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Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

HEPATITIS AND LIVER CANCER

A National Strategy for Prevention and Control of Hepatitis B and C

Heather M. Colvin and Abigail E. Mitchell, Editors

Committee on the Prevention and Control of Viral Hepatitis Infections

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract 200-2005-13434, TO#16, between the National Academy of Sciences and the Department of Health and Human Services (with support from the Centers for Disease Control and Prevention, the Office of Minority Health, and the Department of Veterans Affairs) and by the Task Force for Child Survival and Development on behalf of the National Viral Hepatitis Roundtable. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Hepatitis and liver cancer : a national strategy for prevention and control of hepatitis B and C / Heather M. Colvin and Abigail E. Mitchell, editors ; Committee on the Prevention and Control of Viral Hepatitis Infections, Board on Population Health and Public Health Practice.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-309-14628-9

1. Hepatitis B—United States. 2. Hepatitis C—United States. 3. Liver—Cancer—United States. I. Colvin, Heather M. II. Mitchell, Abigail E. III. Institute of Medicine (U.S.). Committee on the Prevention and Control of Viral Hepatitis Infections. IV. Institute of Medicine (U.S.). Board on Population Health and Public Health Practice. V. National Academies Press (U.S.)

[DNLM: 1. Hepatitis B—complications—United States. 2. Hepatitis B—prevention & control—United States. 3. Hepatitis C—complications—United States. 4. Hepatitis C— prevention & control—United States. 5. Liver Neoplasms—prevention & control—United States. 6. Viral Hepatitis Vaccines—therapeutic use—United States. WC 536 H5322 2010]

RA644.H4H37 2010

616.99'436—dc22

2010003194

Additional copies of this report are available from the

National Academies Press,

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Copyright 2010 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

COMMITTEE ON THE PREVENTION AND CONTROL OF VIRAL HEPATITIS INFECTIONS

R. Palmer Beasley (Chair), Ashbel Smith Professor and Dean Emeritus,

University of Texas, School of Public Health, Houston, Texas

Harvey J. Alter, Chief,

Infectious Diseases Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland

Margaret L. Brandeau, Professor,

Department of Management Science and Engineering, Stanford University, Stanford, California

Daniel R. Church, Epidemiologist and Adult Viral Hepatitis Coordinator,

Bureau of Infectious Disease Prevention, Response, and Services, Massachusetts Department of Health, Jamaica Plain, Massachusetts

Alison A. Evans, Assistant Professor,

Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Drexel Institute of Biotechnology and Viral Research, Doylestown, Pennsylvania

Holly Hagan, Senior Research Scientist,

College of Nursing, New York University, New York

Sandral Hullett, CEO and Medical Director,

Cooper Green Hospital, Birmingham, Alabama

Stacene R. Maroushek, Staff Pediatrician,

Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota

Randall R. Mayer, Chief,

Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health, Des Moines, Iowa

Brian J. McMahon, Medical Director,

Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska

Martín Jose Sepúlveda, Vice President,

Integrated Health Services, International Business Machines Corporation, Somers, New York

Samuel So, Lui Hac Minh Professor,

Asian Liver Center, Stanford University School of Medicine, Stanford, California

David L. Thomas, Chief,

Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

Lester N. Wright, Deputy Commissioner and Chief Medical Officer,

New York Department of Correctional Services, Albany, New York

Study Staff

Abigail E. Mitchell, Study Director

Heather M. Colvin, Program Officer

Kathleen M. McGraw, Senior Program Assistant

Norman Grossblatt, Senior Editor

Rose Marie Martinez, Director,

Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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Reviewers

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Scott Allen, Brown University Medical School

Jeffrey Caballero, Association of Asian Pacific Community Health Organizations

Colleen Flanigan, New York State Department of Health

James Jerry Gibson, South Carolina Department of Health and Environmental Control

Fernando A. Guerra, San Antonio Metropolitan Health District

Theodore Hammett, Abt Associates Inc.

