Viral Hepatitis Prevention-New Challenges, New Directions

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Viral Hepatitis Prevention-New Challenges, New Directions

Posted on: Friday, 2 May 2008, 06:00 CDT

By Holtzman, Deborah

In recognition of Hepatitis Awareness Month, this issue of the Journal

highlights examples of current research on viral hepatitis. As described in the

accompanying editorial, significant changes have occurred in the epidemiology of

viral hepatitis, causing leaders in public health, including the Centers for

Disease Control and Prevention (CDC), to reassess and establish priorities in

line with these changes. Although there are 5 recognized hepatitis viruses

worldwide, the most common in the United States are hepatitis A, B, and C, all

of which have shown substantial declines in incidence over the past 20 years.

Despite these declines, many of those with acute infection have gone on to

develop chronic hepatitis B or C, which accounts for substantially greater

morbidity and leads to other serious health consequences. In the absence of a

vaccine, HCV infection, occurring primarily among those who inject drugs, is

prevented largely through behavioral changes. Latka et al. report significant

new findings that demonstrate the effectiveness of a behavioral intervention in

reducing the lending of used injection equipment among young injection drug

users. Rousseau et al. explore racial differences in evaluating and treating

chronic HCV infection among veterans. In a very thoughtful analysis, they find

that Black veterans are significantly less likely than White veterans to receive

antiviral treatment and to undergo selected viral testing and evaluation. They

also discuss a number of critical issues regarding HCV infection that must be

taken into account when investigating treatment efficacy. In a brief report,

Kritz et al. examine how state funding and guidelines affect substance abuse

treatment programs that provide infection-related services, including those for

HCV. The authors show that available state funding is not always accessed by

community-based substance abuse treatment programs, a key component of the

service network, especially for preventing HCV infection.

Weinbaum et al. report survey results on immunization against hepatitis B virus

(HBV) infection among men who have sex with men. Despite finding that a majority

of the men who were susceptible to infection had a regular source of health

care, most men who have sex with men had not been immunized with the HBV

vaccine. The authors further identify several missed opportunities for the

provision of immunization services. Lastly, Koya et al. examine trends in HBV

vaccine immunization coverage among a sample of high-risk US adults. Although

they observe an increase in immunization over time, it is significant only among

the youngest of 3 age groups, which the authors conclude suggests a " cohort

effect " (successful vaccination of these adults during adolescence) rather than

successful targeted immunization efforts among adults.

Each of these studies has significant public health implications. Until a

vaccine is developed, implementing effective behavioral interventions for the

prevention of HCV infection among injection drug users is critical. Treatment

options, obstacles to treatment, and disparities in treatment for those who are

chronically infected with HCV also require further study. These efforts can be

greatly facilitated by increasing state and local public health capacity to

track the disease and provide prevention and referral services for those with

chronic infection. Finally, findings from the studies that examined HBV

infection clearly illustrate the importance of continuing and enhancing efforts

to immunize vulnerable populations. All of these areas of investigation align

well with the priorities currently identified by CDC for the prevention,

control, and treatment of viral hepatitis.

Deborah Holtzman, PhD, MSW

AJPH Department Editor

doi: 10.2105/AJPH.2008.137281

Copyright American Public Health Association May 2008

© 2008 American Journal of Public Health. Provided by ProQuest Information and

Learning. All rights Reserved.

Source: American Journal of Public Health

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