: The infectious disease profile of India is changing due to increased human environmental interactions, urbanisation and climate change. There are also predictions of explosive growth in infectious and zoonotic diseases. The Integrated Disease Surveillance Project (IDSP) was implemented in Gujarat in 2004. Aims: We aimed to analyse IDSP data on seven laboratory confirmed infectious diseases in the state of Gujarat, India. Methods: The IDSP data was analysed and compared this to the National Health Profile data during the same period and other literature on temporal and spatial trends from 2005 to 2011. We chose seven laboratory confirmed infectious diseases, Enteric fever, Cholera, Hepatitis, Dengue, Chikungunya, Measles and Diphtheria in the state as well designed vertical programs already exist for other diseases. Statistical and GIS analysis was done using appropriate software. Ethical clearence was obtained from the IRB. Results: Our analysis shows that the existing surveillance system in the state is predominantly reporting urban cases. There are wide variations among reported cases within the state with reports of Enteric fever and Measles being less than half of the national average, while Cholera, Viral Hepatitis and Dengue being nearly double. We found some limitations in the IDSP system with regard to the number of reporting units and cases in the background of a mixed health system with multiplicity of treatment providers and payment mechanisms. Conclusions: Despite these limitations IDSP can be strengthened into a comprehensive surveillance system capable of tackling the challenge of reversing the endemicity of these diseases and preventing the emergence of others.

Centers for Disease Control and Prevention Initiatives to Prevent Hepatitis C Virus Infection: A Selective Update

Hepatitis C virus (HCV) infection is a complex public health problem, characterized by a high prevalence of chronic infection, an increasing burden of HCV-associated disease, low rates of testing and treatment, and the prospect of increasing incidence associated with the epidemic of injection drug use. Three-quarters of chronic HCV infections occur among persons born from 1945 through 1965. Prevention efforts are complicated by limited knowledge among health care professionals, persons at risk and in the public at large. At the Centers for Disease Control and Prevention, efforts to improve primary and secondary prevention effectiveness center on policy development, education and training initiatives, and applied research. This report provides a brief overview of some of these efforts, including the development of testing recommendations for the 1945-1965 birth cohort, research and evaluation studies in settings where persons who inject drugs receive services, and a national viral hepatitis education campaign that targets health care professionals, the public, and persons at risk.

News from the CDC: Translating science into HCV infection screening recommendations

News from the CDC: Translating science into HCV infection screening recommendations

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

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,

Low prevalence of hepatitis B and C markers in non-amazonian indigenous population.

In Brazil, there is a high prevalence of markers ofinfection with the hepatitis B virus among groups livingin the Western Amazon. Neighboring countries andindigenous peoples should also be included in thatcontext [1-6].There are virtually no data available on theprevalence of viral hepatitis markers among indigenousgroups living outside the Amazon region or aboutparenterally transmitted hepatitis.Figueiredo et al. [7] reported the prevalence of HBVand HCV markers among the native Xacriaba peopleliving in the northern part of the State of Minas Gerais;they found 0.5%, 2.9%, 62.5, and 0.5% for HBsAg,anti-HBc, anti-HBs and anti-HCV, respectively. Thisgroup is just as acculturated as the Terena and has along history of contact with modern Brazilian society.To assess this situation, a sero-epidemiological studywas conducted in August 1999, involving 312Amerindians from the Buriti, Corrego do Meio andAgua Azul reservations, located in the municipalities ofSidrolândia and Dois Irmaos do Buriti, 100km fromCampo Grande, the state capital of Mato Grosso doSul (Brazil). The samples were randomly selected, andfamily groups were included.This study included all age groups, from childrenunder 1 year to individuals older than 65. Each agegroup was stratified according to gender (Table 1).The material was collected, centrifuged, andseparated into varying aliquots. Tests for anti-HBc, antiHBs and anti-HCV markers were conducted at theOswaldo Cruz Foundation (Fiocruz-RJ) National ViralHepatitis Center. There were small differences in thenumber of tests for each marker due to limitations inthe quantity of material.None of the samples were positive for HBsAg oranti-HCV. Anti-HBc gave positive results in 2.2% ofthe samples and anti-HBs in 13.6%. The highpercentage found for anti-HBs positivity could be aresult of immunity that was artificially acquired throughvaccination.We found very low positivity rates for the abovemarkers in this population. There are discrepanciesbetween our data and findings previously reported forthe same region. Aguiar et al. [8] found prevalencerates of 0.7%, 9.4% and 2.5% for HBsAg, anti-HBcand anti-HCV, respectively among first-time donors inCampo Grande. In a study of people of African descentliving 65 km from Campo Grande and 40 km from themunicipality of Jaraguari (Mato Grosso do Sul), Castro[9] found rates of 9% and 43% for HBsAg and anti-HBc, respectively.These variations in prevalence need to be betterexplained; it may be necessary to use an approachinvolving other components. Authors such as Brabinet al. [10], Passos et al. [11], and Coimbra et al. [12]have suggested that other variables can influence HBVprevalence rates, which would mean that a simpleepidemiological model of this disease is not realistic.It is sometimes necessary to take into accountpecularities of certain population groups in whichdifferent values, norms and cultural standards may beinvolved in health/illness processes [13].

