This document calls for increased federal funding of $32.4 million for hepatitis prevention programs at the CDC. Currently, the CDC's Division of Viral Hepatitis only receives $17.6 million, which is not enough to establish surveillance systems or provide core prevention services for the millions of Americans infected with hepatitis B and C. Increased funding is needed to test more individuals, educate the public and medical providers, vaccinate high-risk adults, and support state prevention programs. Without more funding, hepatitis outbreaks will continue to be addressed reactively rather than systematically preventing new infections.

1. Support FY2009 Hepatitis
Prevention Funding
UNMET PROGRAMMATIC AND FISCAL NEEDS DIVISION OF VIRAL HEPATITIS (DVH)
There is no federal funding to provide core (Dollars in millions)
public health services for viral hepatitis. Funds
FY 2009 NASTAD Recommendation*: $50.0
are needed for hepatitis B and C counseling,
testing, and medical referral. States receive on
FY 2009 President’s Budget: $17.5
average $90,000 for adult hepatitis prevention.
This provides for little more than a position in the FY 2008 Appropriation: $17.6
health department. Availability of testing is
essential so individuals can take steps to protect * $32.4 million increase, including a doubling of funding to the
state adult viral hepatitis prevention coordinators from $5 to $10
their health and prevent infecting others. million
Addressing hepatitis by each outbreak is not
disease prevention. Due to lack of funding, CDC
CDC’S DIVISION OF VIRAL HEPATITIS
treats hepatitis outbreaks as sentinel events rather
than systematically addressing hepatitis B and C
The Centers for Disease Control and Prevention’s (CDC)
epidemics with over 6 million Americans infected.
Division of Viral Hepatitis (DVH) receives only $17.6 million
Addressing one outbreak at a time is not cost-
to provide the scientific and programmatic foundation for
effective nor is it prevention.
the prevention, control, and elimination of hepatitis virus
There is no federally funded chronic hepatitis B
and C surveillance system. The first step to infections in the U.S. DVH sits within the National Center
controlling infectious diseases such as hepatitis B for HIV, Viral Hepatitis, STD and TB Prevention, thereby
and C is establishing a surveillance system to increasing collaboration and coordination for prevention
monitor disease incidence, prevalence, and trends. services to similar populations. In 2001, DVH published the
Education of the public and medical providers on National Hepatitis C Prevention Strategy which is a roadmap
preventing viral hepatitis must be stepped up. to reduce the disease burden of chronic hepatitis C.
Given the recent public health crises in Nevada Unfortunately Congress has not funded the Strategy to make
and New York, it is clear an investment in public
it a reality. DVH provides $5 million to fund the position of
and provider education is warranted. Basic
an Adult Viral Hepatitis Prevention Coordinator in 48 states,
standard precautions are not being adhered to
three cities, and the District of Columbia. This is only
resulting in infections. State public health
enough for the position and not for the provision of
programs must be provided resources to support
prevention services.
education activities.
To eliminate hepatitis A and B an investment in CDC Historical Division of Viral Hepatitis, FY2004-FY2008
vaccination of high risk adults is essential.
Vaccines to prevent hepatitis A and hepatitis B $18.1
$18.2
have been available for over 10 and 20 years, $17.9
$18.0
respectively.1,2 The vaccination of high-risk adults $17.8
$17.6
$17.6
is modest despite recommendations and is $17.6
$17.4
necessary to eliminate both diseases.3 $17.4
There is no hepatitis C vaccine. Provision of basic $17.2
prevention services is the only way to prevent new $17.0
infections. The good news is there are drug $16.8
therapies that can eliminate the virus in over half 2004 2005 2006 2007 2008
of those treated. There are also a number of new Fiscal Year
promising therapies currently under development.

