Hepatitis and Liver Cancer A National Strategy for Prevention and Control of Hepatitis B and C (2010) / Chapter Skim
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Of those, 800,000 to 1.4 million have chronic HBV infections, and 2.7–3.9 million have chronic HCV infections. Chronic viral hepatitis infections are 3–5 times more frequent than HIV in the United States.
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African Americans and Hispanics have a higher rate of HCV infection than whites. THE CHARGE TO THE COMMITTEE Despite federal, state, and local public health efforts to prevent and control hepatitis B and hepatitis C, these diseases remain serious health problems in the United States.
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Surveillance The viral hepatitis surveillance system in the United States is highly fragmented and poorly developed. As a result, surveillance data do not provide accurate estimates of the current burden of disease, are insufficient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate sufficient resources to viral hepatitis prevention and control programs.
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Chapter 3: Knowledge and Awareness about Chronic Hepatitis B and Hepatitis C • 3-1. he Centers for Disease Control and Prevention should work T with key stakeholders (other federal agencies, state and local governments, professional organizations, health-care organiza tions, and educational institutions)
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Chapter 5: Viral Hepatitis Services • 5-1. ederally funded health-insurance programs -- such as Medi F care, Medicaid, and the Federal Employees Health Benefits Program -- should incorporate guidelines for risk-factor screen ing for hepatitis B and hepatitis C as a required core compo nent of preventive care so that at-risk people receive serologic testing for hepatitis B virus and hepatitis C virus and chronically infected patients receive appropriate medical management.
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• e used to guide the development of detailed technical guidance B and standards for viral hepatitis surveillance. • e published in a report.
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Recommendation 2-3. The Centers for Disease Control and Preven tion should support and conduct targeted active surveillance, including serologic testing, to monitor incidence and prevalence1 of hepatitis B virus and hepatitis C virus infections in populations not fully captured by core surveillance.
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Lack of awareness about the prevalence of chronic viral hepatitis in the United States and the target populations and appropriate methodology for screening, testing, and medical management of chronic hepatitis B and hepatitis C probably contributes to continuing transmission; missing of opportunities for prevention, including vaccination; missing of opportunities for early diagnosis and medical care; and poor health outcomes in infected people. To improve knowledge and awareness among health-care providers and social-service providers, the committee offers the following recommendation: Recommendation 3-1.
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• ncourage notification of close household and sexual contacts of E infected people to be tested for HBV and HCV and encourage hepatitis B vaccination of close contacts. Immunization The longstanding availability of effective hepatitis B vaccines makes the elimination of new HBV infections possible, particularly in children.
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Hepatitis B vaccination for adults is directed at high-risk groups -- people at risk for HBV infection from infected household contact and sex partners, from injection-drug use, from occupational exposure to infected blood or body fluids, and from travel to regions that have high or intermediate HBV endemicity. Only about half the adults who are at high risk for HBV infection receive the hepatitis B vaccine.
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• ederal and state agencies should annually determine gaps in hepa F titis B vaccine coverage among at-risk adults and estimate the resources needed to fill those gaps. Immunization-information systems are used for collection and consolidation of vaccination data from multiple health-care providers, vaccine management, adverse-event reporting, and tracking lifespan vaccination histories.
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The committee believes that a coordinated approach is necessary to reduce the numbers of new HBV and HCV infections, illnesses, and deaths associated with these infections. Comprehensive viral hepatitis services should have five core components: outreach and awareness, prevention of new infections, identification of infected people, social and peer support, and medical management of infected people.
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Federally funded health-insurance programs -- such as Medicare, Medicaid, and the Federal Employees Health Ben efits Program -- should incorporate guidelines for risk-factor screening for hepatitis B and hepatitis C as a required core component of pre ventive care so that at-risk people receive serologic testing for hepatitis B virus and hepatitis C virus and chronically infected patients receive appropriate medical management. Foreign-Born Populations Nearly half of US foreign-born people, or 6% of the total US population, originate in HBV-endemic countries.
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Illicit-Drug users HBV and HCV infection rates in illicit-drug users are high, particularly in IDUs. HCV is easily transmitted among IDUs, and methods to promote safe injection can be considered essential for HCV control.
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Recommendation 5-6. The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepa titis B prevention program coordinators to expand and enhance the capacity to identify chronically infected pregnant women and provide case-management services, including referral for appropriate medical management.
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Community Health Centers The Health Resources and Services Administration administers grant programs across the country to deliver primary care to uninsured and underinsured people in community health centers, migrant health centers, homeless programs, and public-housing primary-care programs. In general, funding of viral hepatitis services at community health centers is inadequate.
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Advances in three major categories will be needed: in knowledge and awareness about chronic viral hepatitis among healthcare and social-service providers, the general public, and policy-makers; in improvement and better integration of viral hepatitis services, including expanded hepatitis B vaccination coverage; and in improvement of estimates of the burden of disease for resource-allocation purposes.
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