Department of Health and Human Services releases action plan for prevention, care of viral hepatitis

Federal agencies have unveiled a strategy for getting serious about viral hepatitis. Pediatricians are key to that work in several ways.

The plan calls for routine viral hepatitis testing as part of the standard of care "in a reformed health care system" and for establishing clinical quality measures to monitor performance in treatment in primary care settings.

The strategy was hammered out by agencies under the Department of Health and Human Services over the last year after an Institute of Medicine report on hepatitis B and C stated, "There is insufficient understanding about the extent and seriousness of this public health problem, so inadequate public resources are being allocated to prevention, control, and surveillance programs."

Statistics show that an estimated 3.5 to 5.3 million people are living with viral hepatitis in the United States-65% to 75% of them are unaware of it and thus not receiving care. In the absence of treatment, 15% to 40% of them will develop liver cirrhosis, liver cancer, or other liver conditions.

In an interview at the strategy's announcement, John Ward, MD, director of the Centers for Disease Control and Prevention (CDC) division of viral hepatitis, said that pediatricians are critical in getting their hospitals to implement a birth dose of the hepatitis B vaccine.

The strategy calls for adopting the birth dose as a national quality measure, saying vaccination rates are only at about 55% by the third day of life, and elimination of perinatal hepatitis B transmission has not been achieved largely because of incomplete newborn coverage.

The plan sets the goal of providing postexposure prophylaxis (hepatitis B immune globulin and hepatitis B vaccine) and care coordination to all infants born to hepatitis B-infected women. Currently, it says, only half of the approximately 24,000 such infants get those services.

The number of perinatal hepatitis B cases is particularly concerning, according to the strategy report, because approximately 90% of hepatitis B-infected newborns develop chronic infection. Up to 25% of these children will die of cirrhosis, liver failure, or liver cancer later in life.

Another goal is to study the recent emergence of injection-drug use and hepatitis C transmission in young people in suburban and rural communities.

At the press conference on the strategy, Ward stressed the need for continuous surveillance. He noted the recent report that found that hepatitis C infection has increased in primarily white, non-Hispanic adolescents and young people in urban, suburban, and rural Massachusetts areas, possibly because of injection drug use. Similar increases in hepatitis C infection in that age group have been reported in other states, according to the CDC's Morbidity and Mortality Weekly Report (2011;60[17]:537-541).

Just after the strategy was announced, the Food and Drug Administration announced approval of 2 new drugs for hepatitis C (telaprevir and boceprevir), which are supposed to increase patient responses and potentially decrease treatment duration.

The strategy also states that immunization for infants and adolescents has caused substantial declines in hepatitis B, but 38,000 people were newly infected in 2008. Although childhood vaccination has sharply reduced hepatitis A in all age groups, completion of the 2-dose series in infants is only at about 40%.

The strategy's initiation dates for the work range from this year to 2013. Federal officials do not give many specifics on where resources would come from for all the efforts envisioned, but they do note that health care reform should provide more coverage for prevention and treatment.

The strategy report can be read at http://www.hhs.gov/ash/initiatives/hepatitis.