in people who are older, have metabolic syndrome secondary to obesity, ingest large amounts of alcohol, and are coinfected with HIV (Ghany et al., 2009; Missiha et al., 2008; Pradat et al., 2007). There are also important ethnic and racial differences in the burden of chronic hepatitis C. The prevalence of HCV infection is higher in blacks than in whites (Armstrong et al., 2006; Thomas et al., 2000). Blacks also are less likely to respond to interferon-alpha-based treatment for chronic hepatitis C; this seems to be explained to a large extent by differences in DNA sequences near the interferon lambda 3 gene (Ge et al., 2009; Jeffers et al., 2004; Muir et al., 2004; Thomas et al., 2009). Likewise, there appears to be a greater burden of chronic hepatitis C and reduced response to treatment in Hispanic whites than in non-Hispanic whites (Armstrong et al., 2006; Bonacini et al., 2001; Rodriguez-Torres et al., 2009). In both Hispanics and blacks, HCC risk is increasing, in large part because of chronic hepatitis C (Altekruse et al., 2009). However, there is less evidence than in the case of HBV infection that different HCV genotypes or higher blood HCV concentrations increase the risk of long-term disease outcomes. Health-care use trends from 1994 to 2001 show a 20–30% yearly increase in HCV-related hospitalizations, length of hospital stays, total hospitalization costs, and hospital deaths (Grant et al., 2005).


CDC has developed recommendations for the prevention and control of hepatitis B (Mast et al., 2005, 2006; Weinbaum et al., 2008) and hepatitis C (CDC, 1998, 2001). The National Institutes of Health (NIH) has developed consensus documents on the management of hepatitis B (NIH, 2008) and hepatitis C (NIH, 2002). WHO has published guidelines related to hepatitis B vaccination of children (WHO, 2001). A number of not-for-profit organizations have also worked to increase awareness of the diseases, educate the public about prevention, and advocate for those chronically infected with HBV and HCV. Although government and nongovernment efforts have led to a decline in the number of cases, chronic hepatitis B and hepatitis C continue to be serious public-health problems in the United States. For that reason, CDC in conjunction with the National Viral Hepatitis Roundtable, a not-for-profit coalition of public, private, and voluntary organizations; the Department of Health and Human Services Office of Minority Health; and VA sought guidance from the Institute of Medicine (IOM) in identifying missed opportunities related to the prevention and control of HBV and HCV infections. IOM was asked to focus on hepatitis B and hepatitis C because they are common in the United States and can lead to chronic disease. This report does not address hepatitis A virus, hepatitis E virus, or hepatitis D virus (also called the hepatitis delta virus) infections.

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