Federal health officials last week announced efforts aimed at reducing the prevalence of certain hepatitis-related infections. President Biden last Thursday proposed an $11 billion campaign to eliminate hepatitis C virus (HCV) infections as part of his 2024 budget. And on Friday, the CDC expanded its recommendations for HBV virus (HBV) infection screening to include all adults at least once in their lifetime.
Treatment lags for HCV
HCV infection is one of the deadliest infections in the United States, according to the Centers for Disease Control and Prevention. It was linked to the deaths of over 15,000 people in the United States in 2020 and more than 2 million people in the nation are estimated to have the infection. Some expert clinicians believe the latter number is much higher. The CDC recommends that everyone aged 18 years and older get tested for HCV infection at least once in their lifetime and that people at high risk, such as injection drug users, receive regular testing
There is no vaccine against HCV infection, although effective treatment is available in the form of direct-acting antiviral drugs. But not enough people are aware that they are infected, and most who are do not receive these medications, according to the CDC. One reason is that the drug is unaffordable to many who need it, the medical news outlet STAT has reported.
The disease can affect long-term care residents. Citing limited evidence, a review of studies from 2016 published in Current Infectious Disease Reports found that HCV infection is more likely to occur in LTC facilities than in the general population. Risk factors for HCV infection include older age, female gender, history of blood transfusions, short duration of LTC residence and HBV virus positivity, the review authors found.
The Biden administration’s three-part plan includes budgetary support for a national model that would lower the price of HCV drugs, accelerated development of diagnostic tools and a public health campaign to raise awareness in an effort to increase testing and treatment, according to STAT.
Diagnosing HBV
HBV infections also are likely underdiagnosed and undertreated, although in this case, a vaccine exists. Among the estimated 2.4 million people living with these infections in the United States, two thirds are likely unaware that they have the virus, the CDC reports.
The CDC’s new recommendations include HBV infection screening using three laboratory tests at least once during an adult’s lifetime, rather than relying on risk-based assessments only. Transmission persists, “especially among older adults for whom vaccine uptake is suboptimal,” the agency stated in a new recommendation published in its Morbidity and Mortality Weekly Report.
In addition, the Advisory Committee on Immunization Practices (ACIP) has previously recommended that people aged 60 years and older with risk factors for HBV infection should be vaccinated against the virus, and that vaccination be made available to their same-age patients without known risk factors if they express a desire to do so.
Eldercare concerns
Residents of long-term care facilities and senior living communities are not included in the Centers for Disease Control and Prevention’s list of groups at risk of HBV infection. But some groups at risk, such as people on maintenance dialysis and those living with diabetes, may overlap with residents of these settings.
A study from 2013, published in Infection Control & Hospital Epidemiology, found increasing reports of HBV infection outbreaks among residents of assisted living communities and skilled nursing facilities, despite reduced prevalence reported in these settings since the 1980s.
The authors of an older study (from 2000) of 71 nursing homes concluded that residents of these facilities should be considered at high-risk for HBV infection, and that “vaccination against HBV of these groups is recommended.”
The newly recommended universal screening of adults for HBV infection is cost-effective, and early diagnosis and treatment of chronic infections reduces the odds of cirrhosis, liver cancer and death, the CDC stated in its recommendation update.
“Risk-based testing alone has not identified most persons living with chronic HBV infection and is inefficient for providers to implement,” the CDC noted. “Along with vaccination strategies, universal screening of adults and appropriate testing of persons at increased risk for HBV infection will improve health outcomes, reduce the prevalence of HBV infection in the United States, and advance viral hepatitis elimination goals.”
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