Even medical professionals lack awareness of hepatitis threat, new report finds

Hepatitis B and C remain serious threats to public health, but many healthcare providers fail to screen at-risk patients and don’t know how to treat those infected with the viral diseases that can cause liver failure and cancer, according to a report released today by the National Academy of Sciences.

The long-awaited assessment calls for a campaign to educate the public, doctors and lawmakers about the diseases, an approach similar to HIV/AIDS outreach that has made that issue prominent in people’s minds. Researchers found that even though chronic viral hepatitis infections are three to five times more frequent than HIV in the United States, many doctors and nurses do not understand the extent and seriousness of the problem.

Most of the estimated 3 million to 5 million people with chronic hepatitis B and C don’t know they have the diseases. Infected people can show no signs of illness for years, and by the time they start to show symptoms, they may have already developed scarring of the liver or liver cancer and can be close to death.

“The challenge we have with hepatitis B and C is similar to our HIV stories. ... We really don’t know they are infected until they end up sick and in the hospital,” said Dr. Gail Bolan, chief of the sexually transmitted diseases control branch of the California Department of Public Health. “It’s been a silent epidemic.”

The 176-page report requested by federal health officials was released by the Institute of Medicine, the health arm of the National Academy of Sciences. Although an estimated 1% to 2% of the U.S. population has chronic hepatitis B and C, researchers found that awareness of the diseases remains low.

Each year lack of awareness contributes to about 1,000 infants contracting Hepatitis B from their mothers during childbirth. Although preventative steps can significantly reduce the likelihood of chronic infection in  babies, the number of new infections has not declined in a decade.

“Although hepatitis B and C are preventable, the rates of infection have not declined over the past several years,” R. Palmer Beasley, an epidemiologist at the University of Texas School of Public Health in Houston said in a statement. “We have allowed gaps in screening, prevention and treatment to go unchecked.”

The report calls for those most at risk to be screened. Black adults have the highest rate of acute hepatitis B infection in the United States. And although Asian Americans make up less than 5% of the U.S. population, they account for more than half of chronic hepatitis B cases nationwide, the institute said. California health officials said 10% of Asian Americans have hepatitis B.

Those at greatest risk for hepatitis B include those born in East and Southeast Asia, sub-Saharan Africa, babies born to infected mothers and those who have had sex with or shared needles or syringes with an infected person.

Hepatitis C is usually spread through blood contact, and those at risk are injection drug users and anyone who received a blood transfusion or organ transplant before 1992. There is a vaccine for hepatitis B, but none for hepatitis C.

Bolan, whose department today released a separate report on hepatitis in California, cautioned that baby boomers are at higher risk for hepatitis C if they injected a drug even one time. As that demographic ages, she said, symptoms of the disease, which include fatigue, jaundice, vomiting and abdominal pain, may begin to appear.

According to the U.S. Centers for Disease Control and Prevention, viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplants. California health officials said that hospitalizations related to hepatitis B and C in California cost $2 billion in 2007.

-- Rong-Gong Lin II

Comments

[Iona]

Make clean needles available with no hassle.

Knowledge about infected status can prompt behavioral changes, such as limiting alcohol consumption, and can reduce harm.

Make sure all blood products and other avenues of infection are inspected and monitored.

[HEPLISAV]

Engerix-B(R) (the currently approved hepatitis B vaccine for adults) usually require 3 doses given over 6 months to provide seroprotection of approximately 30%, 75%, and 90% after the first, second, and third doses respectively. The effectiveness of current vaccines is further compromised because only 30% of people receive all 3 doses.

Berkeley based Dynavax HEPLISAV is far superior. In their latest trial, the seroprotection rate at the primary endpoint was 95% in subjects receiving 2 doses of HEPLISAV at 0 and 1 month, compared to 81% in subjects receiving 3 doses of licensed vaccine Engerix-B(R) at 0, 1, and 6 months.

Fewer doses and better protection. What is FDA's hold up?

[sam stephens]

I've dealt with Hep-C and serious side effects including chronic pain from nerve damage for more than eight years. I can't talk about it to anyone for fear of losing my job with the public schools system. It's totally weird to have a disease that includes stereotypical treatment from employers and co-workers, and from the University of Washington liver transplant program. I'm not looking for sympathy, just stop trying to force me out of work because of a virus I must have contracted nearly 40 years ago.
Sign me Afraid To Use My Real Name,
Somewhere near Seattle, WA

[Mimi Chang]

Asian-Americans are disproportionately affected by chronic hepatitis B infection (CHB), accounting for more than half of the estimated two million Americans with CHB. Thirty to 40% of individuals with CHB will develop cirrhosis and /or hepatocellular carcinoma. However, more than 60% of CHB cases are undiagnosed since most patients with CHB are asymptomatic until the onset of complications. Effective treatments are currently available for CHB which can prevent disease progression. Therefore, early diagnosis of CHB is critical so that appropriate medical management can be initiated.

Screening for hepatitis B is mandatory for all pregnant women. The HBsAg status of the mother determines whether the infant receives both hepatitis B immune globulin and vaccine within 12 hours of birth. Awareness of CHB among Asian-Americans is limited. Furthermore, language and cultural barriers along with the conventional barriers such as lack of medical insurance, poor education and low socio-economic status preclude access to medical care among Asian- Americans. Among primary care physicians practicing in the Asian American communities, awareness of CHB and the need for screening and medical management is still limited.

Southern California has the largest Asian American population in the U.S, a montage of communities including Chinese-, Korean-, Vietnamese-, Filipino-, Cambodian- and Thai-Americans. Historically, Screenings for hepatitis B are held sporadically sponsored by various health organizations. However, there has been no mechanism to ensure appropriate medical follow-up of infected individuals.

[Nancy]

One of my closest friends was born with hep B, and she's living a healthy, happy life just like anyone else - except for some extra health checkups.

Any so-called 'awareness' campaigns about the virus do nothing to decrease the stigma. They are, however, very effective in getting people to buy vaccines they might not really need.