Study: Threat of Hepatitis Underestimated

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How's this for an unsettling statistic: up to 1 in 50 Americans are living with chronic viral hepatitis, but most of them don't know it. A new report released by the Institute of Medicine in January describes hepatitis as a "major public-health problem" in the U.S. and calls for greater funding for prevention and treatment, increased vaccination, and a public awareness campaign to curb the threat of hepatitis B and C. "It's long overdue," says Dr. Douglas Dieterich, a professor in the Division of Liver Diseases at the Mount Sinai School of Medicine. "This is really a huge step in the right direction for hepatitis."

Some 800,000 to 1.4 million Americans are currently living with hepatitis B, and 2.7 million to 3.9 million suffer from chronic hepatitis C. Both viruses rank among the world's leading causes of preventable deaths. Hepatitis infection, which attacks the liver, can eventually lead to chronic liver disease or cancer when left unaddressed.

Although both viruses are preventable and treatable if caught early, many people develop no initial symptoms from infection, and don't know they have contracted the virus until they develop signs of advanced disease. As a result, hepatitis B and C are stealth killers, leading to 15,000 American deaths each year and nearly half of the annual liver transplants performed in the U.S.

Hepatitis B is transmitted through blood or bodily fluids — spread through unprotected sex, blood transfusions, sharing of needles or contaminated tattoo or acupuncture instruments. Hepatitis C spreads only through infected blood. Patients with hepatitis B typically fight off the virus on their own, after which they retain lifelong immunity to the disease; however, about 6% to 10% of adults and children over five who are infected go on to develop chronic disease. (The numbers are much higher for younger children and infants who contract the virus.) Hepatitis C is more often a chronic infection, with a minority of patients experiencing acute disease. Both diseases disproportionately affect African Americans and Asian Americans.

Despite its potential lethality, hepatitis has long been one of public health's forgotten stepchildren. There is very little education about the disease, not only among the general public and policymakers, but also among the at-risk population, health-care providers and social workers. That ignorance is one reason the U.S. government devotes comparatively piddling resources to its prevention, tracking and control. Hepatitis receives a fraction of the funding devoted to HIV/AIDS by the Centers for Disease Control and Prevention, for example, although it affects three to five times as many Americans. "The people with hepatitis B and C are less vocal and way less effective communicators than the HIV lobby," explains Dieterich.

The IOM report recommends increasing funding for hepatitis education and prevention. One key area in need of resources is vaccination. Given that 1,000 infants are still infected at birth by their hepatitis B-positive mothers each year, the report recommends that all full-term babies born to infected mothers should receive a first dose of the hepatitis B vaccine before leaving the delivery room, as soon as they are stable and washed. It also recommends that states mandate the vaccine — which, while widely used, is still not required for children entering school or day care in Alabama, Montana and South Dakota — as a requirement for school attendance. (There is no vaccine yet for hepatitis C.)

In tandem with more aggressive vaccination programs, the report suggests educational programs for prisoners and other at-risk populations, including immigrants from areas like East and Southeast Asia, where hepatitis B circulates widely. Some 40,000 to 45,000 people legally emigrate to the U.S. every year from such countries, where in some cases, stigma — such as in China, where infected individuals face job discrimination — may make people wary of seeking testing or medical attention in the U.S.

Experts suspect that greater focus on hepatitis could reveal that hepatitis is vastly underreported. They also emphasize that raising awareness is just a starting point. More funding for research is needed to create better drugs — while several new classes of drugs are already in advanced clinical development, doctors say they are not enough. Further research "has a very significant chance of really leading to some very exciting new therapeutics," says Dr. Jeffrey Glenn, director of Stanford University School of Medicine's Center for Hepatitis and Liver Tissue Engineering. "This is an area where money will be incredibly well spent."