ELIMINATING
THE PUBLIC HEALTH PROBLEM
OF HEPATITIS B AND C
IN THE UNITED STATES

PHASE ONE REPORT

Gillian J. Buckley and Brian L. Strom, Editors

Committee on a National Strategy for the Elimination of
Hepatitis B and C

Board on Population Health and Public Health Practice

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

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International Standard Book Number-13: 978-0-309-43799-8
International Standard Book Number-10: 0-309-43799-7
Digital Object Identifier: 10.17226/23407

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Eliminating the public health problem of hepatitis B and C in the United States: Phase one report. Washington, DC: The National Academies Press. doi: 10.17226/23407.

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COMMITTEE ON A NATIONAL STRATEGY FOR THE ELIMINATION OF HEPATITIS B AND C

BRIAN L. STROM (Chair), Chancellor, Rutgers University, The State University of New Jersey

JON KIM ANDRUS, Executive Vice President and Director, Vaccine Advocacy and Education, Sabin Vaccine Institute

ANDREW ARONSOHN, Assistant Professor of Medicine, University of Chicago

DANIEL CHURCH, Epidemiologist and Viral Hepatitis Prevention Coordinator, Massachusetts Department of Public Health

SEYMOUR COHEN, Instructor Emeritus, Marine Biological Laboratory

ALISON EVANS, Associate Professor, Dornsife School of Public Health, Drexel University

PAUL KUEHNERT, Assistant Vice President, Program, Robert Wood Johnson Foundation

VINCENT LO RE III, Assistant Professor of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania

KATHLEEN MAURER, Director, Health and Addiction Services, Connecticut Department of Correction

RANDALL MAYER, Interim Director, Division of Behavioral Health, Iowa Department of Public Health

SHRUTI MEHTA, Professor of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University

STUART C. RAY, Professor of Medicine, Center for Viral Hepatitis Research, Division of Infectious Diseases, Johns Hopkins University

ARTHUR REINGOLD, Edward Penhoet Distinguished Professor of Global Health and Infectious Diseases, School of Public Health, University of California, Berkeley

SAMUEL SO, Lui Hac Minh Professor, School of Medicine, Stanford University

NEERAJ SOOD, Associate Professor and Vice Dean for Research, Schaeffer Center and Sol Price School of Public Policy, University of Southern California

GRACE WANG, Family Physician, International Community Health Services

LUCY WILSON, Chief, Center for Surveillance, Infection Prevention, and Outbreak Response, Maryland Department of Health and Mental Hygiene

Study Staff

GILLIAN BUCKLEY, Study Director

ANNALYN WELP, Research Assistant

MARJORIE PICHON, Senior Program Assistant

DORIS ROMERO, Financial Associate

ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before

its release. The review of this report was overseen by Robert B. Wallace, University of Iowa, and Don Eugene Detmer, University of Virginia School of Medicine. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Acknowledgments

The Committee on a National Strategy for the Elimination of Hepatitis B and C wishes to acknowledge the many people whose contributions and support made this report possible. The committee benefited from presentations made by a number of experts. The following individuals shared their research, experience, and perspectives with the committee: Adrian Di Bisceglie, Kyong-Mi Chang, Chari Cohen, Jules L. Dienstag, Brian R. Edlin, Marc Ghany, Robert G. Gish, J. Nadine Gracia, Camilla Graham, Jay Hoofnagle, Mandana Khalili, Arthur Kim, T. Jake Liang, Anna Suk-Fong Lok, Rohit Loomba, Brian McMahon, Dan O’Connell, Lara Strick, David L. Thomas, and John Ward.

The following individuals were important sources of information, generously giving their time and knowledge to further the committee’s efforts: Amy Geller, Scott Holmberg, Abbe Mitchell, Stephanie Scappini, Patti Simon, Norah Terrault, and Chia Wang.

The committee acknowledges the support of the National Academies of Sciences, Engineering, and Medicine staff, especially Daniel Bearrs, Chelsea Frakes, Greta Gorman, Hope Hare, Jim Jensen, Nicole Joy, Sarah Kelley, Ellen Kimmel, Fariha Mahmud, Anna Martin, Rebecca Morgan, Tina Ritter, Lauren Shern, Elizabeth Tyson, and Jennifer Walsh. The committee thanks Rebekah Hutton for designing the cover art.

The committee also benefited from the work of committees of the Institute of Medicine that conducted studies relevant to this report, particularly the Committee on a National Strategy for Prevention and Control of Viral Hepatitis Infections in the United States.

Finally, funding for this project was provided by the Centers for Disease Control and Prevention, Division of Viral Hepatitis, and the US Department of Health and Human Services, Office of Minority Health. The committee extends special thanks for that support.

Contents

ACRONYMS

SUMMARY

1 INTRODUCTION

The Global Burden of Hepatitis B and C Virus Infections

The Committee’s Charge

Disease Control, Elimination, and Eradication

References

2 THE ELIMINATION OF HEPATITIS B

Epidemiology of Hepatitis B

The Feasibility of Eliminating the Public Health Problem of Hepatitis B

Ending Transmission of Hepatitis B

Preventing Complications and Deaths Among the Chronically Infected

Crosscutting Barriers to Hepatitis B Elimination

References

3 THE ELIMINATION OF HEPATITIS C

Epidemiology of Hepatitis C

The Feasibility of Eliminating the Public Health Problem of Hepatitis C

Ending Transmission of Hepatitis C

Eliminating Chronic Hepatitis C

Reducing Morbidity and Mortality from Hepatitis C

Crosscutting Barriers to Hepatitis C Elimination

References

4 CONCLUSION

References

APPENDIXES

A Committee Meeting 1 Agenda

B Committee Meeting 2 Agenda

C Committee Biographies

D Glossary

Acronyms