When I first started working on viral hepatitis in 2001, I was blown away by both the numbers of people with chronic infection and the extreme lack of awareness about these infectious diseases. Those first few years, I wondered, what will it take to get a handle on this important public health problem? Is it new therapies? National campaigns? Some kind of change in our health care system? As I shared in a blog last month, the problem of viral hepatitis in the U.S. is significant: more than 4 million Americans from every state and all walks of life are infected with hepatitis B (HBV) or hepatitis C (HCV), and the number of new infections continues to grow. But even in the face of this daunting statistic, we now have some very real opportunities to gain ground against this epidemic. This month, I wanted to share some thoughts on the advances in the prevention and treatment of HBV and HCV to show that we have tools that make it possible to win this fight.
Where Are the Opportunities?
Here are the concrete actions that can make the greatest impacts:
Increase HBV vaccinations: We have safe and effective HBV vaccines, but not enough people get vaccinated. Completing the HBV vaccine series before exposure to HBV provides greater than 90 percent lifelong protection. Vaccinating infants, children, and at-risk adults can prevent more new infections, liver disease, and unnecessary deaths. Providing the birth dose of the HBV vaccine to newborns is recommended by the American Academy of Pediatrics and is key to eliminating mother-to-child transmission of hepatitis B and ultimately protecting all adolescents and adults. Additionally, the FDA recently approved the first new adult HBV vaccine in more than 25 years. The HBV vaccine is usually administered in three doses over six months, which poses challenges to completing the series. This new two-dose vaccine is an opportunity to complete the vaccine series in one month. The Advisory Committee on Immunization Practices (ACIP) has updated its Recommendations on Prevention of Hepatitis B Virus Infection to incorporate this new vaccine for adults at risk.
Improve comprehensive HBV and HCV screening: Improved efforts to screen for HBV and HCV are essential to identify those who are infected, connect them to care, and prevent disease, death, and transmission to others. We have the tools to do this, including accurate blood tests that can detect both HBV and HCV infection years before symptoms appear and liver damage begins. However, most people who are chronically infected with HBV and HCV don’t know it. For this reason, both the Centers for Disease Control (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend:
- Screening all persons at high risk for HBV and HCV
- Screening all pregnant women for HBV
- One-time HCV screening for all baby boomers (persons born between 1945 and 1965)
Specific to HBV, the American College of Physicians (ACP) and CDC recently released new HBV best practice advice for HBV screening, linkage to care, and treatment. These aligned recommendations from ACP, USPSTF, and CDC send a clear signal to health care professionals, policy makers, insurance payers, and the public that screening for HBV is both effective and necessary.
Expand access to HCV treatment: New treatments can cure hepatitis C in about 95 percent of people who are chronically infected, preventing liver disease and liver cancer. By treating people with HCV infection, we can save more than 320,000 lives, avoid nearly $3.3 billion in health care costs associated with disease progression and – importantly – reduce transmission of the virus to others.
One way to save lives and reduce HCV transmission is to expand HCV treatment access to the populations most affected by chronic HCV infection in the U.S.: baby boomers and persons who inject drugs, as well as people living with HIV. Several current efforts are underway, including the Hepatitis C Medicaid Affinity Group and focused initiatives to address HIV and HBV or HCV co-infection through the Ryan White HIV/AIDS Program.
What’s Your Role?
Take action! Seizing these opportunities makes it possible to win the fight against viral hepatitis and save lives. Every county, city, and state has a unique set of strengths and particular needs. Often the first steps in taking action are to identify how your organization engages with people in need of viral hepatitis services, followed by an assessment of their viral hepatitis needs. Asking questions like: Do the people we’re trying to serve have a high rate of chronic infection and need testing and care? Or do they have high rates of new infections and are in need of prevention services? What viral hepatitis services or assistance can you and your partners offer these individuals? In many cases, health departments, health centers, and social service organizations can best serve individuals through partnerships because programs that provide services that work to address the needs of the whole person create better health outcomes. But not every organization is good at every type of service. So partnerships take an important role in our fight against viral hepatitis.
Together, we can maximize opportunities related to viral hepatitis vaccination, screening, and treatment and expand access to needed services for the people we are working to serve. Some partnerships already exist and should be expanded; others need to be developed. Here are some examples:
- Health departments and health care providers can collaborate with community-based programs that serve people who inject drugs to integrate hepatitis testing, vaccination and linkage to care alongside harm reduction, substance use disorder treatment, and recovery programs.
- Healthcare systems can implement strategies to ensure that baby boomers and other populations at risk of HBV or HCV receive screening and linkage to care, for example:
- The Department of Veterans Affairs increased early identification, screening and treatment of veterans with HCV by adopting new strategies within its existing healthcare system.
- Some health centers - PDF have implemented universal screening for HBV for patients from countries where HBV is common.
- Community re-entry programs help connect people returning to communities from prison to access programs like those described in the two previous bullets as well as housing and employment services. Without these critical services, many people return to prison and do not receive important health care.
There is a role for everyone in the fight against viral hepatitis, and every effort is important. The National Viral Hepatitis Action Plan, 2017 – 2020 (Action Plan) outlines a battle plan for us to attack the viral hepatitis epidemic from every angle, with ideas for how each of us can collaborate and get involved. We want to hear about your new and existing activities that support our nation in responding to the needs of your community and reaching the Action Plan’s goals. Working together to leverage these opportunities, we can move toward eliminating viral hepatitis in the United States.