A vaccine for hepatitis B has been available since the 1980s. Research to develop a vaccine for hepatitis C continues although it is unlikely that a vaccine will be developed and licensed in the near future. Given the complexity of the issues surrounding vaccination of children and adults, this report devotes a separate chapter (Chapter 4) to immunization.

Harm Reduction

Harm reduction refers to programs and policies that seek to reduce the medical, social, and economic harms associated with illicit-drug use (IHRA, 2009). Support for abstinence is an element of harm reduction but is not a requirement for participation in harm-reduction programs. Harm reduction focuses on providing information about safer practices (for example, how to inject without exposing oneself to contaminated blood), providing materials for engaging in safer practices (such as needle syringes and condoms), and offering hepatitis B vaccination. Because harm reduction does not condemn illicit-drug use and instead seeks practical solutions to mitigate its harmful consequences, these programs can be controversial (Des Jarlais et al., 2009).

Medical Management

Evidence-based practice guidelines for both chronic hepatitis B and chronic hepatitis C have been published by the American Association for the Study of Liver Diseases (AASLD) and other organizations (Ghany et al., 2009; Lok and McMahon, 2009). The guidelines are updated regularly to reflect advances in care and should be referred to as the basis of appropriate medical management. For the purposes of this report, the committee specifies that the goals of medical management of chronically infected people are to decrease the risk of developing cirrhosis, to prevent hepatic decompensation, to decrease the risk of hepatocellular carcinoma in people chronically infected with HBV or HCV, and to effect secondary prevention of virus transmission.

The AASLD guidelines include recommendations for selection of patients who have chronic hepatitis B or hepatitis C for referral to specialists and for treatment with medications (Ghany et al., 2009; Lok and McMahon, 2009). Persons who are identified as HBsAg-positive should have a history taken and a physical examination performed by a primary-care provider with an emphasis on symptoms and signs of liver disease

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