试着翻译美国“乙肝法案”

askajy

第109次国会第一部分 H.R.4550

旨在改进公共健康服务法案，指导健康和人类服务部建立、改善和支持一个全面的预防、教育、研究和医学管理计划。上述计划致力于显著降低肝硬化，减少由HBV感染所导致的肝癌病例，以及增加上述肝癌病例生存率。

在众议院，Dent先生（代表其本人以及本田先生）提出下列议案，该议案于____递交至委员会。

                                                              议案

为了改进公共健康服务法案，指导健康和人类服务部建立、改善和支持一个全面的预防、教育、研究和医学管理计划。上述计划致力于显著降低肝硬化，减少由HBV感染所导致的肝癌病例，以及增加上述肝癌病例生存率。

使其由美国国会议院及参议员制定和通过该法案。

第一部分 简称

该法案可被引述为“全国乙型肝炎法案”。

第二部分 结论

国会得出如下结论：

（1）约140万美国人有慢性乙型肝炎感染。可认为美国慢性乙型肝炎感染者的数目会随着每年从该病流行国家移民数目的增加而增加。

（2）乙型肝炎极易传染。事实上，该病的传染性比HIV强100倍以上。B型肝炎病毒（HBV）与HIV的传播方式一样：分娩时的母婴传播，通过血液感染或血液感染了的注射传播，以及通过未加防护的性活动传播。

（3）乙型肝炎在该病的早期阶段通常不会引起症状，但经过若干年的临床上的“静止期”，约有25％的感染个体会发展为终末期肝病或肝癌。

（4）乙型肝炎感染的主要后果来自于慢性乙型肝炎感染。慢性乙型肝炎感染者有较高机率发展成为肝硬化（scarring）和肝癌，而后二者都可导致过早死亡。每年有5000例死亡可由慢性乙型肝炎感染所导致。

（5）慢性乙型肝炎感染对美国某些职业和人群的影响是不均衡的。尽管美国的亚裔只占人口总数的4％，美国亚裔和太平洋岛屿人口却占据了全美140万慢性乙型肝炎感染者的半数以上。

（6）乙型肝炎可通过现有的疫苗接种和减少高危行为来预防。乙肝疫苗安全有效，被誉为“第一抗癌疫苗”。

（7）乙型肝炎的诊断可通过一种简单的血液检查进行，该种血液检查价格低廉且容易实施。对乙型肝炎的进行早期诊断，并结合防疫教育以及对家庭成员和其他易感人群进行预防接种，可降低乙型肝炎进一步传播的危险。

（8）如果乙型肝炎在其感染的早期阶段被确诊，则其治疗方法类似与HIV感染，如果处置得当，可降低其发展成为肝癌和肝硬化的危险。

（9）对慢性乙型肝炎患者而言，例行的监测有助于肝癌的早期发现，在此早期阶段，肝癌仍然是可治愈的。肝癌是最致命的癌症种类之一，且用于其研究和预防的资金很少。

（10）尽管该病的研究，预防和治疗费用不低，但较之用于全美国乙型肝炎的医疗保健的费用（据估计约25亿美元，患者人均2000美元），其仍然是相当低的。2000年（在能得到大多数最新的治疗之前）乙型肝炎的终身治疗费用约为每名慢性感染患者80000美元，或总计1000亿美元以上。

第三部分 乙型肝炎全面预防、教育、研究和医学管理计划

对公共健康服务法案标题III进行修改，在其结尾处附加如下内容：

第R段－乙型肝炎全面预防、教育、研究和医学管理计划

第399AA节，计划的研发

“（a） 总体原则－该部应研究并实施一种用于对乙型肝炎进行预防、控制和医学管理的计划，包括扩大疫苗接种范围，中小学防疫的教育、训练、监控和早期诊断，以及相关研究。

“（b）加入计划研发－为研发所述（a）子节的计划，该部应－

  “（1）以现有的人类和健康服务部、疾病控制和预防中心以及国家健康学会的建议为指导方针；且

  “（2）共同商讨，其对象为：

     “（A）疾病控制和预防中心的理事；

     “（B）国家健康学会的理事；

     “（C）国家癌症学会的理事；

     “（D）健康资源和服务局的管理人员；

     “（E）药物滥用和精神健康服务局的管理人员；

     “（F）其他向病毒性肝炎患者提供教育服务的联邦政府和办公机构的领导人员；

     “（G）医学咨询机构，例如国家乙型肝炎专门部门（该部门主要针对亚裔和太平洋岛屿区美国人）、国家病毒性肝炎圆桌会议、斯坦福大学的肝脏中心、乙型肝炎基金会、全美肝脏基金会、国际肝炎基金会，以及亚裔美国人健康研究中心等；以及

     “（H）公众人员，其包括－

           “（i）乙型肝炎患者；以及

           “（ii）从事乙型肝炎事务的志愿人员。

“（c）该计划两年一度的更新－

  “（1）总体原则－该部应对根据（a）子节研发的计划实施两年一度的评估，以求－

[此贴子已经被作者于2006-5-29 7:45:58编辑过]

askajy

待译

[此贴子已经被作者于2006-5-27 5:31:17编辑过]

askajy

109th CONGRESS

1st Session

H. R. 4550

To amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish, promote, and support a comprehensive prevention, education, research, and medical management program that will lead to a marked reduction in liver cirrhosis and a reduction in the cases of, and improved survival of, liver cancer caused by chronic hepatitis B infection.

