Eradicating Hepatitis B and C in the US: a NASEM Report
The National Academies of Sciences, Engineering, and Medicine (NASEM) has issued a report detailing a strategy to eliminate hepatitis B and C as serious health problems and prevent nearly 90,000 deaths by 2030.
According to the report, the number of deaths from hepatitis B could be reduced by half by 2030 through diagnosing 90% of the nation's chronic hepatitis B patients, bringing 90% of those to care, and treating 80% of those for whom treatment is warranted. Aggressive testing, diagnosis, treatment, and prevention methods, such as needle exchange for those who inject drugs, are some of the options that the committee explored to target hepatitis elimination. The NASEM committee stated that a coordinated federal effort is needed to manage hepatitis elimination, offering free hepatitis B vaccine in pharmacies and other easily accessible places, and unrestricted treatment for all patients with hepatitis C.
“Despite being the seventh leading cause of death in the world – and killing more people every year than HIV, road traffic accidents, or diabetes – viral hepatitis accounts for less than 1% of the National Institutes of Health research budget,” stated Brian Strom, chair of the committee that issued the report and chancellor and university professor, Rutgers Biomedical and Sciences, Rutgers University, Newark, NJ.
Children born to women with chronic hepatitis B require immunization within 12 hours of birth, and other children should receive the vaccine within a day of birth. The committee recommended that the National Council on Quality Assurance monitor the delivery of the first dose of hepatitis B vaccine to newborns, and expectant mothers with hepatitis B should have testing early in pregnancy to measure viral DNA.
The best strategies to prevent hepatitis C combine safer injection methods for people who use drugs and treatment options, such as opioid agonist therapy, for the underlying addiction. The committee gave considerable attention to novel ways to pay for these prescriptions and recommended a voluntary licensing agreement between the federal government and a patent-holding pharmaceutical company as a way to make the drugs more affordable.
The committee recommended that the US Department of Health and Human Services work with states to build a comprehensive system of care and support for patients with hepatitis B or C who are born abroad, are uninsured, have substance use problems, and are or have been imprisoned. The committee also recommended that the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America partner with primary care providers and their professional organizations to increase the capacity to treat hepatitis B and C in primary care. To treat people in jails who have limited access to pharmacies and primary care providers, the committee recommended that the criminal justice system screen, vaccinate, and treat hepatitis B and C in correctional facilities according to national clinical practice guidelines.
- US Could Be Rid of Hepatitis B and C as Public Health Problems, Preventing Nearly 90,000 Deaths by 2030, With Better Attention to Prevention, Screening, Treatment, and Creative Financing for Medicines [press release]. National Academies of Sciences, Engineering, Medicine. March 28, 2017.