The Hepatitis B Foundation (HBF) calls for action to ensure all individuals in the U.S. who are chronically infected with hepatitis B be counted. Results from a study conducted by the Foundation’s public health research department have been published in the October 2007 issue of the Journal of Viral Hepatitis, indicating the prevalence of chronic hepatitis B in the U.S. is significantly greater than the currently accepted estimate of 1.25 million.
The HBF believes the true burden of chronic hepatitis B is closer to 2 million, which means there are approximately 800,000 infected people in the U.S. who are not being counted. The underestimation of the true number of infected individuals has occurred mostly because the highest-risk populations are under-represented in surveillance studies, and a large percentage of chronically infected individuals remain undiagnosed.
The National Health and Nutrition Examination Surveys (NHANES), upon which the current estimate is based, are limited because they do not include the significant numbers of Asians who are disproportionately affected and the large influx of new immigrants coming from areas of the world with high rates of hepatitis B.
Census data and current prevalence estimates for each major U.S. ethnicity were used by the HBF to calculate a more accurate estimate of the burden of chronic hepatitis B – almost 2 million Americans. This number has the potential to increase even more when taking into account undocumented immigrants and other high-risk groups that are currently not counted, such as the incarcerated and homeless populations.
While these calculations have limitations, they are provocative in that they highlight the strong likelihood that chronic hepatitis B is an under-recognized disease in the U.S. and deserves greater priority from public health leaders, research institutions and clinicians.
The nation needs to support public health surveillance systems that yield reliable state and local data that can be used to calculate more accurate estimates of chronic hepatitis B. Increased attention and funding are needed for this, as well as for large-scale education, treatment, and prevention initiatives for patients to receive necessary care and treatment, and for high-risk individuals to be screened and vaccinated.
Chronic hepatitis B infection is a leading cause of primary liver cancer (hepatocellular carcinoma), which is rising in both incidence and mortality in the U.S., and now ranks 8th among leading causes of cancer death for Americans. In the Asian American population, liver cancer ranks 3rd among causes of cancer death.
With the number of new infections remaining steady despite the availability of a vaccine and the percentage of infected Americans who are receiving care and treatment remaining low, it is imperative that hepatitis B be prioritized as an important public health concern.
An accurate assessment of the true prevalence of chronic hepatitis B that includes updated estimates from high-risk, undercounted populations is a crucial first step towards significantly reducing the burden of chronic hepatitis B in this country.
Excerpted from Underestimation of Chronic Hepatitis B Virus Infection in the United States of America, J. of Viral Hepatitis Vol. 14, No. 8 October 2007. C. Cohen, MPH, A. Evans, ScD, W.T. London, MD, J. Block, RN, BSN, M. Conti and T. Block, Ph.D. Complete article available through Online Early Access @ www.blackwell-synergy.com/doi/full/10.1111/j.1365-2893.2007.00888.x
