Fighting a Silent Epidemic: A New Strategic Approach to Viral Hepatitis

Millions of baby boomers and other Americans have hepatitis B or C and do not know it. In fact, nearly two percent of the U.S. population may have some form of the disease – and approximately five million individuals will develop a chronic form of the diseases. Yet, startlingly, many of them will not even realize they have a hepatitis infection for decades. At that point it may have caused significant, irreversible damage to their livers.

This month, the U.S. Department of Health and Human Services unveiled a new Action Plan to Prevent, Care, and Treat Viral Hepatitis to take a more strategic approach to deal with the silent epidemic of viral hepatitis. This action plan has the potential to help the nation better identify the millions of Americans living with chronic forms of hepatitis B and C and assure access to treatment for all who need it, and prevent even more Americans from becoming infected.

The plan calls for educating providers and communities, improving treatment, strengthening surveillance, reducing vaccine-preventable cases, protecting patients and health care workers, and curbing the spread of the disease through injection drugs.

If supported by the proper resources, the plan could help spare needless suffering and expensive medical costs – and since people develop these diseases as they age, this could result in particularly big savings for Medicare and Medicaid.

Last year, our organization, the Trust for America’s Health, and the American Association for the Study of Liver Diseases issued a report that found:

An estimated 65 to 75 percent of the 5 million Americans currently infected with the hepatitis B virus (HBV) or hepatitis C virus (HCV) do not even know they have the virus;

The Institute of Medicine (IOM) estimates that 150,000 Americans could die from liver cancer or end-stage liver disease associated with HBV or HCV in the next decade;

The death rate from HCV is expected to triple in the next 10 to 20 years;

An independent analysis found total medical costs for HCV patients could more than double over the next 20 years – from $30 to $80 billion per year;

Liver cancer treatment can be more than $62,000 for the first year cost and the first-year cost of a liver transplant can be more than $267,000;

Two-thirds of HCV cases are baby boomers – and if they are left untreated, it could lead to a major increase in upcoming Medicare spending;

One in 10 Asian and Pacific Islander Americans are estimated to have a chronic HBV infection;

An estimated 540,000 to 858,000 African-Americans are estimated to have a chronic HCV infection;

Approximately 800 to 1,000 infants in the United States are infected with HBV at birth each year; and

At least 100,000 patients have been notified about potential exposure to HBV, HCV, and/or HIV while receiving health care since 1998.

There are a number of unique challenges to combating hepatitis B and C: the health complications often take decades to develop; there are significant social stigmas connected to the viruses since they are spread through blood and sexual contact; the diseases disproportionately impact racial, ethnic, and sexual minorities; and infectious disease prevention strategies have traditionally been siloed.

Up until now, most Americans, including those in the highest risk categories, have never been tested to see if they have hepatitis B or C. And, many of the common sense steps that could help prevent transmission of hepatitis to newborns, injection drug users, or hospital patients have not been taken.

Advocates have been calling an investment in prevention and early treatment to avoid new infections and spare millions of individuals from the pain and financial burden of liver disease, most notably that:

• HBV and HCV screening and HBV vaccination should be the standard of care in the reformed health system;
• All pregnant women should be screened for HBV and appropriate health measures should be taken to prevent perinatal transmission from infected mothers to their newborns. All newborns should receive their initial (birthdose) of hepatitis vaccine within twelve hours of birth;
• Every person diagnosed with HBV or HCV should have access to and receive a minimum standardized level of care and receive support services;
• Strong public education campaigns and improved surveillance must be put in place to help prevent new infections;
• Policies must be established to ensure that health care associated hepatitis infections are treated as a “never event;” and
• The investment in hepatitis-related biomedical and behavior must be significantly increased – and should be more proportionate to the public health threat associated with hepatitis.

The plan along with new opportunities provided by the Affordable Care Act and breakthroughs in technologies offer a new opportunity to transform how the country deals with viral hepatitis.

The plan seems like a no brainer. But the big question remains, will the plan be supported with the resources needed to fully and effectively implement it?

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