In November at the 143rd American Public Health Association (APHA) Annual Meeting & Exposition, OHAIDP facilitated a special session “The Changing Epidemiology of Viral Hepatitis – Hepatitis C Emerging Trends and Disparities.”Michelle Moses-Eisenstein, MPH, the session organizer and moderator, opened the 90-minute Special Epidemiology session and introduced the speakers.
Scott Holmberg, MD, MPH, Chief, Epidemiology and Surveillance Branch, CDC Division of Viral Hepatitis, set the stage by sharing data on the emerging trends in hepatitis C epidemiology in the U.S., describing “the largest, if unappreciated, infectious disease epidemic in the United States.” His presentation highlighted several key points including:
- Hepatitis C remains underreported, and mortality rates are increasing. In 2013, 2,138 acute cases of hepatitis C infection were reported to the CDC; however, it is estimated that only 1 in 13 infections are actually reported due to wide variations in state health department practices. As such, the CDC estimates that nearly 30,000 new hepatitis C infections occurred in 2013 (CDC, 2013 Viral Hepatitis Surveillance Report) (Klevens, et al. 2014). The annual deaths from hepatitis C infection have exceeded those from HIV since 2007, and the number of annual hepatitis C-related deaths continues to rise. A more recent preliminary analysis indicates that hepatitis C-related deaths outnumbered deaths due to all 60 other reportable infectious diseases combined.
- There is an acute hepatitis C epidemic among young persons who inject drugs (PWID). Dr. Holmberg described the epidemic of acute hepatitis C infection primarily among young PWID in rural, suburban, and urban areas of the country. New hepatitis C virus (also referred to as HCV) infections increased by 150% between 2010 and 2013, concurrent with an increase in injection drug use in this population, often occurring in those who have transitioned from oral opioid drug misuse to injectable heroin. Further review of data shows that between 2006 and 2012, 15 states reported increases in HCV incidence of more than 200%.
- Curative hepatitis C therapies need to be more affordable and accessible to all. Dr. Holmberg underscored the importance of adopting an effective strategy to ensure that access to curative hepatitis C treatments are available to all those infected, a goal that will require significant adjustments to the current drug pricing. While the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America’s (IDSA) Recommendations for Testing, Managing, and Treating Hepatitis C state that all persons with hepatitis C infection should be considered for treatment, high drug prices have led to the institution of policies and practices by insurers and other payors that restrict treatment to select groups of patients based on severity of disease, and other factors including a history of substance abuse.
Sonsiere Cobb-Souza, Director, Division of Program Operations, HHS Office of Minority Health, described the burden of hepatitis C among African Americans, as well as strategies to further engage African American communities to increase viral hepatitis awareness and empower people to achieve the goals of the updated Viral Hepatitis Action Plan that of non-Hispanic whites. Chronic liver disease (often due to hepatitis C) is a leading cause of death among African American men aged 45 to 64, and African American women aged 35 to 64. Strategies for improving hepatitis C-related outcomes among African Americans identified during a March 2015 HHS forum included:
- Increasing the number of African Americans who are aware of their chronic HCV infection;
- Developing impactful educational efforts to encourage the general public to get screened for HCV and motivate health care providers to promote and offer recommended HCV screenings; and
- Sharing personal stories to strengthen community engagement.
Ms. Moses-Eisenstein provided an overview of the national Viral Hepatitis Action Plan and its role as a framework for leadership and collaboration across diverse federal and non-federal stakeholders. By 2020, the Action Plan aims, through a coordinated national response, to increase the proportion of persons aware of their hepatitis C infection from 45% to 66%, and to reduce new hepatitis C infections by 25%. Ms. Moses-Eisenstein shared that the Stakeholder’s Workbook: Exploring Vital Roles and Opportunities to Break the Silence accompanies the Action Plan and provides strategies and resources for partners to effectively engage in efforts to work towards achieving the ambitious national goals.
Corinna Dan, RN, MPH, Viral Hepatitis Policy Advisor in the HHS Office of HIV/AIDS and Infectious Disease Policy, provided participants with strategies to strengthen the public health response to hepatitis C by improving outcomes along the continuum of hepatitis C care through effective collaborations among diverse stakeholder groups. Ms. Dan highlighted the opportunities for improving outcomes for persons living with chronic hepatitis C that are afforded by:
- FDA approval of new all-oral curative therapies
- CDC and U.S. Preventive Services Task Force (USPSTF) recommendations for hepatitis C testing among “baby boomers” and those at increased risk
- AASLD/IDSA recommendations for hepatitis C treatment
- Integration of hepatitis screening in substance abuse treatment settings and HIV prevention/screening activities
We were excited to share emerging data with the special session participants, as well as discuss strategies for initiating or reinforcing efforts to address hepatitis C. As we continue to work together, sharing and expanding upon our successes as a nation committed to combating the silent epidemic of viral hepatitis.
Presentations from this session can be downloaded from the links below:
- Hepatitis C Virus (HCV) Epidemiology in the United States: Emerging Trends (Scott Holmberg)
- Hepatitis C in African American communities: Epidemiology and strategies to increase awareness and engagement (Sonsiere Cobb-Souza)
- Viral Hepatitis Action Plan: A Framework for Action (Michelle Moses-Eisenstein), and Confronting Viral Hepatitis in the U.S.: Public Health Challenges & Opportunities (Corinna Dan)