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Addressing Viral Hepatitis
Jonathan Mermin, MD, MPH
National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention, CDC
NASTAD National Hepatitis Technical Assistance Meeting
December 6, 2016
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Office of the Director
Importance of Viral Hepatitis
•
Massive public health burden
•
Major cause of morbidity and mortality
•
Substantial health inequity
•
Discongruity between burden, attention, resources
•
Extraordinary opportunities for public health
•
Moment in time
Hepatitis A Matters
16,000
Number of cases
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
Year
• 53% coverage of HAV vaccine, lowest of any childhood vaccine
• 76 HAV-related deaths in 2014
CDC, National Notifiable Diseases Surveillance System (NNDSS)
Hepatitis A Outbreaks in 2016
HAV Cases by Onset Date,
Multistate Outbreak from Frozen
Strawberries, May-September
2016
• Multistate outbreak from
frozen strawberries imported
from Egypt
− 141 HAV cases in 8 states
(107 in Virginia)
− 54 hospitalizations
• Outbreak in Hawaii linked to
raw scallops from Philippines
− 292 HAV cases confirmed
− 74 hospitalizations
− 2 deaths
9,000
8,000
Number of acute cases
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
Year
• HBV prevalence estimated at 850,000 to 2.2 million
• 1,843 deaths in 2014
Source: National Notifiable Diseases Surveillance System (NNDSS)
Addressing Hepatitis B Virus:
Vaccination and Testing and Therapy
HBV Rates Decline with Vaccination Benefits of HBV
Testing and
Therapy
• U.S. cohorts had
50% reduction in
risk for liver
cancer
• Tenofovir may
become cheaper,
as patent ends in
2018
Source: National Notifiable Disease Surveillance System (NNDSS)
Lai, Hepatology, 2013. Gordon, Clin Gastro Hepatol 2014
3,500
Number of acute cases
3,000
2,500
2,000
1,500
1,000
500
0
Year
• >20,000 deaths per year
Source: National Notifiable Diseases Surveillance System (NNDSS)
HCV diagnosis and treatment
Cascade to Cure
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
>3 million persons living with HCV
50%
Holmberg S, et al, NEJM, 2013
38%
23%
11%
6%
Coverage Restrictions
Most public and private insurers
have criteria for treatment
•
•
•
•
Advanced fibrosis or
cirrhosis
Abstinence from
alcohol, marijuana,
and illicit drug use
No malignancy
Prescriber specialty
or “extensive
experience” treating
hepatitis C
Access to Syringe Services Programs
and Related Interventions
Viral Hepatitis Health Disparities
•
About half of HBV chronic infections
among Asian Americans and Pacific
Islanders
•
Acute HCV incidence rising among
people who inject drugs, especially
poor, rural, medically underserved
•
Chronic HCV is health disparity,
especially for African Americans and
American Indians and Alaska Natives
What to Do?