WASHINGTON, DC—An HHS interagency workgroup is drafting a new strategic plan to strengthen viral hepatitis prevention and control in the US, an HHS official told a House committee at a recent hearing.

About 3.5 million to 5.3 million Americans are living with chronic HBV or HCV infection, according to CDC estimates.

Illness, cost, and death are expected to rise as a result of these diseases in the future. “Up to 75% are not aware that they have HBV or HCV. Moreover, of those who are aware, not enough are in care or are receiving appropriate treatment,” Howard K Koh, MD, MPH, assistant secretary of health at HHS, told the House Committee on Oversight and Government Reform.

An Institute of Medicine (IoM) report conducted at the request of the federal government and the National Viral Hepatitis Roundtable that was issued this year found that the federal government’s current efforts to prevent and control these diseases are impeded by a variety of factors. These factors included a lack of knowledge and awareness about chronic viral hepatitis on the part of healthcare and social service providers, as well as among at-risk populations, members of the public, and policy makers. Inadequate resources are also being allocated to prevention, control, and surveillance programs, the report found.

The comprehensive strategic plan to strengthen the agency’s response to hepatitis should be completed by October of this year, according to Koh. HHS then plans to work across the federal government and connect with community partners on the issue.

Addressing HCV and HBV

HCV is spread by blood-to-blood contact. One out of every seven African American men in their 40s is living with chronic hepatitis C, according to CDC. Injection drug use is currently the most common means of HCV transmission in the US. However, prior to 1992 when blood screening became available, blood and organ transfusions were the most common means of transmission.

HBV is primarily spread through exposure to blood or bodily fluids, such as sex with an infected partner, injection drug use, or birth to an infected mother. There is currently a vaccine for HBV, but there is no vaccine to prevent HCV.

Rep Edolphus Towns, D-NY, chairman of the Committee on Oversight and Government Reform, stated that many call hepatitis “the silent epidemic,” because the attention it has received “has not been in proportion to the vast number of Americans it affects.”

Rep Bill Cassidy R-LA, a hematologist who testified before the committee, said that untreated HCV infections take many years to expand to cirrhosis. While new HCV infections have declined, the prevalence of cirrhosis will continue to increase through the next decade as those individuals who are now in their 50s are discovering they were infected years earlier with HCVand must be treated. “We have this iceberg that is about to impact,” he said.

Cassidy cited a 2009 report that found that without changes to the way in which HCV is diagnosed and treated, the per-patient cost of people with chronic HCV will increase 3.5 times over 20 years. He said that he agrees with the IoM report’s findings that a major challenge in preventing the spread of HBC and HCV is a lack of knowledge and awareness among the public and healthcare providers.

Education, he said, is key. “Education, education, education. You educate doctors to screen, you educate patients to get checked. You educate spouses of patients as to what this means for their family.”

He also said that a better job must be done in making sure that adults have received an HBV vaccination.

Rep Henry “Hank” Johnson, D-GA, who has been treated for HVC, testified that more federal funding is needed for viral hepatitis prevention. In addition, he said that he hopes the HHS workgroup that is drafting a national strategic plan to address viral hepatitis will receive “adequate resources.”

Raising Awareness

The action plan being developed by the HHS group will tackle a number of areas, including increasing community awareness, provider education, and strengthening surveillance.

“Currently, CDC estimates that only 10% of new cases of viral hepatitis are reported each year. Two-thirds of states report cases of HCV infections, but those that do have large backlogs of uninvestigated cases,” said Koh.

Towns wanted to know how those who are infected can be identified, given that they may initially be asymptomatic. Koh conceded it is a challenge. “We need more attention to developing guidelines for screening and testing high risk groups. ”

Members also wanted to know how the strategic plan will address the problem among Asian Americans of which approximately one in 12 is living with chronic hepatitis B. Awareness in the community and among providers must be increased, HHS officials said. “We have to link our community education with provider training so that when people go to a physician, that physician knows who should be screened and how to interpret that screening test, which sometimes can be complex,” said Dr John Ward, director of the Viral Hepatitis Program at CDC.

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