NEW YORK STATE OFFICE OF ALCOHOLISM AND SUBTANCE ABUSE SERVICES
Addition Services for Prevention, Treatment, Recovery
Addiction Medicine FYI
Hepatitis and Liver Cancer
Notes from the January 2010 Report from the Institute of Medicine : A National Strategy for Prevention and Control of Hepatitis B and C
- 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 of the asymptomatic nature of chronic hepatitis B and hepatitis C, most people who have them are unaware until they have symptoms of liver cancer or liver disease many years later.
- Each year about 15,000 people die from liver cancer or liver disease related to hepatitis B and hepatitis C.
- In the next 10 years, about 150,000 people in the United States will die from liver cancer and end-stage liver disease associated with chronic hepatitis B and hepatitis C
- Hepatitis B and hepatitis C can be either acute or chronic:
- The acute form is a short-term illness that occurs within the first six months after a person is exposed to hepatitis B virus (HBV) or hepatitis C virus (HCV) which cause hepatitis B and hepatitis C, respectively.
- Although the number of people with acute hepatitis B is declining in the U.S., mostly because of the availability of hepatitis B vaccines, about 43,000 people still develop acute hepatitis B each year.
- People at risk for hepatitis B include infants born to women with the disease and those who have sexual contact or share injection drug equipment with a person with the disease
- African American adults have the highest rate of acute HBV infection in the United States and the highest rates of acute HBV infection occur in the southern region.
- People from Asia and the Pacific Islands comprise the largest foreign-born population that is at risk for chronic HBV infection.
- The diseases can become chronic, although this does not always happen and, particularly in the case of hepatitis B, the likelihood of this becoming a chronic disease depends on a person’s age at the time of infection.
- Persons likely to have chronic HCV infection include those who received a blood transfusion before 1992 and past or current injection-drug users (IDUs).
- There is no vaccine for hepatitis C.
Viral Hepatitis Services (Recommendations)
- Due to the lack of health services related to viral hepatitis prevention at the federal, state, and local levels, a coordinated approach is necessary to reduce the numbers of new HBV and HCV infections and the illnesses and deaths associated with chronic viral hepatitis. Comprehensive viral hepatitis services should have five core components:
- Outreach and awareness
- Prevention of new infections
- Identification of infected people
- Social and peer support
- Medical management of chronically infected people
- Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepatitis C. The services should include testing to detect infection, counseling to reduce alcohol use and secondary transmission, hepatitis B vaccination, and referral for or provision of medical management.
- Federal, state, and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus prevention programs. At a minimum, the programs should include access to sterile needle syringes and drug-preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus.
- Health care for both IDUs and NIDUs is sporadic and typically received in hospital emergency rooms, corrections facilities, and STD clinics. Given that population’s poor access to health care and services, it is important to have prevention and care services in settings that IDUs and NIDUs are likely to frequent or to develop programs that will draw them into care.
- The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepatitis 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.
- The Centers for Disease Control and Prevention and The Department of Justice should create an initiative to foster partnerships between health departments and corrections systems to ensure the availability of comprehensive viral hepatitis services for incarcerated people.
- Correctional institutions should offer hepatitis B vaccination to all incarcerated persons and accelerated schedules for vaccine administration should be considered for jail inmates.
- The Health Resources and Services Administration and the Centers for Disease Control and Prevention should provide resources and guidance to integrate comprehensive viral hepatitis services into settings that serve high-risk populations such as STD clinics, sites for HIV services and care, homeless shelters, and mobile health units.
The current approach to the prevention and control of chronic hepatitis B and hepatitis C is not working. These diseases are not widely recognized as serious public health problems in the U.S. As a result, inadequate resources are being allocated to viral hepatitis prevention, control, and surveillance programs. Unless action is taken to prevent chronic hepatitis B and hepatitis C, thousands more Americans will die each year from liver cancer or liver disease related to these preventable diseases.
Additional Information - New York State Department of Health Response
New York State Viral Hepatitis Strategic Plan 2010 - 2015 - The mission of the NYS Viral Hepatitis Strategic Plan is to outline a coordinated, comprehensive and systematic approach that will decrease the incidence and reduce the morbidity and mortality of viral hepatitis.