Beauty treatments and risk of parenterally transmitted hepatitis: results from the hepatitis surveillance system in Italy.

The role of ear-piercing, tattooing, attendance at chiropodist or manicurist and barber shop shaving in transmitting hepatitis B and hepatitis non-A, non-B was evaluated. Data reported here were collected from 1985 to 1993 by the National Viral Hepatitis Surveillance System. The association between parenterally transmitted hepatitis and the considered risk factors was estimated, comparing 6,395 hepatitis B and 2,558 hepatitis non-A, non-B cases with 4,789 hepatitis A cases, using the case-control method. Of the non-A, non-B cases tested from 1991 to 1993, 56.6% were anti-HCV positive. The incidence of parenterally transmitted hepatitis cases reporting specific beauty treatments was also evaluated. Tattooing, ear-piercing and barber shop shaving were associated with both parenterally transmitted hepatitides, while attendance at a chiropodist or manicurist was associated only with hepatitis B. During the study period the incidence of acute hepatitis B and non-A, non-B cases reporting beauty treatments declined by 49%. In spite of this decline, considering that a large part of the general population is exposed to the considered risk factors, the role of beauty treatments in transmitting hepatitis B and hepatitis non-A, non-B should not be underestimated.

Immunogenicity of Hepatitis A Virus Vaccine in Primates

Journal Article Immunogenicity of Hepatitis A Virus Vaccine in Primates Get access R. K. Chaudhary, R. K. Chaudhary Laboratory of the National Viral Hepatitis Reference Centre, National Laboratory for Special Pathogens, Bureau of Microbiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa Reprints and correspondence: Dr. R. K. Chaudhary, Laboratory for Viral Hepatitis, Bureau of Microbiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Thnney's Pasture, Ottawa, Ontario, Canada KIA OL2. Search for other works by this author on: Oxford Academic PubMed Google Scholar T. Mo T. Mo Laboratory of the National Viral Hepatitis Reference Centre, National Laboratory for Special Pathogens, Bureau of Microbiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 161, Issue 3, March 1990, Pages 586–587, https://doi.org/10.1093/infdis/161.3.586 Published: 01 March 1990

Effect of ribavirin on hepatitis A virus replication in vitro : R.K. Chaudhary and A.P. Andonov. Laboratory of the National Viral Hepatitis Reference Centre, Viral Diagnostic Services Division, Bureau of Microbiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa

Effect of ribavirin on hepatitis A virus replication in vitro : R.K. Chaudhary and A.P. Andonov. Laboratory of the National Viral Hepatitis Reference Centre, Viral Diagnostic Services Division, Bureau of Microbiology, Laboratory Centre for Disease Control, Health and Welfare Canada, Ottawa