Tens of thousands of lives could be saved each year if we focused more attention on preventing hepatitis infections, identifying them early on, and ensuring accessible, affordable treatment for those who are diagnosed, according to a national report released Tuesday.
Produced by a committee of the National Academies of Sciences, Engineering and Medicine chaired by a Rutgers University chancellor, the report said that by working together to better reach and care for the millions of hepatitis patients nationwide, government officials and healthcare providers could essentially “eliminate these diseases as serious public health problems” and prevent nearly 90,000 deaths by 2030.
Hepatitis B and C are the most common forms of the disease, a viral liver infection that can lie dormant for years, but, when activated, can cause liver disease, cancer, and death. More than 8,000 New Jersey residents were diagnosed with the disease in 2015, the vast majority with chronic hep-C, and an estimated 150,000 more are carriers potentially unaware of their risk. Baby boomers account for most of those infected.
In particular, the committee called for free vaccine programs to guard against hep-B, expanding needle-exhange initiatives to protect intravenous drug users — who account for three out of four new hep-C infections — and helping hep-C patients obtain powerful new treatments that remain unaffordable to many.
“Viral hepatitis is simply not a sufficient priority in the United States,” said committee chair Brian Strom, an epidemiologist who is chancellor and a professor with Rutgers Biomedical and Sciences. The diseases kill more than HIV, traffic accidents, or diabetes, he said, but receive little research funding or other resources. “The world has the tools to prevent these deaths,” the report states.
In New Jersey, the state has stepped up its investment in several of these efforts in recent years. There are five clean-needle pilot programs approved, some operating for close to a decade, and two more cities — Asbury Park and Trenton — requested permission last fall to launch similar work, according to the state Health Department.
Last summer, Gov. Chris Christie approved $200,000 in state funding for these projects, which are primarily bankrolled by private donations, the DOH said. Hep-C can be contracted by drug users who share dirty needles; providing clean syringes has been proven to reduce infection rates.
The state also has an aggressive program to ensure youngsters are vaccinated against hepatitis B, which is required for them to start school; the DOH echoes the recommendation from the federal Centers for Disease Control and Prevention, also noted in the report, that this process starts in infancy, so the family is aware of the importance. Officials also work with local health departments and maternity clinics to ensure parents are aware of these requirements. Nearly 94 percent of children are inoculated, state officials said, slightly higher than the national rate.
Reaching hepatitis carriers
In the report, Strom’s committee said the harder challenge is reaching the adults who haven’t been vaccinated as children; in 2013, only a quarter of those over 19 had received the immunization. It is particularly important for pregnant women who can pass the disease on during birth. The report urges states to expand adult hep-B vaccine programs. In New Jersey, the DOH maintains a list of some 75 sites that offer free or low-cost hepatitis vaccinations, screening programs, and other resources throughout the state.
New Jersey Sen. Joseph Vitale (D-Middlesex), the longtime health committee chairman, has also worked for several years to boost screening for hep-C among baby boomers, who make up nearly 75 percent of those infected. Individuals born between 1945 and 1965 are more than five times more likely to be infected, according to the DOH, and may have contracted the virus in the 1970s or 1980s when the infection rates were highest and understanding about its transmission was more limited.
The CDC recommends baby boomers get tested for hep-C, and many states require physicians to offer screening and connect patients with follow-up services, if needed. Vitale has pushed a bill (S-1279) that would require doctors and hospitals to make this test available to patients in this age group, and others who are high-risk because of IV drug use or other behaviors, as part of any regular panel of blood screenings. (Patients can decline to participate.)
Questioning proposed legislation
Hospitals have agreed to support the legislation, which passed the Senate last year, and some, including Holy Name Medical Center in Teaneck, have implemented testing programs on their own. But advocates for physicians have raised concerns about the bill, as written; they questioned who would pay for these procedures and urged regulators to leave it up to doctors to determine when and where to recommend hep-C screening. The measure has yet to receive a vote in the Assembly, where it is pending in the health committee chaired by Assemblyman Herb Conaway (D-Burlington), a physician who has made clear his opposition to government mandates for medical practitioners.
The report from the national academies also offered several ideas for improving access to costly hep-C treatments, newly developed drugs that have been prohibitively expensive for many patients. In September, Garden State lawmakers heard from patients and others concerned about the rapidly escalating costs of EpiPens, a lifesaving injection to counter serious allergy attacks, and other drugs, including those for hep-C.
The committee recommended a voluntary licensing agreement between the federal government and pharmaceutical patent-holders to reduce the cost of these medicines for those covered by government programs like Medicaid. There is currently no vaccine for hep-C, but the direct-acting antiviral drugs now available make “elimination feasible” — but cost remains an obstacle, the report said.