Report Explores Measures to Eliminate Hepatitis B and C

The United States can end the transmission of hepatitis B and C and prevent further sickness and death from the diseases — but it will take considerable resources and a long-term commitment, according to a report from the National Academies of Sciences, Engineering, and Medicine. The study, “Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report (2016),” lays out the scope of the problem. It notes that up to 1.4 million Americans have chronic hepatitis B, and between 2.5 million and 4.7 million have chronic hepatitis C. Together, these diseases kill 20,000 Americans each year.

The committee-led study suggests the first step in eliminating hepatitis B would be universal immunization, which confers 95% immunity. Once individuals contract the hepatitis B virus, there is no cure, but treatment can prevent progression and death from cirrhosis and liver cancer. Although no vaccine exists for hepatitis C, this condition can be cured in eight to 12 weeks with new antiviral drugs. The report says roadblocks remain:

• Drugs are expensive. Curing a patient with chronic hepatitis C costs $54,000 to $168,000 for drugs alone. Medicaid and insurers have responded by restricting access.
• The cost creates challenges in determining which patients should get priority, because those at immediate risk of death tend to be older — and, thus, less likely to pass on the virus through typical transmission routes, such as illegal drug use, sex or childbirth.
• Two-thirds of people with chronic hepatitis B and half of those with chronic hepatitis C don’t know they are infected.
• Most new hepatitis B cases are in foreign-born individuals, who may face language or social barriers to care.

According to the American Dental Association, it is rare for dental professionals to become infected with hepatitis via contact with blood at work. But the ADA warns clinicians to guard against transmission in the dental setting by following accepted infection prevention protocols. To protect the safety of dental teams, the federal Occupational Safety and Health Administration requires employers to offer the hepatitis B vaccine to employees.

A follow-up report will be released in early 2017 outlining a strategy for meeting the goals discussed in the initial study.