ongoing risk behaviors, and the impact of HIV co-infection and other cofactors.

  • Assess the role of state and local disease registries in the delivery of prevention and care services for persons with chronic hepatitis B and persons with hepatitis C.

  • Assess the role of laboratory testing strategies for the identification of markers for acute HCV infection.

  • Assess laboratory testing strategies for identification of antiviral resistance for HBV and HCV.

Finally, the committee should pay attention to addressing the special needs of specific subpopulations at high risk, such as Asian Americans, African Americans, and persons born in HBV-endemic countries.

THE COMMITTEE’S APPROACH TO ITS TASK

To address its charge, the committee first reviewed available evidence on a variety of topics related to the prevention of hepatitis B and hepatitis C, management of these diseases, and surveillance activities related to viral hepatitis. The evidence was drawn from the published literature and from open-session presentations by recognized experts in the field (see Appendix B). Oral testimony presented by members of the public during the open sessions was also taken into account. Additional information was obtained from written testimony submitted to the committee (available from the National Academies’ Public Access Records Office, publicac@nas.edu).

A comprehensive review and evaluation of treatments for HBV and HCV infections (for example, which medications to use) is beyond the scope of this report. However, treatment information can be found in guidelines published by the American Association for the Study of Liver Diseases (Ghany et al., 2009; Lok and McMahon, 2009) and in NIH consensus statements on the management of hepatitis B (NIH, 2008) and hepatitis C (NIH, 2002).

The committee also has not been tasked with comprehensively reviewing information about the safety of the hepatitis B vaccine. Safety issues surrounding this vaccine were reviewed in the IOM report Immunization Safety Review: Hepatitis B Vaccine and Demyelinating Neurological Disorders (IOM, 2002). The committee that wrote that report concluded that the evidence favored rejection of a causal relationship between hepatitis B vaccine administered to adults and incident multiple sclerosis and multiple-sclerosis relapse. It also found the evidence inadequate for accepting or rejecting a causal relationship between hepatitis B vaccine and the first episode of a central nervous system demyelinating disorder, acute disseminated encephalomyelitis, optic neuritis, transverse myelitis, Guillain-Barré syndrome, or brachial neuritis. IOM has undertaken another review of the



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