2. FY2009 Hepatitis Prevention Funding Needs
HEPATITIS A VIRUS (HAV)
HEPATITIS C VIRUS FACTS
Hepatitis A is one of the most frequently reported • An estimated 3 to 5 million Americans have been
vaccine preventable diseases in the United States.1 The infected with the hepatitis C virus
hepatitis A vaccine, available since 1995, is recommended • Each year, 1 to 4 percent of people with HCV-
for children aged one year and older and adults at-risk4; related cirrhosis develop liver cancer
however vaccination among adults remains low. DVH • 19,000 Americans were newly infected in 2006
responds to hepatitis A outbreaks and assists health • 3.2 million American are have chronic HCV—three
departments in vaccine delivery. times the number of individuals with HIV
• 25 percent of people living with HIV/AIDS are also
HEPATITIS A VIRUS FACTS
infected with HCV
• 32,000 new cases of HAV infection were estimated in
2006
• 11-22 percent of persons infected with HAV are
THE COST OF INACTION
hospitalized each year
• Approximately 100 cases of HAV result in death
• Total costs of HCV each year: $489 million6
• Costs of medical care and lost wages due to HCV:
HEPATITIS B VIRUS (HBV)
$658 million1
Hepatitis B virus is a common vaccine preventable • Direct medical costs of HCV: $750 million/year2
disease. The hepatitis B vaccine was developed in 1981; • Total medical expenditures for people with
since 1991 infants have been routinely vaccinated against hepatitis: $15 billion/year4
hepatitis B virus.2 Although the cost-effectiveness of • Employer costs for absentee losses due to hepatitis
vaccination of at-risk adults has been demonstrated, C: $4-5 billion/year4
implementation has not yet occurred, resulting in • Cost of premature disability and death (2010-2019):
thousands of unnecessary infections each year. Chronic $75.5 billion7
hepatitis B infection is a leading cause of liver disease
and cancer in the United States, and effective treatments
to clear the virus remain elusive.
REFERENCES
HEPATITIS B VIRUS FACTS 1Centers for Disease Control and Prevention. Prevention of
• 1.25 million Americans suffer from chronic HBV Hepatitis A Through Active and Passive Immunization:
• 46,000 new HBV infections were estimate in 2006 Recommendations of the Advisory Committee on
• 5,000 deaths result from HBV infection each year Immunization Practices (ACIP).
• $658 million in medical costs and lost wages occur 2Centers for Disease Control and Prevention. Inactivated
hepatitis B vaccine. MMWR Morb Mortal Wkly Rep. 1982;
each year as a result of HBV
31:317-318.
• Up to 10 percent of persons living with HIV are also
3Centers for Disease Control and Prevention A
infected with HBV
Comprehensive Immunization Strategy to Eliminate
Transmission of Hepatitis B Virus Infection in the United
HEPATITIS C VIRUS (HCV) States: Recommendations of the Advisory Committee on
Immunization Practices (ACIP), Part II: Immunization of
Hepatitis C is the most common blood-borne, chronic
Adults, MMWR Morb Mortal Wkly Rep. 2006; 55:1-25.
viral disease in the United States. Approximately 3.2 4Centers for Disease Control and Prevention.
million Americans are living with chronic hepatitis C, Recommendations for prevention and control of hepatitis C
and CDC estimates that approximately 20,000 new virus (HCV) infection and HCV-related chronic disease.
infections occurred in 2005.4 With no vaccine to prevent MMWR. 1998;47(No. RR-19):1-39.
5Centers for Disease Control and Prevention. Prevention of
infection, hepatitis C is now the leading indication for
Hepatitis A Through Active or Passive Immunization. As of
adult liver transplantation in the United States. Although
March 2008. available at
transmission of hepatitis C has significantly decreased in
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.
the U.S. over the past twenty years, the incidence of liver htm?s_cid=rr5507a1_e
disease and liver cancer is rising, as persons infected with 6Centers for Disease Control and Prevention. Disease burden
hepatitis C decades ago begin to develop complications from viral hepatitis A, B and C in the United States. As of
February 2006. available at
of their infection. Without increased resources for
http://www.cdc.gov/ncidod/diseases/hepatitis/resource/P
counseling, testing and medicals referral services, the
DFs/disease_burden.pdf
CDC predicts that deaths due to HCV will double by 7Berge, JJ, Drennan, DP, Jacobs, RJ, Jakins, A, Stubblefield, W,
2020. Weinberg, M. The cost of hepatitis A infections in American
adolescents and adults in 1997. Hepatology, 2000; 31: 469-473.