Jay Hoofnagle, National Institute of Diabetes and Digestive and Kidney Diseases

Charles D. Howell, University of Maryland School of Medicine

Walter A. Orenstein, Bill & Melinda Gates Foundation

Philip E. Reichert, Florida Department of Health

Charles M. Rice III, The Rockefeller University

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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Tracy Swan, Treatment Action Group

Su Wang, Charles B. Wang Community Health Center

John B. Wong, Tufts Medical Center

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Bradford H. Gray, Senior Fellow, The Urban Institute, and Elena O. Nightingale, Scholar-in-Residence, Institute of Medicine. Appointed by the Institute of Medicine and the National Research Council, they were responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

Acknowledgments

The committee acknowledges the valuable contributions made by the many persons who shared their experience and knowledge with the committee. The committee appreciates the time and insight of the presenters during the public sessions: John Ward, Dale Hu, Cindy Weinbaum, and David Bell, Centers for Disease Control and Prevention; Chris Taylor and Martha Saly, National Viral Hepatitis Roundtable; Lorren Sandt, Caring Ambassadors Program; Joan Block, Hepatitis B Foundation; Gary Heseltine, Council of State and Territorial Epidemiologists; William Rogers, Centers for Medicare and Medicaid Services; Tanya Pagán Raggio Ashley, Health Resources Services Administration; Carol Craig, National Association of Community Health Centers; Daniel Raymond, Harm Reduction Coalition; and Mark Kane, formerly of the Children’s Vaccine Program, PATH. We are also grateful for the thoughtful written and verbal testimony provided by members of the public affected by hepatitis B or hepatitis C.

Several persons contributed their expertise for this report. The committee thanks David Hutton, of the Department of Management Science and Engineering at Stanford University; Victor Toy, Beverly David, and Kathleen Tarleton, of IBM; Shiela Strauss, of the New York University College of Nursing; Ellen Chang and Stephanie Chao, of the Asian Liver Center at Stanford University; Gillian Haney, of the Massachusetts Department of Public Health; and all the State Adult Viral Hepatitis Prevention Coordinators that provided information to the committee.

This report would not have been possible without the diligent assistance of Jeffrey Efird and Daniel Riedford, of the Centers for Disease Control and

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

Prevention. We appreciate the assistance of Ronald Valdiserri, of the Department of Veterans Affairs, for providing literature for the report.

The committee thanks the staff members of the Institute of Medicine, the National Research Council, and the National Academies Press who contributed to the development, production, and dissemination of this report. The committee thanks the study director, Abigail Mitchell, and program officer Heather Colvin for their work in navigating this complex topic and Kathleen McGraw for her diligent management of the committee logistics.

This report was made possible by the support of the Division of Viral Hepatitis and Division of Cancer Prevention and Control of the Centers for Disease Control and Prevention, the Department of Health and Human Services Office of Minority Health, the Department of Veterans Affairs, and the National Viral Hepatitis Roundtable.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

2

 

SURVEILLANCE

 

41

   

 Applications of Surveillance Data,

 

43

   

 Outbreak Detection and Control,

 

44

   

 Resource Allocation,

 

45

   

 Programmatic Design and Evaluation,

 

45

   

 Linking Patients to Care,

 

45

   

 Disease-Specific Issues Related to Viral-Hepatitis Surveillance,

 

46

   

 Identifying Acute Infections,

 

47

   

 Identifying Chronic Infections,

 

51

   

 Identifying Perinatal Hepatitis B,

 

54

   

 Other Challenges for Hepatitis B and Hepatitis C Surveillance Systems,

 

56

   

 Infrastructure and Process-Specific Issues with Surveillance,

 

57

   

 Funding Sources,

 

58

   

 Program Design,

 

59

   

 Reporting Systems and Requirements,

 

59

   

 Capturing Data on At-Risk Populations,

 

61

   

 Case Evaluation, Followup, and Partner Services,

 

62

   

 Recommendations,

 

63

   

 Model for Surveillance,

 

66

   

 Core Surveillance,

 

67

   

 Targeted Surveillance,

 

71

   

 References,

 

72

3

 

KNOWLEDGE AND AWARENESS ABOUT CHRONIC HEPATITIS B AND HEPATITIS C

 

79

   

 Knowledge and Awareness Among Health-Care and Social-Service Providers,

 

80

   

 Hepatitis B,

 

