CDC: Protecting Americans from Viral Hepatitis
Protecting Against a Serious and Deadly Disease
CDC’s viral hepatitis program protects Americans at greatest risk of becoming infected with hepatitis B or C, and helps those who are living with viral hepatitis infection to lead healthier, more productive, and longer lives.
Each year, over 20,000 death certificates have hepatitis listed somewhere on them, however deaths related to hepatitis are largely underestimated. Viral hepatitis is a major cause of liver cancer in the United States. Reported cases of acute hepatitis C infections increased 2.8 fold from 2010 to 2015, and the number of reported cases of acute hepatitis B increased 20 percent from 2014 to 2015. Recent surges of hepatitis B and hepatitis C are fueled by the opioid crisis and related increases in injection drug use. CDC provides national leadership and expertise for establishing, monitoring, and evaluating vaccination and testing recommendations; supports state and local efforts to promote prevention; assists with outbreak investigations and response; develops and deploys innovative laboratory methods; and tracks and monitors disease trends to guide prevention priorities.
Detecting and Responding to Viral Hepatitis Threats to Reduce New Infections, Including among Newborns
Collecting, verifying, and reporting the many cases of hepatitis B and C in the U.S. is beyond the capacity of many health departments. CDC investigations have found that the highest reported rate of new cases of hepatitis C is among persons aged 20-29 years. Transmission of viral hepatitis among this group is related to injection drug use – typically prescription opioids or heroin – including in rural and suburban areas across the country, such as in Appalachia, the Midwest, and New England. Of additional concern is the newly recognized population of newborns of hepatitis C-infected mothers, who represent an emerging consequence of the continuing hepatitis C epidemic among young persons. With CDC’s support, states are able to reduce new infections of hepatitis B and C in their communities. Fourteen states – including Florida, Georgia, Indiana, Kentucky, Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Oklahoma, Tennessee, Utah, Washington, and West Virginia – use CDC funds for hepatitis surveillance and case investigation to collect more extensive and complete patient information and disease transmission trends.
- Massachusetts was able to determine that there has been significant underreporting of new cases of hepatitis C. Philadelphia identified perinatal cases of hepatitis C and launched a perinatal hepatitis C program.
- Albuquerque, NM, and Cincinnati, OH implement projects that prevent new hepatitis infections among young people who inject drugs and help them receive prevention services, care, and treatment. The New Mexico site outfitted a van to use as a mobile research lab to meet participants where they are, decreasing some of the barriers to testing and care. In one instance, a recently enrolled pregnant woman learned her hepatitis C infection status from the study and her husband who already knew his status, but had never sought treatment, was newly motivated to seek treatment. Project staff helped connect him with a doctor.
- CDC used advanced molecular detection techniques to identify three clusters of persons with hepatitis C in Scott County, IN, and determined that hepatitis C had been circulating in the community for some time.
- To help improve identification of pregnant women currently infected with hepatitis B, CDC and numerous partners have worked together to include pregnancy status in laboratory test reports sent to health departments by commercial and hospital laboratories. This effort has paved the way for reporting of pregnancy status for Zika.
- In Georgia, Michigan, New York, Pennsylvania, and Wisconsin, increased capacity to identify hepatitis B-infected pregnant women has led to increased testing and treatment of their infants.
Hepatitis C infection can be cured in greater than 95 percent of patients, yet deaths associated with the virus continue to occur. Implementation of CDC and U.S. Preventive Services Task Force recommendations for hepatitis C testing could save an estimated 320,000 lives. Forty-six states, five cities, and the District of Columbia use CDC funds to support their health departments’ efforts to increase testing for hepatitis B and hepatitis C and link them to care and treatment services in public health, clinical care, and community settings.
- New York evaluated its hepatitis C testing law by surveying all commercial labs, and analyzing Medicaid and surveillance data; the evaluation showed marked increases in the number of hepatitis C screening tests and screening rates.
- In Chicago, IL, Baltimore, MD, and Seattle, WA, community-based projects are strengthening capacity to track, diagnose, and cure hepatitis C infection, including strategies to reduce cost and improve patient and provider acceptance of hepatitis C services at clinical sites. Through the first quarter of the third year of the project, approximately 175,000 people were tested and 12,700 were identified as chronically infected. Similarly, projects in Chicago, IL, Northern New Jersey and New York City, NY, and Sacramento, CA, increase the identification of hepatitis B-infected persons born outside the U.S. and link them to high-quality care. Approximately 6,000 people were tested and 419 were identified as chronically infected. Community-based screening and treating or vaccinating programs have been demonstrated to be cost-effective.
- In Philadelphia, PA, Seattle, WA, and Washington, DC, CDC funds key partners to extend the reach of national campaigns and enhance testing and linkage to care in high risk communities through national coalitions, and to develop up-to-date web-based, hepatitis materials, resources, and trainings for health professionals.
- The Pennsylvania-based Hepatitis B Foundation/Hepatitis B United program educated more than 52,000 people and screened more than 22,500 Asian American Pacific Islanders at community-based screening events over the 36-month project period, with an overall infection rate of 7.2 percent.
- The Know Hep B national communications campaign has had more than 12.4 billion documented impressions, worth more than $47.2 million in media value, and one of its public service announcements has received multiple creative competition awards.
CDC invests approximately $12.8 million annually to advance viral hepatitis prevention efforts; 80 percent of those funds are awarded to 46 states, five cities, and Washington, D.C. to detect and respond to viral hepatitis threats, reduce new infections, and prevent deaths by improving diagnosis, linkage to care, and treatment of people living with viral hepatitis. CDC also invests about $5.5 million annually to support state and local health departments to produce reliable estimates of the incidence of hepatitis B and hepatitis C infections, document the current epidemiology of hepatitis B and hepatitis C infections, and support and evaluate prevention programs.
Establishing a Path to Eliminate Hepatitis B and C as Public Health Threats
CDC is providing technical assistance with establishing the program framework and program evaluation to the Cherokee Nation of rural eastern Oklahoma for its Path Towards Elimination of Hepatitis C Program, a comprehensive program with goals for eliminating hepatitis C as a health disparity for the population. In the Cherokee Nation, over 43 percent of the adult population have been tested and over one-third of hepatitis C-infected persons successfully treated.