Silence is Deadly: Combating the Epidemic of Viral Hepatitis

Silence=Death. That phrase was used by the advocacy group ACT UP to end the silence about the AIDS crisis in the United States. This is no less true for the issue of viral hepatitis, which claims the lives of 12,000-18,000 Americans each year. Our inactivity can fuel the spread of viral hepatitis—viruses which are largely preventable. The U.S. Department of Health and Human Services has long acknowledged hepatitis as a hidden epidemic with significant public health consequences:

• An estimated 3.5-5.3 million persons are living with viral hepatitis in the United States, and millions more are at risk for infection;
• Because viral hepatitis can persist for decades without symptoms, 65%-75% of infected Americans remain unaware of their infection status and are not receiving care and treatment;
• Hepatitis is the leading cause of liver cancer. Without timely care, 1 in 4 persons with chronic hepatitis will develop liver cirrhosis or liver cancer.

The prevention, care and treatment of viral hepatitis requires stakeholder, community, and individual involvement. Creating awareness within communities and educating providers; improving testing, care and treatment to prevent liver disease and cancer; strengthening surveillance to detect viral hepatitis transmission and disease; eliminating transmission of vaccine-preventable Hepatitis A and B; reducing viral hepatitis caused by drug use and unsafe sex; and protecting patients and workers from health care-associated viral hepatitis are just a few of the things that we can do collectively to strengthen the nation’s response to viral hepatitis.

Leading by example, in April 2014, the Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), Justice (DOJ), and Veterans Affairs (VA) released an update of Combating the Silent Epidemic of Viral Hepatitis: Action for the Prevention, Care, & Treatment of Viral Hepatitis which details more than 150 actions to be undertaken between 2014 and 2016 by 20 federal agencies or offices.

The U.S. Preventive Services Task Force (USPSTF) recently upgraded its recommendation to ‘B’, recommending that persons at high risk for hepatitis B virus (HBV) be screened. The USPSTF defined high-risk groups as those populations with a HBV prevalence of at least 2%, to include:

• Persons who were born in the United States but who were not vaccinated as infants, and whose parents were born in regions such as Sub-Saharan Africa and southeast and central Asia, where prevalence of HBV infection is 8%;
• Persons testing positive for HIV;
• Users of injection drugs;
• Men who have sex with men;
• Household contacts of persons with HBV infection.

This recommendation will enable widespread adoption of screening for HBV infection in high-risk populations. It follows a similar USPSTF recommendation from 2013 that the 1945-1965 birth cohort have a one-time test for hepatitis C, as well as anyone else at risk for HCV infection and that follow up testing be administered periodically for those at ongoing high risk including users of injection drugs, those having multiple sex partners, and anyone who got a tattoo with an unsterilized needle.

According to experts, under the Patient Protection and Affordable Care Act, most private insurers and all Medicare programs must cover any preventative service with a grade A or B recommendation by the USPSTF. These implications are huge and a major step in the right direction for our nation.Dr. McCance-Katz is one of SAMHSA’s representatives on the federal Viral Hepatitis Implementation Group, which is coordinating implementation of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. This post originally appeared over the summer on the SAMHSA blog.(1) U.S. Department of Health and Human Services, Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), Office of the Assistant Secretary for Health. (2014). Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis Updated 2014–2016: Factsheet. Retrieved from https://www.hiv.gov/sites/default/files/2014-vhap-at-a-glance.pdf .

(2) U.S. Department of Health and Human Services. (2014). Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. Retrieved from https://www.hhs.gov/hepatitis/index.html.