Viral Hepatitis a Major Public Health Problem: Presented at HEP-DART

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Viral Hepatitis a Major Public Health Problem: Presented at HEP-DART

By Barbara J. Rutledge, PhD

LAHAINA, HAWAII -- December 18, 2007 -- Viral hepatitis continues to be a major

public health problem globally and in the United States, according to a lecture

presented here at the HEP-DART 2007 Frontiers in Drug Development for Viral

Hepatitis symposium.

" New public health recommendations have helped to ensure domestic prevention

activities are evolving to meet current and future challenges, but multifaceted

approaches are crucial for effective prevention and control of viral hepatitis

in the future, " said Fenton, MD, PhD, FFPH, Director, National Center for

HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control

and Prevention (CDC), Atlanta, Georgia, United States.

In the US, approximately 45,000 new cases of chronic hepatitis B virus (HBV) are

reported each year, with 90% of the new cases occurring in immigrants, Dr.

Fenton said in his lecture on December 9. Since the early 1990s, there has been

a 25% reduction in acute HVB infection, largely the result of the increasing

availability of an effective vaccine, and universal infant vaccination

strategies. In 2005, 95% of new HBV infections occurred in adults. Individuals

at highest risk for HBV infection in the US are men who have sex with men,

injection-drug users, and individuals with multiple sexual partners.

The CDC issued revised recommendations for HBV vaccination in 2006. Universal

vaccination is now recommended in settings with a high proportion of adults at

risk for HBV infection, such as STD clinics, HIV counselling/testing centres,

drug treatment centres, and correctional facilities. Barriers to adult

vaccination include fiscal concerns, the three-dose vaccination schedule, and

patient acceptance, among others.

In 2005, an estimated 3.2 million individuals in the US were chronically

infected with hepatitis C virus (HCV). African-Americans are disproportionately

affected by chronic HCV disease in the US.

" While African Americans are less likely to develop acute HCV infections, they

are at the highest risk for developing chronic HCV infections, " said Dr. Fenton.

" Therefore, the prevalence of HCV among blacks is two to three times that among

whites. "

Standard HCV treatment is less likely to be effective in African-Americans, and

African-Americans with HCV are twice as likely as whites to develop

hepatocellular carcinoma.

There are multiple challenges to the prevention and treatment of HCV disease.

Injection-drug use is currently the primary risk factor for HCV infection in the

US, and there is a high incidence of HCV infection among injection-drug users.

Prevention of HCV infection in that population is more difficult than prevention

of HIV infection, said Dr. Fenton. An estimated 60% of individuals with chronic

HCV disease are unaware of their infection. Barriers limit access to antiviral

treatment, and antiviral treatment leads to sustained response in only 50% to

80% of individuals with HCV disease.

Strategies to prevent HCV infection include protection of the blood and tissue

supply, promotion of safe injection practices among injection-drug users,

infection control in health care settings, HCV screening and education for

high-risk individuals, and referrals of infected individuals to treatment

centres.

[Presentation title: The Changing Global Epidemiology of HBV and HCV. Abstract

01]

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