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National Hepatitis Testing Day: Most Infected Are Unaware, All Boomers Should Get HCV Test

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In advance of the National Hepatitis Testing Day on Saturday, May 19, the U.S. Centers for Disease Control and Prevention (CDC) has issued a new recommendation that all Baby Boomers born between 1945 and 1965 should get tested at least once for hepatitis C. Testing Day events will also promote hepatitis B screening, especially for Asian communities. Research shows that a large majority of people with hepatitis B or C do not know they are infected.

Coming in the middle of Hepatitis Awareness Month, May 19 has been designated the first-ever National Hepatitis Testing Day to encouraging more people to learn whether they carry hepatitis B virus (HBV) or hepatitis C virus (HCV).

According to the CDC, an estimated 1 million people in the U.S. have chronic hepatitis B. Fortunately, the rate of infection has declined dramatically since an effective vaccine became widely available and is now included in routine childhood immunizations.

Experts estimate that more than 3 million -- and possibly as many as 5 million -- people in the U.S. have chronic hepatitis C. The recent development of the first direct-acting antiviral agents has revolutionizing hepatitis C treatment, but there us still no effective HCV vaccine.

Hepatitis B is most common among Asians and Pacific Islanders. HBV is endemic in these parts of the world, and many people are infected at birth. Hepatitis C is most common among Baby Boomers in their mid-40s to mid-60s, many of whom were infected decades ago. Research indicates that this age group accounts for nearly 80% of all hepatitis C cases in the U.S., and as many as 1 in 30 people in this cohort is infected.

Many of these people were infected long ago, before HCV was identified, often through shared injection drug equipment or blood transfusions; because HCV is easily transmitted through blood-to-blood contact, occasional experimentation or even a single exposure is high-risk. In addition, over the past decade sexually transmitted HCV has become a growing epidemic among HIV positive gay and bisexual men. But a substantial proportion of people with hepatitis C do not have any traditional risk factors and do not know how they became infected.

Majority Unaware of Infection

Over years or decades hepatitis B and C can lead to serious liver disease including cirrhosis and hepatocellular carcinoma (a type of liver cancer); hepatitis C is now the leading indication for liver transplantation in the U.S. But both diseases often have no symptoms until advanced stages, and most people do not realize they are infected.

Experts estimate that around 75% of people with chronic hepatitis C are not aware they carry the virus, and a new survey released this week by the American Gastroenterological Association (AGA) found that more than 80% of Baby Boomers do not consider themselves -- or their generation -- at risk. About half are unaware that African Americans and Hispanics have a significantly higher prevalence than whites, and only 18% understand that for many people hepatitis C can be cured.

"Many baby boomers have a potentially dangerous 'it's not me' mentality about hepatitis C," said Ira Jacobson from Weill Medical College of Cornell University, a physician co-advisor to AGA’s I.D. Hep Ccampaign. "Given the potentially deadly consequences of allowing hepatitis C to go undiagnosed, the AGA urges all baby boomers to talk to their doctors about getting tested."  

I.D. Hep C is a new campaign to educate people, especially baby boomers, about hepatitis C and encourage them to speak up and get tested to learn their status.

HCV Screening for Boomers

The CDC on Friday issued a draft recommendation to expand hepatitis C testing, advising that everyone born between 1945 and 1965 should receive one-time screening for hepatitis C. Those with ongoing risk should undergo regular testing. Those who are diagnosed with HCV infection should be linked to care and treatment.

A study published earlier this year estimated that birth-cohort screening would identify more than 800,000 additional cases of chronic hepatitis C compared with the current practice of only testing people with known or suspected traditional risk factors. Researchers calculated that expanded screening followed by treatment for those who need it would be cost-effective. Many people with chronic hepatitis C do not have progressive liver disease and do not need treatment, but it is important to undergo liver biopsy or a non-invasive test such as FibroScan to determine the extent of liver damage.

"Identifying these hidden infections early will allow more baby boomers to receive care and treatment, before they develop life-threatening liver disease," said Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention. 

A fact sheet explaining the new recommendation is available online. The draft is open for public comment until June 8, 2012.

The CDC also announced the availability of $6.5 million in new funding to expand hepatitis B and C testing, encourage earlier diagnosis, and enhance linkage to care, treatment, and preventive services. The funding will focus on groups disproportionately affected, including Asian-American and Pacific Islander communities who have the highest rates of hepatitis B, and injection drug users and people born between 1945-1965 who are most at risk for hepatitis C.

Events and Resources

Events are taking place across the country to recognize National Hepatitis Testing Day. See the Hepatitis Testing Day Event Page to find events in your area.

In San Francisco, San Francisco Hep B Free and the San Francisco Hepatitis C Task Force are collaborating to provide free hepatitis B and C testing and education at the Asian Heritage Street Festival on Saturday. Across the bay, free screenings will be offered at the Berkeley Free Clinic from 2 to 10 pm.

The CDC's Know More Hepatitis Campaignoffers further information about viral hepatitis awareness and testing.

The CDC also offers an online Hepatitis Risk Assessment tool on its web site to help people determine whether they are at risk, either at home or in a health care setting.

5/18/12

Sources

Centers for Disease Control and Prevention. CDC Announces First Ever National Hepatitis Testing Day and Proposes that All Baby Boomers be Tested Once for Hepatitis C. Press release. May 18, 2012.

American Gastroenterological Association. Most Baby Boomers Never Tested for Hepatitis C, Despite Being Most at Risk. Press release. May 14, 2012.

R Valdiserri. May 19 Is Hepatitis Testing Day. AIDS.gov Blog. May 14, 2012.

K Fenton. CDC Letter on Hepatitis Testing Day & Hepatitis Awareness Month. May 10, 2012.

San Francisco Hep B Free and San Francisco Hepatitis C Task Force. Mayor Lee and U.S. Centers for Disease Control (CDC) Kick Off Historic 1st National Hepatitis Testing Day in San Francisco. Press release. May 18, 2012.