81

   

 Hepatitis C,

 

83

   

 Recommendation,

 

85

   

 Community Knowledge and Awareness,

 

89

   

 Hepatitis B,

 

89

   

 Hepatitis C,

 

93

   

 Recommendation,

 

96

   

 References,

 

101

4

 

IMMUNIZATION

 

109

   

 Hepatitis B Vaccine,

 

109

   

 Current Vaccination Recommendations, Requirements, and Rates,

 

110

   

 Immunization-Information Systems,

 

126

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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BOXES, FIGURES, AND TABLES

Boxes

S-1

 

Recommendations,

 

4

2-1

 

Role of Disease Surveillance,

 

42

2-2

 

CDC Acute Hepatitis B Case Definition,

 

48

2-3

 

CDC Acute Hepatitis C Case Definition,

 

49

2-4

 

CDC Chronic Hepatitis B Case Definition,

 

52

2-5

 

CDC Hepatitis C Virus Infection Case Definition (Past or Present),

 

53

2-6

 

CDC Perinatal Hepatitis B Virus Infection Case Definition,

 

55

3-1

 

Geographic Regions That Have Intermediate and High Hepatitis B Virus Endemicity,

 

81

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

4-1

 

Summary of ACIP Hepatitis B Vaccination Recommendations,

 

112

5-1

 

Summary of Recommendations Regarding Viral Hepatitis Services,

 

148

5-2

 

Mission Statement of Centers for Disease Control and Prevention Division of Viral Hepatitis,

 

150

5-3

 

Components of Comprehensive Viral Hepatitis Services,

 

155

5-4

 

Summary of CDC At-Risk Populations for Hepatitis B Virus Infection,

 

156

5-5

 

Summary of CDC At-Risk Populations for Hepatitis C Virus Infection,

 

158

5-6

 

Hepatitis B Virus-Specific Antigens and Antibodies Used for Testing,

 

160

Figures

1-1

 

Approximate global preventable death rate from selected infectious diseases and other causes, 2003,

 

20

1-2

 

The committee’s approach to its task,

 

34

2-1

 

Natural progression of hepatitis B infection,

 

46

2-2

 

Natural progression of hepatitis C infection,

 

47

4-1

 

Estimated cost of adult hepatitis B vaccination per quality adjusted life year (QALY) gained for different age groups and different rates of acute hepatitis B virus (HBV) infection incidence,

 

119

4-2

 

Trends in private health-insurance coverage,

 

133

5-1

 

Hepatitis B services model,

 

157

5-2

 

Essential viral hepatitis services for illicit-drug users,

 

180

Tables

1-1

 

Key Characteristics of Hepatitis B and Hepatitis C,

 

21

1-2

 

Burden of Selected Serious Chronic Viral Infections in the United States,

 

26

4-1

 

Hepatitis B Vaccine Schedules for Newborns, by Maternal HBsAg Status—ACIP Recommendations,

 

114

4-2

 

Hepatitis B Immunization Management of Preterm Infants Who Weigh Less Than 2,000 g, by Maternal HBsAg Status—ACIP Recommendations,

 

115

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

4-3

 

Estimated Chance That an Acute Hepatitis B Infection Becomes Chronic with Age,

 

118

4-4

 

Studies of Hepatitis B Vaccination Rates in Injection-Drug Users,

 

122

4-5

 

Public Health-Insurance Plans,

 

130

5-1

 

Summary of Adult Viral Hepatitis Prevention Coordinators Survey,

 

153

5-2

 

Interpretation of Hepatitis B Serologic Diagnostic Test Results,

 

161

5-3

 

Interpretation of Hepatitis C Virus Diagnostic Test Results,

 

164

5-4

 

Studies of Association Between Opiate Substitution Treatment and Hepatitis C Virus Seroconversion,

 

178

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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×

