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T he global epidemic of hepatitis B and hepatitis C is a serious public-health problem.
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preventable death worldwide. Hepatitis B and hepatitis C are contagious liver diseases caused by the hepatitis B virus (HBV) reserved. Copyright © 2010. National Academies Press. All rights reserved.

INTRODUCTION TABLE 1-1 Key Characteristics of Hepatitis B and Hepatitis C Hepatitis B Hepatitis C Causative agent Partially double-stranded DNA virus Enveloped, positive-strand RNA virus Hepadnaviridae family Hepacavirus genus, Flaviviridae family Statistics In the United States, 0.8– 1.4 million people are chronically infected with HBV In the United States, 2.7– 3.9 million people are chronically infected with HCV Routes of transmission Contact with infectious blood, semen, and other body fluids, primarily through: • Birth to an infected mother • Sexual contact with an infected person • Sharing of contaminated needles, syringes, or other injection-drug equipment Less commonly through: • Contact with infectious blood through medical procedures Contact with blood of an infected person, primarily through: • Sharing of contaminated needles, syringes, or other injection-drug equipment • • Less commonly through: • Sexual contact with an infected person Birth to an infected mother Contact with infectious blood through medical procedures Persons at risk • Persons born in geographic regions that have HBsAg prevalence of at least 2% • Infants born to infected mothers • Household contacts of persons who have chronic HBV infection • Sex partners of infected persons • Injection-drug users • Sexually active persons who are not in long-term, mutually monogamous relationships (for example, more than one sex partner during previous 6 months) • Men who have sex with men • Persons who have ever injected illegal drugs, including those who injected only once many years ago Recipients of clotting-factor concentrates made before 1987 Recipients of blood transfusions or solid-organ transplants before July 1992 Patients who have ever received long-term hemodialysis treatment Persons who have known exposures to HCV, such as health-care workers after needlesticks involving HCVpositive blood and recipients of blood or organs from donors who later tested HCV-positive All persons who have HIV infection • • HEPATITIS AND LIVER CANCER TABLE 1-1 Continued Persons at risk Hepatitis B • Health-care and publicsafety workers at risk for occupational exposure to blood or blood-contaminated body fluids • Residents and staff of facilities for developmentally disabled persons • Persons who have chronic liver disease • Hemodialysis patients • Travelers to countries that have intermediate or high prevalence of HBV infection Hepatitis C • Patients who have signs or symptoms of liver disease (for example, abnormal liver-enzyme tests) Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before the age of 18 months) • Potential for chronic infection Among newly infected, unimmunized persons, chronic infection occurs in: • >90% of infants • 25– 50% of children aged 1– 5 years • 6– 10% of older children and adults 75– 85% of newly infected persons develop chronic infection Clinical outcomes • 15– 25% of chronically infected persons will die from cirrhosis, liver failure, or hepatocellular carcinoma • 3,000 deaths each year are due to hepatitis B-related liver disease in the United States • 60– 70% of chronically infected persons develop chronic liver disease 5– 20% develop cirrhosis over a period of 20– 30 years 1– 5% will die from cirrhosis or hepatocellular carcinoma 12,000 deaths each year are due to hepatitis C-related liver disease in the United States • • • Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HBsAg, hepatitis B surface antigen. SOURCE: Adapted from CDC, 2009a.
Colvin, Heather M., and Mitchell, Abigail E.. Hepatitis and Liver Cancer : A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC, USA: National Academies Press, 2010. ProQuest ebrary. Web. 10 September 2015.
Copyright © 2010. National Academies Press. All rights reserved.

Three to five times more people are living with chronic viral hepatitis infections than with HIV infection. Table 1-2 presents the burden of HBV, HCV, and HIV infections in the United States. The US Centers for Disease Control and Prevention (CDC) estimates that 3.5– 5.3 million people in the United States— 1– 2% of the population— are living with chronic HBV or HCV infection— about 800,000 to 1.4 million people with chronic hepatitis B

2009d). However, an accurate estimate is difficult to obtain because there is no national chronic-hepatitis surveillance program. Each year, about 15,000 deaths are caused by HBVor HCV-associated liver cancer or endstage liver disease (CDC, 2009d). Almost half the liver transplantations in the United States are necessitated by end-stage liver disease associated with HBV or HCV infection (Kim et al., 2009).

The national strategy for preventing new HBV infection in infants and children— including routine screening of pregnant women for hepatitis B surface antigen (a blood marker for chronic HBV infection), universal infant hepatitis B immunization, and catchup vaccination of unvaccinated children and adolescents— has resulted in a dramatic reduction in chronic

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Hepatitis and Liver Cancer : A National Strategy for Prevention and Control of Hepatitis B and C by Colvin, Heather M., Mitchell, Abigail E.