Archival Content: 1999-2005
Millions of Americans have viral hepatitis. It is a particularly significant problem among injection drug users (IDUs). Growing awareness of this problem is leading to new initiatives, but efforts to prevent these diseases and reduce their medical, financial, and social costs face challenges.
Viral Hepatitis is an Important Health Issue for the Nation
Hepatitis, literally an “inflammation of the liver,” has a number of causes. Viral infection is one of them. The most common types are hepatitis A, hepatitis B, and hepatitis C.
Viral hepatitis affects millions.
Hepatitis C virus (HCV) infection occurs when blood (or to a lesser extent, other body fluids such as semen or vaginal fluid) from an infected person enters the body of an uninfected person. Injection drug use is the major risk factor for HCV infection. About 3.9 million Americans have been infected with HCV and 2.7 million have chronic HCV infection. Hepatitis C disproportionately affects people of color: 3.2% of African Americans and 2.1% of Mexican Americans are infected with HCV, compared to 1.5% of non- Hispanic whites. These numbers underestimate the actual impact because they do not include infections in prisoners or the homeless. In 2000, about 30,000 new infections occurred. Most of these infections occurred among young adults 20-39 years old.
Hepatitis B virus (HBV) infection occurs when blood or body fluids from an infected person enter the body of an uninfected person. High-risk sexual behaviors (unprotected sex with multiple partners) and injection drug use are the major risk factors. About 5% of people in the U.S. have evidence of past infection with HBV and approximately 1.25 million people have chronic HBV infection. Like hepatitis C, hepatitis B disproportionately affects people of color. An estimated 73,000 new HBV infections occurred in 2000. Most infections occurred in young adults, aged 20-39 years. Hepatitis B can be prevented through immunization.
Hepatitis A virus (HAV) is primarily transmitted through the fecal-oral route, when a person puts something in his or her mouth (such as food or a beverage) that has been contaminated with the feces of a person infected with HAV. Outbreaks occur more easily in overcrowded areas where poor sanitary conditions exist. Outbreaks of hepatitis A also have been reported among IDUs. About one-third of Americans have evidence of past infection with HAV. Hepatitis A can be prevented through immunization.
The medical and health care costs of viral hepatitis are high.
Each year, 8,000 to 10,000 people die from the complications of liver disease caused by hepatitis C and about 5,000 die from complications caused by hepatitis B. Chronic liver disease is currently the 10th leading cause of death, and liver failure due to hepatitis C is the leading reason for liver transplants. Annual health care costs and lost wages associated with hepatitis-related liver disease are estimated to be $600 million for hepatitis C and $700 million for hepatitis B. The costs to individuals and society of illness related to hepatitis A are also substantial.
Viral hepatitis can be insidious. Frequently, symptoms of newly acquired (acute) infection are mild or nonexistent, so people may not even be diagnosed as having viral hepatitis. Those who do have symptoms might experience “flu-like” symptoms, fatigue, nausea, pain in the upper abdomen, and sometimes jaundice.
People who get HAV infection are able to clear the virus from their bodies and recover fully. They develop a lifelong immunity to the virus. The situation is different with hepatitis B and hepatitis C:
Many people with chronic infection – 60% of those with HBV infection and 70% of those with HCV infection – develop chronic liver disease, a situation in which the virus damages the liver. The damage may progress to severe disease, including cirrhosis, liver cancer, and liver failure. This progressive liver disease usually develops slowly over 20 to 30 years. Because symptoms are so frequently mild or nonexistent, the majority of people with chronic HBV and HCV infections do not know they are infected and can unknowingly transmit the virus to others. For many, signs and symptoms appear only when liver disease is advanced and treatments are less effective.
Hepatitis C is a particular concern.
Viral Hepatitis is a Very Significant Problem Among IDUs
Because HBV and HCV are transmitted through exposure to infected blood and body fluids, IDUs are at very high risk of acquiring and transmitting both viruses. For example, it is estimated that 60%, or 17,000, of the 30,000 new cases of HCV that occurred in 2000 occurred among IDUs. Is it estimated that 17%, or 13,000 of the 73,000 new cases of hepatitis B that occurred in 2000, occurred among IDUs.
