Some 3 million to 5 million people in the United States are chronically
infected with hepatitis B and hepatitis C, a number far greater than those
carrying the AIDS virus, yet there is little attention paid to screening
and treatment for viral hepatitis, according to a Jan. 11 Institute of
Medicine report.
About 15,000 people die from liver diseases caused by HBV or HCV each year,
yet most people are unaware they are infected until they develop liver
cancer or liver disease, according to the report. The infections also lead
to about half of the nation's liver transplants necessitated by end-stage
liver disease.
"Although hepatitis B and C are preventable, 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 R. Palmer Beasley, MD, chair of the IOM panel that drafted the report.
Dr. Beasley is a professor and dean emeritus of the University of Texas
Health Science Center's School of Public Health.
"The committee strongly believes it is possible for the U.S. to do
considerably better, but it will take better resources and approaches," Dr.
Beasley said.
The federal budget includes very little funding for viral hepatitis, said
panel member Samuel So, MD, director of Stanford University's Asian Liver
Center in California. "Chronic viral hepatitis is probably one of the most
neglected public health problems in the country."
More than 1 million Americans have chronic hepatitis B; nearly 4 million
have chronic hep C.
Daniel Church, MPH, also a panel member and adult viral hepatitis
coordinator at the Massachusetts Dept. of Public Health, said the average
grant to a major city is $90,000, "which usually covers one salary." There
is no funding for surveillance, he said.
Dr. Beasley, Dr. So and Church spoke during a briefing to release the
report.
An estimated 800,000 to 1.4 million Americans have chronic HBV, and 2.7
million to 3.9 million have chronic HCV. 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 and their families from infection.
An efficient screening mechanism
It's likely that physicians, especially primary care physicians, don't have
time to query each patient about risk factors for viral hepatitis, said
panel member David Thomas, MD, MPH, chief of the Division of Infectious
Diseases at Johns Hopkins University School of Medicine in Baltimore.
To boost screening efforts, Dr. Thomas suggests physicians "take 15 minutes
some day this week to look at your intake form and think about how to add
screening questions." For example, patients could be asked whether they
have traveled in countries with a high prevalence of viral hepatitis,
whether they have used intravenous drugs or had blood transfusions before
1992. "You could ask in a way that's not pejorative."
The IOM report was applauded by the American Assn. for the Study of Liver
Diseases, which said it would work with federal agencies to implement the
IOM recommendations.
There is also congressional support for increasing resources for viral
hepatitis. The Viral Hepatitis and Liver Cancer Control and Prevention Act
was introduced in October 2009 by Reps. Mike Honda (D, Calif.) and Bill
Cassidy, MD (R, La.). The measure would amend the Public Health Service Act
to include education, training, surveillance and immunization for hepatitis
B and C.
In addition, Rep. Hank Johnson (D, Ga.) announced in December 2009 that he
has been treated for chronic hepatitis C since 1998. He said he did not
know how he contracted the disease. His announcement was hailed by the
National Viral Hepatitis Roundtable, a coalition of advocacy groups, for
providing heightened attention to the disease.
The full and original article can be found here:
http://www.ama-assn.org/amednews/2010/01/25/prsa0125.htm
