IOM REPORT RECOMMENDS STEPS TO REDUCE THREATS POSED BY HEPATITIS B AND C, WHICH DISPROPORTIONATELY AFFECT MINORITIES

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IOM REPORT RECOMMENDS STEPS TO REDUCE THREATS POSED BY HEPATITIS B AND C, WHICH

DISPROPORTIONATELY AFFECT MINORITIES

WASHINGTON -- Stepped-up vaccination requirements, a boost in resources for

prevention and treatment, and a public awareness campaign similar to the effort

that dispelled the stigma of HIV/AIDS are needed to curb the health threats

posed by hepatitis B and hepatitis C, says a new report from the Institute of

Medicine.

Chronic hepatitis B and C cause thousands of cases of liver cancer, liver

disease, and death each year -- taking the heaviest toll among Asians, Pacific

Islanders, and blacks in the U.S. -- and these infections account for nearly

half

of the liver transplantations that must be performed annually. Resources and

efforts to contain the viruses that cause hepatitis B and C lag behind those

directed at other infectious diseases of similar impact to public health, noted

the committee that wrote the report.

" Although hepatitis B and C are preventable, the rates of infection have not

declined over the past several years, underscoring the conclusion that we have

allowed gaps in screening, prevention, and treatment to go unchecked, " said

committee chair R. Palmer Beasley, professor of epidemiology and disease

control, University of Texas School of Public Health, Houston. " This report

outlines the additional resources and actions needed to reduce the unacceptably

high burden of liver disease and cancer associated with these viruses. "

An estimated 800,000 to 1.4 million Americans have chronic hepatitis B and

between 2.7 million and 3.9 million have chronic hepatitis C. The majority of

infected individuals are not aware of their condition until they develop

symptoms of liver cancer or liver disease. Few among the populations most at

risk -- immigrants from countries where the diseases are endemic, non-Hispanic

black men, injection-drug users, and people who had blood transfusions before

1992 -- seek testing or information on how to protect themselves from infection.

Moreover, health care and social service providers' knowledge about hepatitis B

and C is generally poor, and many fail to follow guidelines for screening

patients and providing prevention, treatment, and follow-up services.

The report calls for a public awareness initiative along the lines of the effort

that succeeded in increasing recognition, prevention, and treatment of HIV/AIDS,

which affects three to five times fewer Americans than viral hepatitis.

Educational programs and materials that outline risk factors for viral hepatitis

and provide information on immunization, prevention, and proper monitoring of

infected individuals should be developed and made available to all health

professionals and social service providers.

Steps need to be taken to eliminate the stigma associated with viral hepatitis.

Negative attitudes about hepatitis B in some cultures may contribute to

immigrants' reluctance to seek testing. In China, for example, people with

chronic hepatitis B face job and social discrimination. In addition, negative

perceptions about illicit-drug users, who make up the greatest percentage of

those with hepatitis C, can affect the care they receive or their willingness to

seek care.

Although the availability of an effective vaccine against hepatitis B has

significantly reduced its spread, some 1,000 infants born to infected mothers

develop chronic infections each year, a number that has not declined over the

past decade. Moreover, three states -- Alabama, Montana, and South Dakota --

still do not require that children be vaccinated against hepatitis B before

entering daycare or school. All full-term newborns whose mothers test positive

for hepatitis B should receive the vaccine once they are stable and before

leaving the delivery room rather than up to 12 hours after birth as is currently

recommended. All states should make hepatitis B vaccination a requirement for

school attendance, and health plans need to fully cover the costs associated

with the immunization. Particular attention should be given to screening and

vaccinating children who were born in countries where hepatitis B circulates

widely. Each year, roughly 40,000 to 45,000 people legally emigrate to the

United States from countries where hepatitis B is endemic.

Health care and social services related to viral hepatitis are sparse and

fragmented among providers and organizations, leading to missed opportunities to

prevent the spread of infection and to lessen the impact of chronic infections,

the report concludes. The committee recommended several steps to create a

more-coordinated approach, including ways to improve identification of infected

individuals, social and peer support to reduce the stigma of infection, and

medical management of those with chronic hepatitis B or C. These strategies are

aimed at not just health professionals in hospitals and doctors’ offices, but

also individuals and groups that provide services to at-risk populations,

including prisons and jails, HIV and STD clinics, shelter-based programs, and

mobile health units.

People at greatest risk for hepatitis B include individuals born in East and

Southeast Asia, sub-Saharan Africa, and other areas where the virus circulates

widely; infants born to women with the disease; and those who have sexual

contact or share injection-drug equipment with an infected person. Asians and

Pacific Islanders make up 4.5 percent of the U.S. population but account for

more than 50 percent of chronic hepatitis B cases. Those at greatest risk for

hepatitis C are individuals who received a blood transfusion before 1992 and

past or current injection-drug users. The chances of contracting hepatitis C

increase with years of drug use and may be as high as 90 percent among long-term

users. Deaths related to hepatitis C have increased, with the highest number

occurring among middle-aged men, non-Hispanic blacks, and American Indians.

The report was sponsored by the U.S. Centers for Disease Control and Prevention,

U.S. Department of Health and Human Services' Office of Minority Health, U.S.

Department of Veterans Affairs, and the National Viral Hepatitis Roundtable.

Established in 1970 under the charter of the National Academy of Sciences, the

Institute of Medicine provides independent, objective, evidence-based advice to

policymakers, health professionals, the private sector, and the public. The

National Academy of Sciences, National Academy of Engineering, Institute of

Medicine, and National Research Council make up the National Academies. A

committee roster follows.

Copies of HEPATITIS AND LIVER CANCER: A NATIONAL STRATEGY FOR PREVENTION AND

CONTROL OF HEPATITIS B AND C are available from the National Academies Press;

tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU.

Reporters may obtain a copy from the Office of News and Public Information

(contacts listed above. Additional information on the study can be found at

HTTP://WWW.IOM.EDU/VIRALHEPATITIS.

[ This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG ]

INSTITUTE OF MEDICINE

Board on Population Health and Public Health Practice

COMMITTEE ON PREVENTION AND CONTROL OF VIRAL HEPATITIS INFECTIONS IN THE UNITED

STATES

R. PALMER BEASLEY, M.D. (CHAIR)

Ashbel Professor and Dean Emeritus

School of Public Health

University of Texas

Houston

HARVEY J. ALTER, M.D. 1,2

Chief

Infectious Diseases Section

Department of Transfusion Medicine

National Institutes of Health

Bethesda, Md.

MARGARET L. BRANDEAU, PH.D.

Professor

Department of Management Science and Engineering

Stanford University

Stanford, Calif.

DANIEL R. CHURCH, M.P.H.

Epidemiologist and Adult Viral Hepatitis Coordinator

Bureau of Infectious Disease Prevention, Response, and Services

Massachusetts Department of Health

Jamaica Plain

ALISON A. EVANS, SC.D.

Assistant Professor

Department of Epidemiology and Biostatistics

Drexel University School of Public Health

Drexel Institute of Biotechnology and Viral Research

Doylestown, Pa.

HOLLY HAGAN, PH.D., M.P.H.

Senior Research Scientist

College of Nursing

New York University

New York City

SANDRAL HULLETT, M.D., M.P.H. 2

CEO and Medical Director

Green Hospital

Birmingham, Ala.

STACENE R. MAROUSHEK, M.D., PH.D., M.P.H.

Staff Pediatrician

Department of Pediatrics

Hennepin County Medical Center

Minneapolis

RANDALL R. MAYER, M.S., M.P.H.

Chief

Bureau of HIV, STD, and Hepatitis

Iowa Department of Public Health

Des Moines

BRIAN J. MCMAHON, M.D.

Medical Director

Liver Disease and Hepatitis Program

Alaska Native Tribal Health Consortium

Anchorage

MARTIN JOSE SEPULVEDA, M.D., M.P.H., FACP

Vice President

Integrated Health Services

IBM Corp.

Somers, N.Y.

SAMUEL SO, M.B., B.S.

Lui Hac Minh Professor

Asian Liver Center

School of Medicine

Stanford University

Stanford, Calif.

DAVID L. THOMAS, M.D., M.P.H.

Chief

Division of Infectious Diseases

Department of Medicine

s Hopkins School of Medicine

Baltimore

LESTER N. WRIGHT, M.D., M.P.H.

Deputy Commissioner and Chief Medical Officer

New York Department of Correctional Services

Albany

STAFF

ABIGAIL MITCHELL, PH.D.

Study Director

1 Member, National Academy of Sciences

2 Member, Institute of Medicine