est foreign-born population that is at risk for chronic HBV infection. The number of people in the United States who are living with chronic HBV infection may be increasing as a result of immigration from highly endemic countries. On the basis of immigration patterns in the last decade, it is estimated that every year 40,000–45,000 people from HBV-endemic countries enter the United States legally.

There is no vaccine for hepatitis C. HCV is efficiently transmitted by direct percutaneous exposure to infectious blood. Persons likely to have chronic HCV infection include those who received a blood transfusion before 1992 and past or current injection-drug users (IDUs). Most IDUs in the United States have serologic evidence of HCV infection (that is, they have been exposed to HCV at some time). While HCV incidence appears to have declined over the last decade, a large portion of IDUs, who often do not have access to health-care services, are not identified by current surveillance systems making interpretation of that trend complicated. 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. Therefore, the Centers for Disease Control and Prevention (CDC) in conjunction with the Department of Health and Human Services Office of Minority Health, the Department of Veterans Affairs, and the National Viral Hepatitis Roundtable sought guidance from the Institute of Medicine (IOM) in identifying missed opportunities related to the prevention and control of HBV and HCV infections. IOM was asked to focus on hepatitis B and hepatitis C because they are common in the United States and can lead to chronic disease. The charge to the committee follows.

The IOM will form a committee to determine ways to reduce new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis. The committee will assess current prevention and control activities and identify priorities for research, policy, and action. The committee will highlight issues that warrant further investigations and opportunities for collaboration between private and public sectors.

FINDINGS AND RECOMMENDATIONS

Upon reviewing evidence on the prevention and control of hepatitis B and hepatitis C, the committee identified the underlying factors that impede current efforts to prevent and control these diseases. Three major factors were found:



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