Strategies for prevention of viral hepatitis in the United States

The seroepidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the United States reveals that injection IV drug use remains the most important risk factor for both HBV and HCV. Despite availability of the HBV vaccine, there was a subsequent 37% increase in cases of HBV infection. To prevent perinatal spread of HBV, the initial approach was to vaccinate only mothers at increased risk of carrying HBV. As this strategy failed, the approach has been changed to universal vaccination of all newborn infants with HBV vaccine, plus those entering their teenage years. It is hoped that this dual approach will enable better control of HBV by eliminating the majority of individuals from being at risk. Several approaches to reducing the incidence of transfusion-associated hepatitis have had a significant effect in reducing this risk. Careful screening of volunteer (unpaid) donors, implementation of surrogate tests for non-A, non-B hepatitis (ALT and anti-HBc), measures to decrease the risk of transfusion-associated AIDS, and especially the current use of a second generation anti-HCV test have all combined to reduce dramatically the risk of transfusion-associated hepatitis today. Current estimates reveal that the risk of HBV transmission by transfusions is on the order of 1 per 50 000 units and for HCV, as low as 1 per 62 000 units. The little ‘transfusion-associated hepatitis’ which remains appears largely to be due to non-transfusion related acquisition of HBV and HCV in patients who are incidentally receiving transfusions as part of their medical or surgical therapy.