1. There is a lack of knowledge and awareness about chronic viral hepatitis on the part of health-care and social-service providers.

2. There is a lack of knowledge and awareness about chronic viral hepatitis among at-risk populations, members of the public, and policy-makers.

3. There is insufficient understanding about the extent and seriousness of this public-health problem, so inadequate public resources are being allocated to prevention, control, and surveillance programs.

That situation has created several consequences:

• Inadequate disease surveillance systems underreport acute and chronic infections, so the full extent of the problem is unknown.

• At-risk people do not know that they are at risk or how to prevent becoming infected.

• At-risk people may not have access to preventive services.

• Chronically infected people do not know that they are infected.

• Many health-care providers do not screen people for risk factors or do not know how to manage infected people.

• Infected people often have inadequate access to testing, social support, and medical management services.

To address those consequences, the committee offers recommendations in four categories: surveillance, knowledge and awareness, immunization, and services for viral hepatitis. The recommendations are discussed below, and listed in Box S-1.

The viral hepatitis surveillance system in the United States is highly fragmented and poorly developed. As a result, surveillance data do not provide accurate estimates of the current burden of disease, are insufficient for program planning and evaluation, and do not provide the information that would allow policy-makers to allocate sufficient resources to viral hepatitis prevention and control programs. The federal government has provided few resources—in the form of guidance, funding, and oversight—to local and state health departments to perform surveillance for viral hepatitis. Additional funding sources for surveillance, such as funding from states and cities, vary among jurisdictions. The committee found little published information on or systematic review of viral hepatitis surveillance in the United States and offers the following recommendation to determine the current status of the surveillance system: