HEPATITIS AND LIVER CANCER
A National Strategy for Prevention and Control of Hepatitis B and C
Heather M. Colvin and Abigail E. Mitchell, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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
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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.
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.
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
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
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.
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
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.
BOXES, FIGURES, AND TABLES
Boxes
S-1 |
Recommendations, |
|||
2-1 |
Role of Disease Surveillance, |
|||
2-2 |
CDC Acute Hepatitis B Case Definition, |
|||
2-3 |
CDC Acute Hepatitis C Case Definition, |
|||
2-4 |
CDC Chronic Hepatitis B Case Definition, |
|||
2-5 |
CDC Hepatitis C Virus Infection Case Definition (Past or Present), |
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2-6 |
CDC Perinatal Hepatitis B Virus Infection Case Definition, |
|||
3-1 |
Geographic Regions That Have Intermediate and High Hepatitis B Virus Endemicity, |
4-1 |
Summary of ACIP Hepatitis B Vaccination Recommendations, |
|||
5-1 |
Summary of Recommendations Regarding Viral Hepatitis Services, |
|||
5-2 |
Mission Statement of Centers for Disease Control and Prevention Division of Viral Hepatitis, |
|||
5-3 |
Components of Comprehensive Viral Hepatitis Services, |
|||
5-4 |
Summary of CDC At-Risk Populations for Hepatitis B Virus Infection, |
|||
5-5 |
Summary of CDC At-Risk Populations for Hepatitis C Virus Infection, |
|||
5-6 |
Hepatitis B Virus-Specific Antigens and Antibodies Used for Testing, |
Figures
1-1 |
Approximate global preventable death rate from selected infectious diseases and other causes, 2003, |
|||
1-2 |
The committee’s approach to its task, |
|||
2-1 |
Natural progression of hepatitis B infection, |
|||
2-2 |
Natural progression of hepatitis C infection, |
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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, |
|||
4-2 |
Trends in private health-insurance coverage, |
|||
5-1 |
Hepatitis B services model, |
|||
5-2 |
Essential viral hepatitis services for illicit-drug users, |
Tables
1-1 |
Key Characteristics of Hepatitis B and Hepatitis C, |
|||
1-2 |
Burden of Selected Serious Chronic Viral Infections in the United States, |
|||
4-1 |
Hepatitis B Vaccine Schedules for Newborns, by Maternal HBsAg Status—ACIP Recommendations, |
|||
4-2 |
Hepatitis B Immunization Management of Preterm Infants Who Weigh Less Than 2,000 g, by Maternal HBsAg Status—ACIP Recommendations, |
4-3 |
Estimated Chance That an Acute Hepatitis B Infection Becomes Chronic with Age, |
|||
4-4 |
Studies of Hepatitis B Vaccination Rates in Injection-Drug Users, |
|||
4-5 |
Public Health-Insurance Plans, |
|||
5-1 |
Summary of Adult Viral Hepatitis Prevention Coordinators Survey, |
|||
5-2 |
Interpretation of Hepatitis B Serologic Diagnostic Test Results, |
|||
5-3 |
Interpretation of Hepatitis C Virus Diagnostic Test Results, |
|||
5-4 |
Studies of Association Between Opiate Substitution Treatment and Hepatitis C Virus Seroconversion, |
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
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
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