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What Stands in the Way of Making Hepatitis B and C Rare Diseases in the United States?Hepatitis B and C Could Be Rare

Gillian J. Buckley, PhD, MPH; and Brian L. Strom, MD, MPH
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 12 April 2016.

From the Board on Population Health and Public Health Practice, Division of Health and Medicine, Academies of Sciences, Engineering, and Medicine, Washington, DC, and Rutgers Biomedical & Health Sciences, Rutgers University, The State University of New Jersey, Newark, New Jersey.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0772.

Requests for Single Reprints: Gillian J. Buckley, PhD, MPH, National Academies of Sciences, Engineering, and Medicine, 500 Fifth Street NW, Washington, DC 20001; e-mail, GBuckley@nas.edu.

Current Author Addresses: Dr. Buckley: National Academies of Sciences, Engineering, and Medicine, 500 Fifth Street NW, Washington, DC 20001.

Dr. Strom: Rutgers Biomedical & Health Sciences, Rutgers University, The State University of New Jersey, 65 Bergen Street, Suite 1535, Newark, NJ 07103.

Author Contributions: Conception and design: B.L. Strom.

Drafting of the article: G.J. Buckley.

Critical revision for important intellectual content: B.L. Strom.

Final approval of the article: G.J. Buckley, B.L. Strom.

Ann Intern Med. 2016;165(4):284-285. doi:10.7326/M16-0772
© 2016 American College of Physicians
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Highlighting recent findings of a National Academies of Sciences, Engineering, and Medicine report, this commentary addresses the feasibility of eliminating hepatitis B and C viruses in the United States.

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Hepatitis B Remains a Global and National Health Burden
Posted on August 31, 2016
Amy Shen Tang MD, Perry Pong MD, Su Wang MD MPH
(AST, PP) Charles B. Wang Community Health Center, New York, (SW) Center for Asian Health, Saint Barnabas Medical Center, New Jersey
Conflict of Interest: Su Wang was a reviewer for the National Academies report "Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. She did not receive any honoraria as a reviewer.

No funding was received in support of this work.
NOTE: This is a correction to a prior submitted comment. There is one change to the previous comment regarding the prior hepatitis B infection rate.

We fully agree with Buckley and Strom that viral hepatitis warrants more action in the United States and globally if the goal of elimination (as passed by the WHO’s World Health Assembly in May 2016) is to be reached (1). They boldly conclude “medical management of chronic hepatitis B has advanced to the point that no one in the United States (US) should die of it,” yet liver cancer incidence and mortality continue to increase largely due to viral hepatitis, and in the US, Asian Pacific Islanders’ rates exceed those of Whites, Blacks or Hispanics (2).

At the Charles B. Wang Community Health Center in New York City, we see firsthand how HBV disproportionately affects our mostly Asian population. We screened 6,448 patients for hepatitis B (HBV) in 2015. For adults, we found 10.3% to be chronically infected and 44.9% to have had prior infection. In the US, more than 1/2 of those with HBV are Asian, and many face considerable barriers in healthcare access.

Great strides have been made with the hepatitis B vaccine in reducing acute infections, yet many vulnerable adults have not been vaccinated (3). Eliminating mother-to-child transmission of HBV also continues to evade the US, and almost 1000 infants a year are infected.
Birth dose coverage in the US is at 71.6% (4) but this is disappointing compared to many countries which have achieved over 95% coverage (5).

In 2015, our center cared for 71 children with chronic hepatitis B. Half were born in the US, and of those, we determined that infection occurred in 88% despite adequate vaccination at birth. This highlights the issue of vaccine failure in mothers with high viral loads during pregnancy. In response, our center instituted a comprehensive Hep B Moms program with a protocol of maternal education and early detection and antiviral treatment of high-risk pregnancies, resulting in a significant decrease in infections.

It is imperative viral hepatitis be made a public priority for true elimination to be achieved. Buckley and Strom aptly observe that “elimination in the United States is not likely to occur without changes to policy and directed research.” Many affected by viral hepatitis are silent minorities, and if the status quo is continued, the US healthcare system will continue to overlook them and liver cancer rates will continue to soar.

1. Buckley GJ, Strom BL. What Stands in the Way of Making Hepatitis B and C Rare Diseases in the United States? Ann Intern Med. 2016; 165:284-285.
2. Siegel, RL, Miller, K. D. and Jemal, A. (2016), Cancer statistics, 2016. CA: A Cancer Journal for Clinicians, 66: 7–30. doi:10.3322/caac.21332
3. Ioannou GN. Hepatitis B Virus in the United States: Infection, Exposure, and Immunity Rates in a Nationally Representative Survey. Ann Intern Med. 2011; 154:319-328.5.
4. MMWR National, State, and Local Area Vaccination Coverage Among Children Aged
19–35 Months — United States, 2012 September 13, 2013 / 62(36); 733-740
5. Pan American Health Organization. Hepatitis Vaccination in the Americas. Regional Office of the World Health Organization. Sante Fe De Bogata, March 1, 2012. URL: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=18115&Itemid=270, accessed August 25, 2016
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