In 2010, the World Health Organization (WHO) declared July 28th as annual World Hepatitis Day. The theme for 2015 is Prevent Hepatitis: It's Up to You (http://www.worldhepatitisday.info).1 There are different types of hepatitis virus infections, but the Hepatitis C virus (HCV) has received a lot of attention in the past year, and several new, more effective drugs have recently been approved for treatment. Worldwide, approximately 150 million individuals are chronically infected with HCV, and 1.3 million die annually (http://www.who.int/mediacentre/factsheets/fs164/en).2 The CDC estimates that approximately 3.2 million individuals in the United States have chronic HCV infection (http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1).3 This number is most likely low because many have never been tested and do not know they are infected.
The majority of infected individuals were born between 1945 and 1965, known as the post-World War II baby boomers. Because there is no vaccine for HCV, prevention is a key strategy in managing the disease and associated morbidity and mortality. Campaigns such as World Hepatitis Day strive to raise awareness about the disease, call for access to treatment, better prevention programs, and government action-particularly in high prevalent, poor resource countries. In the United States, almost three-fourths of individuals with chronic HCV infection live in 8 of the 41 states that reported HCV infection rates in 2013. One of the 8 states is New York, where legislators passed a bill that was signed into law in 2013-the first in the nation mandating that health service providers offer one-time HCV testing to all patients born between 1945 and 1965 seen in hospitals and primary care settings even if they have no other risk factors (https://vimeo.com/90666805).4
Government-sponsored free testing is available at certain registered facilities for designated populations. All providers are encouraged to screen with a rapid HCV test following a positive screen with confirmatory testing. The CDC developed an algorithm to guide testing and decision making (http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_flow.pdf).5
Appropriate screening
Several of my patients with chronic, stable HCV infection have been given renewed hope because of new oral treatments.3 They had either failed with earlier treatments or were reluctant to undergo treatment because of the debilitating adverse reactions. After 2 weeks of initiating the prescribed 12-week regimen, viral RNA loads were undetectable in all of the patients. Of course, these patients are hopeful that this early cure is not temporary but indicative of complete resolution of their HCV infection or a sustained virologic response.
Patient education
Our role is to identify individual patients at risk for HCV and screen them appropriately; however, educating patients about prevention for all types of hepatitis is also important. The WHO recommends that people know the risks, demand safe injections, vaccinate children, get tested, and seek treatment when indicated. A successful attack on reducing the burden of hepatitis disease to individuals and society requires a team approach that includes legislators, but you can make a difference for the population most affected by HCV in the United States by offering screenings to the baby boomer generation.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, DPNAP
EDITOR-IN-CHIEF [email protected]
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