Institute of Medicine Report on Viral Hepatitis

Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C (JAN 2010)

Key findings and recommendations from the Institute of Medicine’s Report:

The committee identified the underlying factors that impede current efforts to prevent and control these diseases. Three major factors were found:

• There is a lack of knowledge and awareness about chronic viral hepatitis on the part of the health-care and social-service providers

• There is a lack of knowledge and awareness about chronic viral hepatitis among at-risk populations, members of the public and policy-makers

• There is insufficient understanding about the extent and seriousness of the public health problem, so inadequate public resources are being allocated to prevention, control and surveillance programs

Surveillance Recommendations

2-1: The Centers for Disease Control and Prevention should conduct a comprehensive evaluation of the national hepatitis B and hepatitis C public health surveillance system.

2-2: The Centers for Disease Control and Prevention should develop specific cooperative viral hepatitis agreements with all state and territorial health departments to support core surveillance for acute and chronic hepatitis B and hepatitis C.

2-3: The Centers for Disease Control and Prevention should support and conduct targeted active surveillance, including serologic testing, to monitor incidence and prevalence of hepatitis B virus and hepatitis C virus infections in populations not fully captured by core surveillance.

Knowledge and Awareness Recommendations

3-1: The Centers for Disease Control and Prevention should work with key stakeholders (other federal agencies, state and local governments, professional organizations, health care organizations and educational institutions) to develop hepatitis B and hepatitis C educational programs for healthcare and social service providers.

3-2: The Centers for Disease Control and Prevention should work with key stakeholders to develop, coordinate, and evaluate innovative and effective outreach and education programs to target at-risk populations and to increase awareness in the general population about hepatitis B and hepatitis C.

Immunization Recommendations

4-1: All infants weighing at least 2,000 grams and born to hepatitis B surface antigen-positive women should receive single-antigen hepatitis B vaccine and hepatitis B immune globulin in the delivery room as soon as they are stable and washed. The recommendations of the Advisory Committee on Immunization Practices should remain in effect for all other infants.

4-2: All states should mandate that the hepatitis B vaccine series be completed or in progress as a requirement for school attendance.

4-3: Additional federal and state resources should be devoted to increasing hepatitis B vaccination of at-risk adults.

4-4: States should be encouraged to expand immunization-information systems to include adolescents and adults.

4-5: Private and public insurance coverage for hepatitis B vaccination should be expanded.

4-6: The federal government should work to ensure an adequate, accessible and sustainable hepatitis vaccine supply.

4-7: Studies to develop a vaccine to prevent chronic hepatitis C virus infection should continue.

Viral Hepatitis Services Recommendations

5-1: Federally funded health insurance programs – such as Medicare, Medicaid and the Federal Employees Health Benefits Program – should incorporate guidelines for risk-factor screening for hepatitis B and hepatitis C as a required core component of preventive care so that at-risk people receive serologic testing for hepatitis B and hepatitis C virus and chronically-infected patients receive appropriate medical management.

5-2: The Centers for Disease Control and Prevention, in conjunction with other federal agencies and state agencies, should provide resources for the expansion of community-based programs that provide hepatitis B screening, testing and vaccination services that target foreign-born populations.

5-3: Federal, state and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus prevention programs. At a minimum, the programs should include access to sterile needle syringes and drug preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus.

5-4: Federal and state governments should expand services to reduce harm caused by chronic hepatitis B and hepatitis C. The services should include testing to detect infection, counseling to reduce alcohol use and secondary transmission, hepatitis B vaccination and referral for or provision of medical management.

5-5: Innovative, effective, multicomponent hepatitis C virus prevention strategies for injection drug users and non-injection drug users should be developed and evaluated to achieve greater control of hepatitis C virus transmission.

5-6: The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepatitis B prevention program coordinators to expand and enhance the capacity to identify chronically infected pregnant women and provide case management services, including referral for appropriate medical management.

5-7: The National Institutes of Health should support a study of the effectiveness and safety of peripartum antiviral therapy to reduce and possibly eliminate perinatal hepatitis B virus transmission from women at high risk for perinatal transmission.

5-8: The Centers for Disease Control and Prevention and the Department of Justice should create an initiative to foster partnerships between health departments and corrections systems to ensure the availability of comprehensive viral hepatitis services for incarcerated people.

5-9: The Health Resources and Services Administration should provide adequate resources to federally funded community health facilities for provision of comprehensive viral hepatitis services.

5-10: The Health Resources and Services Administration and the Centers for Disease Control and Prevention should provide resources and guidance to integrate comprehensive viral hepatitis services into settings that serve high-risk populations such as STD clinics, sites for HIV services and care, homeless shelters and mobile health units.

NEWS ARCHIVE:

CDC’s Media Statement is available at: http://www.cdc.gov/nchhstp/Newsroom/IOMmediastatement011110.html

CDC Foundation launches Viral Hepatitis Action Coalition that will respond to the Institute of Medicine Report on Viral Hepatitis and support CDC research and programs: http://www.cdcfoundation.org/pr/2010/CDCFoundationLaunchesViralHepatitisActionCoalition.aspx

Page last updated: January 24, 2010

CDC, along with other partners, commissioned the IOM to examine the prevention and control of viral hepatitis infections in the United States. The report was released on January 11, 2010.

REPORT: The IOM released a prepublication version of the report which contains the committee's detailed findings and recommendations [PDF - 191 pages].

WEBINAR: To view a webinar on the IOM report recommendations, featuring the Director of CDC’s Division of Viral Hepatitis, Dr. John Ward, please visit, www.KnowHepatitis.org/training/center.