It is possible to end the transmission of hepatitis B and C and prevent further sickness and deaths from the diseases, but time, considerable resources, and attention to various barriers will be required, says a new report from the National Academies of Sciences, Engineering, and Medicine. However, controlling the diseases by reducing the number of new and overall cases in the U.S. is more feasible in the short term. This is the first report of a two-phase study; the second report, to be released in early 2017, will outline a strategy for meeting the goals discussed in this report.
At least 700,000 to 1.4 million Americans have chronic hepatitis B, and between 2.5 million and 4.7 million have chronic hepatitis C. Together, the diseases kill approximately 20,000 people every year in the U.S. In the past, the term “disease elimination” often referred to complete termination of any new infections in a population, but eliminating a disease as a public health problem is a less absolute goal. The report describes a public health problem as a disease that commands attention as a major threat to the health of the community. In the case of hepatitis B and C, elimination of the diseases as public health problems would mean ending their transmission in the U.S., and for the infections that remain, preventing their undesirable signs and symptoms entirely.
Hepatitis B is transmitted three ways: from an infected mother to her child, from direct contact with infected blood, or from unprotected sex with an infected partner. The committee that carried out the study and wrote the report said the first step in eliminating hepatitis B is ending its transmission, which could be prevented with universal immunization. Administered in three doses, the hepatitis B vaccine confers long-lasting, 95 percent immunity. Although mother-to-child transmission of hepatitis B is rare in the U.S., 800 to 1,000 such infections occur every year. These infections could be avoided by better identifying infected pregnant women to allow for early treatment of their newborns; a dose of hepatitis B vaccine at birth and completion of the full vaccine series helps prevent these transmissions. There is also room for improvement in hepatitis B vaccination in children and adults in the U.S. Only about 64 percent of infants receive the hepatitis B vaccine within one day of birth, and approximately 72 percent receive it within the first three days. Vaccination of adults is more complicated, because a comprehensive system for immunization after school age does not exist. Targeting people at elevated risk of contracting hepatitis B virus might be an efficient way to reach susceptible adults. For example, routine vaccinations could be given at prisons or in sexually transmitted disease clinics.