Acronyms and Abbreviations

AASLD American Association for the Study of Liver Diseases

ACIP Advisory Committee on Immunization Practices

ACOG American College of Obstetricians and Gynecologists

AHRQ Agency for Healthcare Research and Quality

AIDS acquired immunodeficiency syndrome

ALT alanine aminotransferase

anti-HBc Hepatitis B core antibody

anti-HBs Hepatitis B surface antibody

anti-HCV Hepatitis C antibody

API Asian and Pacific Islander

AST aspartate transaminase

AVHPC adult viral hepatitis prevention coordinators

CDC Centers for Disease Control and Prevention

CHIP Children’s Health Insurance Program

CI confidence interval

CIA enhanced chemiluminescence

CMS Centers for Medicare and Medicaid Services

DIS disease intervention specialist

DTaP diptheria and tetanus toxoids and acellular pertussis adsorbed vaccine

DUIT drug user intervention trial

DVH Division of Viral Hepatitis

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

EIA enzyme immunoassay

EIP Emerging Infections Program

EPSDT early periodic screening diagnosis and treatment program

FDA Food and Drug Administration

FEHBP Federal Employee Health Benefit Program

FQHC federally qualified health center

HAV Hepatitis A virus

HBIG Hepatitis B immunoglobulin

HBsAg Hepatitis B surface antigen

HBV Hepatitis B virus

HCC hepatocellular carcinoma

HCV Hepatitis C virus

HCW health-care workers

HDHP high deductable health plan

HIAA Health Insurance Association of America

HIB haemophilus influenzae type B

HIV human immunodeficiency virus

HMO health maintenance organization

HPV human papilloma virus

HRSA Health Resources and Services Administration

IDU injection-drug user

IIS immunization information systems

IOM Institute of Medicine

IPV inactivated polio virus

MMTP methadone maintenance treatment program

NASTAD National Alliance of State and Territorial AIDS Directors

NAT nucleic acid test

NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention

NEDSS National Electronic Disease Surveillance System

NETSS National Electronic Telecommunications System for Surveillance

NGO nongovernmental organization

NHANES National Health and Nutrition Examination Survey

NIDU non-injection-drug user

NVAC National Vaccine Advisory Committee

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
×

OB/GYN obstetrician/gynecologist

OMH Office of Minority Health

OR odds ratio

PEI peer education intervention

PHIN Public Health Information Network

POS point of service

PPO preferred provider organization

PY person year

QALY quality adjusted life year

RCT randomized clinical trial

RIBA recombinant immunoblot assay

RNA ribonucleic acid

RSV respiratory syncytial virus

SAMHSA Substance Abuse and Mental Health Services Administration

SARS severe acute respiratory syndrome

SEP syringe exchange program

STD sexually transmitted disease

STRIVE Study To Reduce Intravenous Exposures

TB tuberculosis

TCM traditional Chinese medicine

USPHS US Public Health Service

USPSTF US Preventive Services Task Force

VA Department of Veterans Affairs

vCJD variant Creutzfeldt-Jakob disease

VFC Vaccines for Children

WHO World Health Organization

Suggested Citation:"Front Matter." Institute of Medicine. 2010. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC: The National Academies Press. doi: 10.17226/12793.
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The global epidemic of hepatitis B and C is a serious public health problem. Hepatitis B and C are the major causes of chronic liver disease and liver cancer in the world. In the next 10 years, 150,000 people in the United States will die from liver disease or liver cancer associated with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Today, between 800,000 and 1.4 million people in the United States have chronic hepatitis B and between 2.7 and 3.9 million have chronic hepatitis C. People most at risk for hepatitis B and C often are the least likely to have access to medical services. Reducing the rates of illness and death associated with these diseases will require greater awareness and knowledge among health care workers, improved identification of at-risk people, and improved access to medical care.

Hepatitis B is a vaccine-preventable disease. Although federal public health officials recommend that all newborns, children, and at-risk adults receive the vaccine, about 46,000 new acute cases of the HBV infection emerge each year, including 1,000 in infants who acquire the infection during birth from their HBV-positive mothers. Unfortunately, there is no vaccine for hepatitis C, which is transmitted by direct exposure to infectious blood.

Hepatitis and Liver Cancer identifies missed opportunities related to the prevention and control of HBV and HCV infections. The book presents ways to reduce the numbers of new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis. It identifies priorities for research, policy, and action geared toward federal, state, and local public health officials, stakeholder, and advocacy groups and professional organizations.

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