Institute of Medicine's Report on Viral Hepatitis
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[Dr. John Ward] Viral hepatitis kills about 12 to 15,000 Americans each year, a number similar to or even slightly greater than the number of deaths from HIV/AIDS, a disease more people know about and have concerns about.
Four-and-a-half to five million persons are living with viral hepatitis. Those individuals are at risk for progressing towards end-stage liver disease, known as liver cirrhosis, and liver cancer. Viral hepatitis is the major cause of both of those conditions in the United States.
The Institute of Medicine, or the IOM, is the official agency that advices the Federal government on matters of science. In 2008, they convened an expert panel to look at ways the United States can improve our efforts to prevent viral hepatitis, both infections that cause viral hepatitis and the diseases that come from it once infected. And they put together a report that was released in January.
The IOM felt that the viral hepatitis is greatly underappreciated as a public health problem and this lack of attention and awareness and understanding about viral hepatitis translates into missed opportunities for prevention.
The Institute of Medicine outlined four areas that the nation can improve in regards to viral hepatitis prevention. … Number one: public health surveillance. Number two: knowledge and awareness regarding viral hepatitis. Number three: Immunizations to eliminate Hepatitis B transmissions in the United States. And four: the services that must be made available to prevent illness and death for persons living with viral hepatitis.
The IOM made it very clear that they thought that surveillance … needed to be greatly improved to detect outbreaks, such as the ones that we are seeing in health care settings and among key populations.
The second part is this whole issue of knowledge and awareness.Viral hepatitis is underappreciated even in communities where it is quite common, such as Asian-American communities or African-American communities.
… This is compounded by studies that also show that providers or clinicians, doctors who take care of these people, also don’t have basic facts about how it is transmitted, how it can be prevented through vaccination, who needs to be screened, and even what you do once one is found to be positive. So there are multiple aspects of education of communities and providers that need to be undertaken ….
Thirdly, the IOM emphasized the role of vaccination. Not every disease has a vaccine. … We have a vaccine for a major form of viral hepatitis known as Hepatitis B. … the vaccine has translated into large declines in the number of people being infected in this country, which is great news. However, here, 30 years after it has been made available to our nation, we still have about 50,000 persons getting infected. Some of those are newborns infected at the time of birth because their mother was infected. If given promptly, the vaccine can protect almost all of those infants.
Adults do not have as ready access to vaccine as do children in our country. And, as a result, vaccine coverage is very low for adults. And Hepatitis B is very readily transmitted through sexual contact, through other blood exposures, and even within families … The IOM emphasized that the nation must make a bigger and full commitment to our national goal of eliminating Hepatitis B transmission in the United States … We have a safe and effective vaccine, and so we have the means to do this.
The last body of work that the IOM emphasized were the viral hepatitis prevention services needed for persons living with viral hepatitis. We have a prime opportunity at this point as the IOM recognized for a couple of reasons. One, in particular, is that treatment has greatly improved for viral hepatitis compared to earlier years. And those improvements are going to accelerate in the next several years as new drugs come on the market and are available for persons before they develop end-stage liver disease and cancer. Secondly, we can identify people … before their livers get so severely damaged that you cannot reverse the impact of these viral infections on the liver. So we have an opportunity to have programs that can detect infections early before the disease has progressed to a severe stage. …We can bring to bear these effective drugs and even cure this viral infection in the case of Hepatitis C.
The Institute of Medicine confirmed what CDC and our partners have long known: that scaling up our current efforts will have a much greater health impact which will translate into infections prevented, deaths averted and health care costs saved. We can do this by having better and more effective surveillance, having vaccination programs with the capacity to eliminate a major form of viral hepatitis, and the prevention and public health infrastructure to screen persons at risk for viral hepatitis, and to lengthen the care and other prevention services.
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