LETTER: Dr. John Ward, CDC, recaps National Hepatitis Awareness Month

Below is a partner letter from Dr. John Ward, Director of the Division of Viral Hepatitis, Centers for Disease Control and Prevention announcing the release of DVH’s 2016-2020 strategic plan. The letter also recaps Hepatitis Awareness Month activities and highlights several hepatitis B and C reports and campaigns that have been released over the past few weeks.

May 24, 2016

May is National Hepatitis Awareness MonthDear Colleagues,
During May, CDC and our public health partners are celebrating National Hepatitis Awareness Month, with May 19th designated as Hepatitis Testing Day. These observances provide opportunities to raise awareness of viral hepatitis in the United States and to shed light on this large but under-recognized viral hepatitis epidemic. CDC’s Division of Viral Hepatitis (DVH) has released a 5-year strategic plan  (2016-2020) describing our efforts to decrease incidence and prevalence of viral hepatitis, decrease morbidity and mortality from viral hepatitis, and reduce viral hepatitis-related health disparities.
Viral hepatitis takes a tremendous toll on the lives of many persons in the United States.  As reported in the 2014 viral hepatitis surveillance report, the U.S. is continuing to identify persons newly infected with viral hepatitis, new reports of persons living with viral hepatitis, and deaths associated with viral hepatitis.  Overall, as many as 2.2 million and 3.5 million people are living with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, respectively with a significant increase in new HCV cases reported among young people who inject drugs. Together, these infections represent the primary cause of chronic liver disease and liver cancer as shown in the recent annual report to the nation on the status of cancer.
Now is the time to work together to increase awareness of viral hepatitis and encourage viral hepatitis testing.  Half of the persons living with HBV or HCV do not know they are infected. Only through testing and knowledge of infection status can persons infected with HBV or HCV receive the care and treatment needed to vastly improve their health outcomes.
HBV represents a major health disparity for Asian and Pacific Islander Americans (AAPI).  CDC’s Know Hepatitis B education campaign has new material available in multiple languages to inform AAPIs about the benefits of knowing one’s status and receiving recommended care and treatment for HBV.
HCV disproportionately affects persons born from 1945–1965. CDC and the U.S. Preventive Services Task Force (USPSTF)  recommend a one-time hepatitis C test for all persons born from 1945 –1965.  CDC’s Know More Hepatitis campaign has new material available to educate persons born from 1945–1965 about the importance of being tested for HCV.  There is good news for persons who test positive for HCV as highly effective, safe therapies are now available that can cure 90% or more of patients who complete therapy.
Despite advances in treatment, HCV-related deaths continue to climb. A CDC study, published online in Clinical Infectious Diseases, reveals that more persons die from HCV than 60 other infectious diseases reported to CDC.  This trend can be reversed by increasing the proportion of persons tested for HCV along with the proportion of HCV-infected persons referred for care and treatment.
The number of persons becoming infected with HCV is also on the rise in the United States, particularly in certain populations. American Indians/Alaska Natives (AI/AN) have the highest rates of new HCV infections among all racial/ethnic populations and are at increased risk of HCV-related morbidity and mortality compared to the general population.  Two reports published in CDC’s Morbidity and Mortality Weekly Report (MMWR) highlight programs that have successfully increased in the number of AI/AN tested for HCV; the greatest increases in HCV testing occurred among AI/AN born from 1945-1964. The article, “Identification and Clinical Management of Persons with Chronic Hepatitis C Virus (HCV) Infection in the Cherokee Nation, 2012-2015” reports a five-fold increase in testing from 3,337 persons initially tested to 16,772 tested by 2015. The second report, “Birth Cohort Screening for Hepatitis C Virus in the Indian Health Service 2012-2015”  reports an increase in testing from a baseline of 8% to 33% among AI/AN nationwide. These two AI/AN HCV testing programs use of clinical decision tools, provider education, and care models can serve as examples of best practices for other settings seeking to improve HCV testing and linkage to care for persons with HCV.  To facilitate implementation of CDC’s viral hepatitis testing recommendations in diverse settings, CDC developed the Hepatitis Testing and Linkage to Care (HepTLC) initiative, which is featured in a recently released supplemental issue of Public Health Reports.
The National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) recently released the Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report.  The expert panel determined that achievement of feasible elimination goals for HBV and HCV was possible but that sufficient resources, commitment, and energy would be needed to overcome barriers for reaching eliminations goals.  The follow-up (Phase Two) report, due to be released in early 2017, is expected to include specific recommendations and targets for elimination.
On Thursday, May 19, 2016, the White House, in collaboration with HHS, hosted a National Hepatitis Testing Day Observance.  The theme of the event was “Responding to Viral Hepatitis in the United States.” Presentations and panel discussions with senior White House and Administration officials, clinical and public health experts, and people affected by viral hepatitis and HIV focused on the importance of testing for viral hepatitis, the increase in new hepatitis infections related to the opioid abuse and heroin epidemic, and key opportunities to improve the health of people living with HIV and viral hepatitis coinfection. A video of the event is available at https://www.youtube.com/watch?v=tuWl14LuiIk.
Additional resources are available via CDC’s webpage, including Resources for Hepatitis Awareness Month.
I thank each of you for your hard work and commitment to preventing new viral hepatitis infections and reducing viral-hepatitis-associated morbidity and mortality in the United States. Collaboration is a key component toward meeting our mutual prevention goals.  DVH colleagues and I look forward to working with you during National Hepatitis Awareness Month and beyond to improve the lives of millions of HBV- and HCV-infected persons, and to prevent others from becoming infected.


John W. Ward,
Division of Viral Hepatitis
Centers for Disease Control and Prevention


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