Viral Hepatitis Strategic Plan

Executive Summary

Viral hepatitis represents a disease entity caused by at least five unrelated viruses, which attack the cells of the liver. The majority of viral hepatitis cases are due to the hepatitis A virus (HAV) , hepatitis B virus (HBV) , or hepatitis C virus (HCV). Hepatitis A is an acute self-limited disease caused by the HAV. Infection with HBV can produce a chronic infection which may lead to death from chronic liver disease or hepatocellular carcinoma. HCV infection is responsible for the majority of cases of parenterally transmitted non-A, non-B hepatitis, and in most individuals causes chronic liver disease.

HAV infection is one of the most frequently reported vaccine-preventable diseases in the United States. According to the CDC Third National Health and Nutrition Examination Survey (NHANES III) study conducted during 1988-1994, approximately 31.3% of the US population has ever been infected with HAV.2 The costs associated with HAV infection are substantial. Between 11% and 22% of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs providing postexposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $422 to $1,492 per case for children <18 years of age.3 Fortunately, once someone has been infected with HAV they are immune for a lifetime and there are no chronic sequelae.

HBV and HCV infections are common chronic bloodborne viral infections in the United States. The estimated number of new hepatitis B and hepatitis C infections per year is approximately 78,000 and 25,000, respectively. Studies show that 4.9% of Americans have been infected with HBV, of whom 1.25 million are chronically infected. The expected direct medical costs associated with acute and chronic HBV infection for one U.S. birth cohort are estimated to be $81.9 million.4 It is estimated that 1.8% of Americans have been infected with HCV, of whom most (2.7 million) are chronically infected. The consequences of hepatitis-induced chronic liver disease may not become apparent until decades after infection. Chronic liver disease is the tenth leading cause of death in the United States, with 40%—60% due to HCV infection. HCV-associated chronic liver disease is the most frequent indication for liver transplantation among adults. The costs of hepatitis C in direct medical expenditures during 1997 were estimated at $1.8 billion.5 Similarly, a computer simulation model has projected that, from 2010 through 2019, the direct medical expenditures for HCV will be $10.7 billion.6 An effective vaccine is available to prevent HAV and HBV infection; however, no such vaccine has been developed for HCV.

Using the national data, it is estimated that over 931,000 New Yorkers have been infected with HBV, with 46,550 of these persons chronically infected. An estimated 342,000 New Yorkers have been infected with HCV, with 237,500 of these persons chronically infected. Hepatitis B and hepatitis C are complex infections that have significant epidemiologic, social and medical impact.

In addition to the potential financial burden to the state, viral hepatitis can have a tremendous impact on the lives of many New Yorkers. As a result, the New York State Department of Health (NYSDOH) identified the need for a comprehensive, collaborative and organized approach by partners across New York to address the public health problems associated with viral hepatitis.

On June 3 and 4, 2003, the NYSDOH, along with partners and stakeholders from across the state, participated in the Viral Hepatitis Strategic Planning Summit. This summit was to be the beginning of the development of a statewide viral hepatitis strategic plan. The two-day meeting began with presentations by representatives from the CDC and the NYSDOH. Then the participants were divided into four focus areas: 1) Prevention, 2) Education, 3) Surveillance and Research, and 4) Medical and Case Management. The focus areas served as the central elements of the strategic plan. By the end of the two-day meeting, each focus area identified three to five priority issues, which were then developed into long-term goals, each with strategies and five-year action plans for meeting the goals. A summary of the long-term goals for each of the four focus areas is provided below:

Prevention

  • Substantially increase awareness and knowledge about viral hepatitis through a comprehensive statewide viral hepatitis prevention and education initiative.
  • Develop and utilize standard NYSDOH viral hepatitis protocols for screening, testing, counseling, vaccination, referral and treatment.

Education

  • Increase the capacity of all appropriate health care and service providers to screen, diagnosis, treat, educate and counsel clients.
  • Increase awareness of and access to primary, secondary, and tertiary prevention measures for infected and at-risk populations.

Surveillance and Research

  • Establish an enhanced surveillance system that will generate accurate data on hepatitis to support primary and secondary prevention, education and medical management.
  • Promote research activities that will assist with decreasing the incidence of viral hepatitis and benefit those with chronic hepatitis.

Medical and Case Management

  • Develop and establish standards of medical care and case management for those at risk for and infected with viral hepatitis.
  • Ensure vaccination and treatment of all patients and clients likely to benefit per current (best available) standard of care.

The overall purpose of this plan is to provide a blue print for the NYSDOH and its stakeholders and partners for the development and delivery of viral hepatitis services in New York State. Due to the limited federal, state and local resources for viral hepatitis initiatives, implementation of the plan will occur over time. The success of this plan will involve a coordinated, collaborative and sustained approach for prevention, education, surveillance and research, and medical and case management of viral hepatitis by many stakeholders across the state. Partnerships between the NYSDOH and stakeholders, including those who helped in the development of the plan, will be necessary to fully implement this plan.