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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
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ELIMINATING
THE PUBLIC HEALTH PROBLEM
OF HEPATITIS B AND C
IN THE UNITED STATES

PHASE ONE REPORT

Gillian J. Buckley and Brian L. Strom, Editors

Committee on a National Strategy for the Elimination of
Hepatitis B and C

Board on Population Health and Public Health Practice

Health and Medicine Division

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. 10002774 with the US Department of Health and Human Services [Centers for Disease Control and Prevention]. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43799-8
International Standard Book Number-10: 0-309-43799-7
Digital Object Identifier: 10.17226/23407

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Copyright 2016 by the National Academy of Sciences. All rights reserved.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the public health problem of hepatitis B and C in the United States: Phase one report. Washington, DC: The National Academies Press. doi: 10.17226/23407.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

COMMITTEE ON A NATIONAL STRATEGY FOR THE ELIMINATION OF HEPATITIS B AND C

BRIAN L. STROM (Chair), Chancellor, Rutgers University, The State University of New Jersey

JON KIM ANDRUS, Executive Vice President and Director, Vaccine Advocacy and Education, Sabin Vaccine Institute

ANDREW ARONSOHN, Assistant Professor of Medicine, University of Chicago

DANIEL CHURCH, Epidemiologist and Viral Hepatitis Prevention Coordinator, Massachusetts Department of Public Health

SEYMOUR COHEN, Instructor Emeritus, Marine Biological Laboratory

ALISON EVANS, Associate Professor, Dornsife School of Public Health, Drexel University

PAUL KUEHNERT, Assistant Vice President, Program, Robert Wood Johnson Foundation

VINCENT LO RE III, Assistant Professor of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania

KATHLEEN MAURER, Director, Health and Addiction Services, Connecticut Department of Correction

RANDALL MAYER, Interim Director, Division of Behavioral Health, Iowa Department of Public Health

SHRUTI MEHTA, Professor of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University

STUART C. RAY, Professor of Medicine, Center for Viral Hepatitis Research, Division of Infectious Diseases, Johns Hopkins University

ARTHUR REINGOLD, Edward Penhoet Distinguished Professor of Global Health and Infectious Diseases, School of Public Health, University of California, Berkeley

SAMUEL SO, Lui Hac Minh Professor, School of Medicine, Stanford University

NEERAJ SOOD, Associate Professor and Vice Dean for Research, Schaeffer Center and Sol Price School of Public Policy, University of Southern California

GRACE WANG, Family Physician, International Community Health Services

LUCY WILSON, Chief, Center for Surveillance, Infection Prevention, and Outbreak Response, Maryland Department of Health and Mental Hygiene

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

Study Staff

GILLIAN BUCKLEY, Study Director

ANNALYN WELP, Research Assistant

MARJORIE PICHON, Senior Program Assistant

DORIS ROMERO, Financial Associate

ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. 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:

CHRIS BEYRER, Johns Hopkins Bloomberg School of Public Health

JULES L. DIENSTAG, Harvard Medical School

NANCY DUNLAP, University of Virginia Medical School

JEREMY GOLDHABER-FIEBERT, Stanford University

AMY JESSOP, HepTREC University of the Sciences

ANNA S. LOK, University of Michigan Health System

CHARLES RICE, The Rockefeller University

CARLOS DEL RIO, Emory University

JOSHUA M. SHARFSTEIN, Johns Hopkins Bloomberg School of Public Health

SU H. WANG, Saint Barnabas 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

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

its release. The review of this report was overseen by Robert B. Wallace, University of Iowa, and Don Eugene Detmer, University of Virginia School of Medicine. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

Acknowledgments

The Committee on a National Strategy for the Elimination of Hepatitis B and C wishes to acknowledge the many people whose contributions and support made this report possible. The committee benefited from presentations made by a number of experts. The following individuals shared their research, experience, and perspectives with the committee: Adrian Di Bisceglie, Kyong-Mi Chang, Chari Cohen, Jules L. Dienstag, Brian R. Edlin, Marc Ghany, Robert G. Gish, J. Nadine Gracia, Camilla Graham, Jay Hoofnagle, Mandana Khalili, Arthur Kim, T. Jake Liang, Anna Suk-Fong Lok, Rohit Loomba, Brian McMahon, Dan O’Connell, Lara Strick, David L. Thomas, and John Ward.

The following individuals were important sources of information, generously giving their time and knowledge to further the committee’s efforts: Amy Geller, Scott Holmberg, Abbe Mitchell, Stephanie Scappini, Patti Simon, Norah Terrault, and Chia Wang.

The committee acknowledges the support of the National Academies of Sciences, Engineering, and Medicine staff, especially Daniel Bearrs, Chelsea Frakes, Greta Gorman, Hope Hare, Jim Jensen, Nicole Joy, Sarah Kelley, Ellen Kimmel, Fariha Mahmud, Anna Martin, Rebecca Morgan, Tina Ritter, Lauren Shern, Elizabeth Tyson, and Jennifer Walsh. The committee thanks Rebekah Hutton for designing the cover art.

The committee also benefited from the work of committees of the Institute of Medicine that conducted studies relevant to this report, particularly the Committee on a National Strategy for Prevention and Control of Viral Hepatitis Infections in the United States.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

Finally, funding for this project was provided by the Centers for Disease Control and Prevention, Division of Viral Hepatitis, and the US Department of Health and Human Services, Office of Minority Health. The committee extends special thanks for that support.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×

Acronyms

AASLD American Association for the Study of Liver Diseases
ACIP Advisory Committee on Immunization Practices
AIDS acquired immune deficiency syndrome
ALT alanine aminotransferase
anti-HBe antibody to HBeAg
anti-HBc antibody to HBcAg
anti-HBs hepatitis B surface antibody
cccDNA covalently closed circular DNA
CDC Centers for Disease Control and Prevention
CI confidence interval
DNA deoxyribonucleic acid
FDA Food and Drug Administration
HBcAg hepatitis B core antigen
HBeAg hepatitis B e antigen
HBsAg hepatitis B surface antigen
HBV hepatitis B virus
HCV hepatitis C virus
HHS Department of Health and Human Services
HIV human immunodeficiency virus
IDSA Infectious Diseases Society of America
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
IgG immunoglobulin G
IgM immunoglobulin M
IOM Institute of Medicine
MELD Model for End-Stage Liver Disease
mRNA messenger ribonucleic acid
NHANES National Health and Nutrition Examination Survey
R0 basic reproduction number
RNA ribonucleic acid
TB tuberculosis
TORCH toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex
UN United Nations
USPSTF United States Preventive Services Task Force
WHO World Health Organization
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC: The National Academies Press. doi: 10.17226/23407.
×
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Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world’s hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide.

The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.

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