The AIDS Institute (TAI) is a collaborative agency. And although we create our own training and education tools and content within the realm of viral hepatitis, we also want you to have easy access to information that is current and authoritative from other sources that we trust and work with. Hence, we will be organizing the following links and resources (with bold orange text) with explanations about each, so that you can learn more and become familiar with other work in this field in addition to our own. We will take the care and time to update this page each time we find additional resources about viral hepatitis screening, testing, counseling, referal to care, treatment and follow up.
Centers For Disease Control and Prevention (CDC)
The Centers for Disease Control and Prevention (CDC) works for you 24/7 protecting the nation's health and containing threats worldwide. The CDC was formed on July 1, 1946, and is the primiere agency globally for disease prevention. It actually began as an office that was centered on the prevention and control of malaria in the early 1940s. In 2014, among the CDC's priorities are: infectious disease, environmental health, occupational safety, foodborne illnesses, injury prevention, and health promotion. The CDC houses 12 Offices and 8 Centers as their mainstay of activity. We offer you here some CDC links relevant to your interest in the world of viral hepatitis.
Did you know that there are 5 recognized hepatitis viruses? And several of them have many sub-types. Most of the research today is focused on HCV treatment because of all 5 viral hepatitis viruses, HCV causes the most morbidity and mortality. Nonetheless, the CDC (and The AIDS Institute) is interested in preventing all 5 types and educating medical and public health professionals--as well as the general public--about the devastation that viral hepatitis can cause and how to prevent individual infection. EVERY individual is susceptible and vulnerable. Read on!
HEPATITIS A (HAV): Hepatitis A, caused by infection with the Hepatitis A virus (HAV), has an incubation period of approximately 28 days (range: 15–50 days). HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness. HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. The Must-Know HAV information is found in the two links directly below.
HEPATITIS B (HBV): Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic. The Must-Know HBV information is found in the two links directly below.
HEPATITIS C (HCV): Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available. Below you will find a basic CDC HCV Fact Sheet, but no such sheet for vaccination because at present there is no vaccine for HCV.
HEPATITIS D (HDV): Hepatitis D, also known as "delta hepatitis," is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus (HBV). HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination.
HEPATITIS E (HEV): Hepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in countries with poor sanitation. Vaccination: There is currently no FDA-approved vaccine for Hepatitis E.
Department of Health and Human Services (HHS)
The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. HHS is headed by the Secretary who is the chief managing officer for our family of agencies, including 11 operating divisions, 10 regional offices, as well as the Office of the Secretary.
When confronting any epidemic or set of diseases that are endemic (established in the population), it becomes necessary to derive a set of plans or operations that can at least control the disease(s) if they are unable to be eradicated. And that is what the HHS 'Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis (2014-2016)' has attempted to do.
The Plan has 4 essential goals:
Increase the proportion of persons who are aware of their hepatitis B virus (HBV) infection from 33 percent to 66 percent,
Increase the proportion of persons who are aware of their hepatitis C virus (HCV) infection from 45 percent to 66 percent,
Reduce the number of new cases of HCV infection by 25 percent, and
Eliminate mother-to-child transmission of HBV.
The Plan also has 6 priority areas:
Educating Providers and Communities to Reduce Health Disparities
Improving Testing, Care, and Treatment to Prevent Liver Disease and Cancer
Strengthening Surveillance to Detect Viral Hepatitis Transmission and Disease
Eliminating Transmission of Vaccine-Preventable Viral Hepatitis
Reducing Viral Hepatitis Caused by Drug Use Behaviors
Protecting Patients and Workers from Health Care-Associated Viral Hepatitis
Department of Veterans Affairs (VA)
The Department of Veterans Affairs (VA) operates the nation's largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities. These facilities and services are available to the more than 21 million veterans now living in the United States. Historically, it has been thought that veterans have a far higher proportion of HCV that those in the non-veteran population. And that is true of veterans who use the VA Hospital System. However, when comparing all veterans (those who do, and do not, use the VA system) to the general population, veterans who do not use the VA, may actually have a lower prevalence of HCV than the general population. Nonetheless, viral hepatitis treatment--particularly with regard to HCV--has been a mainstay of VA care for decades. Below are 3 basic links to information about this subject.
National Institutes of Health (NIH)
The National Institutes of Health (NIH) is a major governmental health research agency whose mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. The NIH is composed of 27 different components called Institutes and Centers. Each has its own specific research agenda. All but three of these components receive their funding directly from Congress, and administrate their own budgets. 4 overarching goals of the agency are to:
Foster fundamental creative discoveries, innovative research strategies, and their applications as a basis for ultimately protecting and improving health
Develop, maintain, and renew scientific human and physical resources that will ensure the Nation's capability to prevent disease;
Expand the knowledge base in medical and associated sciences in order to enhance the Nation's economic well-being and ensure a continued high return on the public investment in research; and
Exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science.
Below are some examples of NIH research into viral hepatitis, via the National Institute of Diabetes and Digestive and Kidney Diseases:
The American Association of the Study of Liver Disease (AASLD) is the leading organization of scientists and health care professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists (including Hans Popper, Leon Schiff, Fred Hoffbauer, Cecil Watson, Jesse Bollman, and Sheila Sherlock, to name a few) to bring together those who had contributed to the field of hepatology.
AASLD has grown to an international society responsible for all aspects of hepatology, and our annual meeting, The Liver Meeting®, has grown in attendance from 12 to more than 9,500 physicians, surgeons, researchers, and allied health professionals from around the world.
The AASLD Guidance on Chronic HBV Treatment and Chronic HCV Treatment is perhaps considered to be the most sought after information for both public health and medical liver specialists when considering all aspects of testing and treatment.
The AASLD says the following about HCV Guidance:
Chronic hepatitis C virus (HCV) infection affects more than 3 million Americans and is a major cause of liver disease, cirrhosis, and liver cancer. Although several new drugs have now made it possible to cure almost all individuals with this infection, several obstacles remain. First, most persons with the disease are not aware of the infection so the Centers for Disease Control and Prevention (CDC) has recently recommended testing of all persons at risk and in the age groups where the disease is most common. Second, access to treatment is restricted by the complexity of treatment, the limited number of healthcare practitioners familiar with the disease, insurance coverage, and the high cost of the most recently approved antiviral drugs.
The rapidity of change in this field makes development of a formal published Guideline impractical so the work is referred to as HCV GUIDANCE. This distinction in the name -- Guidance vs. Guidelines -- is essential. The primary goal of this document was to facilitate the most rapid implementation of optimal care for our infected patients. The panel relied on peer-reviewed reports (papers published in the medical literature and abstracts presented at major national and international scientific conferences), FDA submission data, and expert consensus to develop recommendations to assist clinicians treating patients infected with HCV. Some of this supporting material does not meet the rigid criteria required to support a published Guideline.
Florida Department of Health Local Viral Hepatitis Testing and Vaccination Programs:
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