Eliminating the Public Health Problem of Hepatitis B and C in the United States Phase One Report (2016) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 13-32
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 13... ...
The two diseases together account for more than 1 million deaths per year, including 78 percent of the world's hepatocellular carcinoma, the most common type of liver cancer, and 55 percent of fatal cirrhosis (WHO, 2016b)
|
From page 14... ...
SOURCE: IHME, 2016. TABLE 1-1 Key Characteristics of Hepatitis B and Hepatitis C Hepatitis B Hepatitis C Causative Agent Partially double-stranded DNA Enveloped, positive-strand RNA virus virus Figure 1-1 revised, vectorimage, color genus, Flaviviridae Hepadnaviridae family Hepacavirus family Statistics In the United States, there are an In the United States, there are an estimated 0.7-1.4 million people estimated 2.7-4.7 million people chronically infected with HBV, chronically infected with HCV, with approximately 19,800 new with approximately 29,700 new infections every year a infections every yeara Routes of Contact with infectious blood, Contact with infectious blood, Transmissiond semen, and other body fluids; primarily througha transmitted througha • Sharing contaminated needles, • Birth to an infected mother syringes, or other injection-drug • Sexual contact with an infected equipment person • Sharing contaminated needles, Less commonly throughc syringes, or other injection-drug • Sexual contact with an infected equipment person • Birth to an infected mother Less commonly through • Contact with infectious blood • Contact with infectious blood through medical procedures through medical procedures Persons at Riskd • Persons born in geographic • Persons who have ever injected regions that have HBsAg illegal drugs, including those prevalence greater than 2 who injected only once many percentb years agoa
|
From page 15... ...
• Patients with signs or symptoms • All persons who have HIV of liver disease infectiona • Hemodialysis patientsa • Patients with signs or symptoms • Persons requiring of liver diseasea immunosuppressive or cytotoxic • Children born to HCV-positive therapya mothersc • Travelers to countries that have intermediate or high prevalence of HBV infectiona Potential for Among newly infected, persons, Chronic infection develops in 75-85 Chronic Infection chronic infection occurs inb percent of newly infected personsc • >90 percent of infants • 25-50 percent of children aged 1-5 years • 5 percent of older children and adults Clinical Outcomes • 15-25 percent of chronically • Chronic liver diseasec develops infected persons will die in 60-70 percent of chronically prematurely from cirrhosis, infected persons liver failure, or hepatocellular • Cirrhosis develops in 5-20 percent carcinomab over a period of 20-30 yearsc • In the United States, 2,000- • 1-5 percent will die from 4,000 deaths each year are due cirrhosis or hepatocellular to chronic HBV infectionb carcinomac • In the United States, about 15,000 deaths a year are due to HCV infectionc NOTES: HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus. d In no particular order.
|
From page 16... ...
In places with a low prevalence of hepatitis B, such as North America and Western Europe, the virus is more commonly transmitted through injection drug use and unprotected sex, while immigrants from hepatitis B-endemic countries are the major source of chronic infection. Chronic hepatitis C is most prevalent in the Middle East and Asia (see Figure 1-3)
|
From page 17... ...
. While Asian-American men have the highest age-adjusted incidence of liver cancer, other ethnic groups have seen rapid proportional increases, as have people aged 45-60, and people in southern states (see Figure 1-4)
|
From page 18... ...
. Without medical management and appropriate antiviral treatment, chronic hepatitis B carries a 15 to 25 percent risk of serious liver conditions (CDC, 2015a)
|
From page 19... ...
. Though it is difficult to estimate the disease burden among people who inject drugs, recent surveys among active drug injectors suggest about a third of those under 30 and as many as 70 to 90 percent of those over 30 have chronic hepatitis C (CDC, 2016)
|
From page 20... ...
The Committee's Approach to Its Charge To address the charge laid out in Box 1-3, the committee reviewed the available evidence on the burden of hepatitis B and C, the screening, treatment, and management of chronic infection, and scientific and logistical ob BOX 1-2 National Goals for Reducing the Burden of Viral Hepatitis by 2020 • Increase in the proportion of persons who are aware of their hepatitis B virus infection, from 33 percent to 66 percent • IIncrease in the proportion of persons who are aware of their hepatitis C virus infection, from 45 percent to 66 percent • Reduce by 25 percent the number of new cases of HCV infection • Eliminate mother-to-child transmission of HBV SOURCE: HHS, 2014.
|
From page 21... ...
As the two diseases have widely different viral origins, natural histories, epidemiological features, and clinical management, the committee dealt with the elimination question separately for each disease. The remainder of this chapter gives background and context for understanding disease elimination and explains the committee's conclusions about a suitable disease elimination goal.
|
From page 22... ...
When, in 1966, the World Health Assembly resolved to eradicate smallpox from the Earth, it was clear that eradication meant preventing any new cases of smallpox in the world; the surveillance and documentation system developed to support that goal left no room for a single infection. Smallpox eradication emboldened policy makers; it seemed at the time that other human and animal diseases might be equally susceptible (Hopkins, 2009)
|
From page 23... ...
Clarifying the hierarchy of different public health efforts was a goal of the 1998 Dahlem Conference, which proposed mutually exclusive definitions for terms relevant to disease eradication. These definitions overlap with those of the earlier task force, especially in their understanding of disease eradication and control (both shown in Box 1-5)
|
From page 24... ...
Elimination of infection: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographic area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required. Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.
|
From page 25... ...
Without a clear idea of the level of control sought, it is difficult to judge a program's progress, or even know what information the surveillance system should supply. In the smallpox example, the goal of no new cases without continued vaccination was possible because of the disease's recognizable clinical presentation, the lack of chronic infection or silent transmission, the absence of a nonhuman reservoir in nature, and the availability of a highly effective vaccine.
|
From page 26... ...
With this in mind, the committee concluded that disease control -- defined as a reduction in the incidence and prevalence of hepatitis B and C and their sequelae with ongoing control measures required -- is feasible in the relatively short term. It also saw value in setting a goal to eliminate the public health problem of these diseases; in this case, elimination refers to cessation of transmission in the United States, allowing that the infections may remain but their particularly undesirable clinical manifestations prevented entirely.
|
From page 27... ...
. The CDC and Council of State and Territorial Epidemiologists set national guidelines on classifying and reporting acute and chronic infections, but state and local health departments are responsible for implementing these guidelines in the field and for feeding information to the national surveillance network (Church et al., 2014)
|
From page 28... ...
Morbidity and Mortality Weekly Report CDC Surveillance Summaries 41(03)
|
From page 29... ...
Morbidity and Mortality Weekly Report CDC Surveillance Summaries 64(04)
|
From page 30... ...
Morbidity and Mortality Weekly Report CDC Surveillance Summaries 64(19)
|
From page 31... ...
2010. Disease eradication in the context of global health in the 21st century.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.