21. Hepatitis B - What Do the Numbers Tell Us?

So what is my take on this, in terms of trying to put it into different categories? (And yes, I have not presented any data on treatment issues, but I will talk about it here using this slide.) In terms of primary prevention, I think we are doing very well - the data show that we are doing very well in terms of primary prevention in young children. In adolescents we are doing pretty well. There is plenty of room for improvement, but we have the mechanisms and the programs in place to do it. In adults, we are not doing well at all - really quite poor in terms of that's where the disease is, that is where our problems still exist. What about secondary prevention; the issue of preventing transmission from infected people, people who have chronic hepatitis B, to others? Well, we don't have very good data, in fact we have very little data, but we do have some data from one program, and that is from pregnant women who are screened to identify whether they are chronically infected. That has been a program that has been in place for almost a decade now. And what we have seen is that because there is a program, the household and sexual contacts of those women are being vaccinated, and we are seeing that in households, there are fewer and fewer of them to be vaccinated, because we have been catching up - we have been finding these people. Now, we don't have much information about the rest of them - the 1.25 million people out there with chronic infections. And in fact, only this last year did chronic hepatitis B infection become a reportable condition. About 25 states now have databases, but we actually don't know how well they are following these people up to see whether they are being vaccinated or counseled. That gets us to the last part, tertiary prevention - treatment, or even medical evaluation for treatment. Frankly, we have no national numbers on this in terms of how well we are doing, and I think we know that a number of new treatments have real potential in terms of prevention of cirrhosis and primary hepatocellular carcinoma in people with chronic infection and that is an area that needs a lot more work. So, I think we have some good information in the area of primary prevention, but we are really lacking information in terms of how well we are doing in secondary and tertiary prevention.