HBV and HCV infections are also acquired relatively rapidly among IDUs. Within 5 years of beginning injection drug use, 50%-70% of IDUs become infected with HBV. Between 50%-80% of IDUs become infected with HCV within 5 years of beginning injection drug use; it is usually the first bloodborne virus they acquire. Several factors favor the rapid spread of HCV infection among IDUs:
Agencies and Providers Face a Number of Pressing Issues in their Efforts to Address Viral Hepatitis
In many ways, the current challenges of viral hepatitis, especially hepatitis B and hepatitis C, resemble those of HIV in the late 1980s and early 1990s. Awareness of viral hepatitis as an important public health issue is growing, but agencies, providers, communitybased organizations, and others who work with those at risk must address several key issues:
The National Hepatitis C Prevention Strategy is One Key Response In 2001, in collaboration with other federal, state, and private sector agencies, the Centers for Disease Control and Prevention (CDC) launched the National Hepatitis C Prevention Strategy. This effort is aimed at lowering the incidence of acute HCV infections in the U.S. and reducing the disease burden from chronic hepatitis C. The principal components of this effort are:
For more information about the Strategy, visit: CDC's Hepatitis C Strategy
To Learn More About This Topic
Visit these websites for additional information on viral hepatitis:
Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. New England Journal of Medicine 1999;341(8):556-562.
Alter MJ, Moyer LA. The importance of preventing hepatitis C virus infection among injection drug users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S6-S10.
Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000;31(3):777-782.
Centers for Disease Control and Prevention (CDC). National hepatitis C prevention strategy. Summer 2001.
Centers for Disease Control and Prevention (CDC). Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCVrelated chronic disease. Morbidity and Mortality Weekly Report 1998;47(RR19):1-39.
Centers for Disease Control and Prevention (CDC). Epidemiologic notes and reports: hepatitis A among drug abusers. Morbidity and Mortality Weekly Report 1988;37(19):297-300, 305.
Garfein RS, Doherty MC, Monterroso ER, et al. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1): S11-S19.
Gunn RA, Murray PJ, Ackers ML, et al. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic – rationale for integrating services. Sexually Transmitted Diseases 2001;28(3):166-170. Hagan H, McGough JP, Thiede H, et al. Syringe exchange and risk of infection with hepatitis B and C viruses. American Journal of Epidemiology 1999;149(3):203-213.
Hagan H, Thiede H, Weiss NS, et al. Sharing of drug preparation equipment as a risk factor for hepatitis C. American Journal of Public Health 2001;91(1):42-46.
Hagan H, Des Jarlais DC. HIV and HCV infection among injecting drug users. The Mount Sinai Journal of Medicine 2000;67(5-6):423-428.
Hutin Y, Sabin KM, Hutwagner LC, et al. Multiple modes of hepatitis A virus transmission among methamphetamine users. American Journal of Epidemiology 2000;152(2):186-192.
Margolis HS, Alter MJ, Hadler SC. Hepatitis B: evolving epidemiology and implications for control. Seminars in Liver Disease 1991;11(2):84-92.
National AIDS Treatment Advocacy Project (NATAP). Current review and update on hepatitis C and HIV/HCV coinfection. New York: NATAP; Summer 2001.
National Institutes of Health (NIH). Management of hepatitis C: 2002. Consensus Development Statement #116. June 10-12, 2002.
Novick DM. The impact of hepatitis C virus infection on methadone maintenance treatment. (36 KB, 7 pages) The Mount Sinai Journal of Medicine 2000;67(5-6): 437-443.
O’Donovan D, Cooke RPD, Joce R, et al. An outbreak of hepatitis A amongst injecting drug users. Epidemiology and Infection 2001;127(3):469-473.
Ompad DC, Fuller CM, Vlahov D, Thomas D. Lack of behavior change after disclosure of hepatitis C virus infection among young injection drug users in Baltimore, Maryland. Presented at 128th Annual Meeting of the American Public Health Association. Boston, MA. November 12-16, 2000.
Thorpe LE, Ouellet LJ, Hershow R, et al. Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment. American Journal of Epidemiology 2000;155(7):645- 653.
Vento S, Garofano T, Renzini C, et al. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. New England Journal of Medicine 1998; 338(5):286-290.
Wong JB, McQuillan GM, McHutchison JG, Pynard T. Estimating future hepatitis C morbidity, mortality, and costs in the United States. American Journal of Public Health 2000;90(10); 1562-1569.
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