IN THE HOUSE OF REPRESENTATIVES

December 15, 2005
Mr. DENT (for himself and Mr. HONDA) introduced the following bill; which was referred to the Committee on Energy and Commerce

--------------------------------------------------------------------------------

A BILL

To amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish, promote, and support a comprehensive prevention, education, research, and medical management program that will lead to a marked reduction in liver cirrhosis and a reduction in the cases of, and improved survival of, liver cancer caused by chronic hepatitis B infection.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `National Hepatitis B Act'.

SEC. 2. FINDINGS.

The Congress makes the following findings:

(1) Approximately 1.4 million Americans are chronically infected with hepatitis B. The number of chronically infected persons in the United States is believed to be increasing each year with the influx of new immigrants from areas where it is endemic.

(2) Hepatitis B is extremely infectious. In fact, the disease is 100 times more infectious than HIV. The hepatitis B virus (HBV) is transmitted the same way as HIV: from mother to newborn at birth, from infected blood or injections contaminated by infected blood, and from unprotected sex.

(3) Chronic hepatitis B usually does not cause any symptoms early in the course of the disease, but after many years of a clinically `silent' phase, as many as 25 percent of infected individuals may develop end-stage liver disease or liver cancer.

(4) The major burden of hepatitis B infection in the United States is from chronic hepatitis B infection. Persons chronically infected with hepatitis B are at higher risk of developing cirrhosis (scarring) of the liver and liver cancer, both of which can lead to premature death. About 5,000 deaths per year in the United States can be attributed to chronic hepatitis B infection.

(5) Chronic hepatitis B infection disproportionately affects certain occupations and populations in the United States. Although representing only four percent of the population, Asian Americans and Pacific Islanders account for over half of the 1.4 million chronic hepatitis B cases in the United States.

(6) Hepatitis B infection is preventable through currently available vaccinations and by reducing high-risk behavior. The hepatitis B vaccine is safe and effective and has the designation of being the `first anti-cancer vaccine'.

(7) The diagnosis of chronic hepatitis B infection can be made with a simple blood test that is inexpensive and widely available. The early diagnosis of chronic hepatitis B can reduce the risk of further transmission of the virus through harm reduction education and the vaccination of household members and other susceptible persons at risk.

(8) If the diagnosis of hepatitis B infection is made at an early stage of the infection, treatment of chronic hepatitis B infection with antiviral therapy similar to that employed in HIV, when appropriate, can reduce the risk of progression to liver cancer and cirrhosis.

(9) For those who are chronically infected, regular monitoring can lead to the early detection of liver cancer at a stage where cure is still possible. Liver cancer is one of the deadliest types of cancer and one that has received little funding for research and prevention.

(10) Although the costs of education, research, and treatment are not trivial, they are substantially less than the annual health care cost attributable to hepatitis B in the Unites States, which is estimated to be approximately $2.5 billion ($2000 per infected person). The lifetime cost of the hepatitis B virus in 2000--before the availability of most of the current therapies--was approximately $80,000 per person chronically infected, or more than $100 billion.

SEC. 3. COMPREHENSIVE HEPATITIS B PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PROGRAM.

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by adding at the end of the following:

`PART R--COMPREHENSIVE HEPATITIS B PREVENTION, EDUCATION, RESEARCH, AND MEDICAL MANAGEMENT PROGRAM

`SEC. 399AA. PROGRAM DEVELOPMENT.

`(a) In General- The Secretary shall develop and implement a plan for the prevention, control, and medical management of hepatitis B, which includes strategies for expanded vaccination programs, primary and secondary preventive education and training, surveillance and early detection, and research.

`(b) Input in Development of Plan- In developing the plan under subsection (a), the Secretary shall--

`(1) be guided by existing recommendations of the Department of Health and Human Services, the Centers for Disease Control and Prevention, and the National Institutes of Health; and

`(2) consult with--

`(A) the Director of the Centers for Disease Control and Prevention;

`(B) the Director of the National Institutes of Health;

`(C) the Director of the National Cancer Institute;

`(D) the Administrator of the Health Resources and Services Administration;

`(E) the Administrator of the Substance Abuse and Mental Health Services Administration;

`(F) the heads of other Federal agencies or offices providing education services to individuals with viral hepatitis;

`(G) medical advisory bodies, such as the National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans, the National Viral Hepatitis Roundtable, the Asian Liver Center at Stanford University, the Hepatitis B Foundation, the American Liver Foundation, Hepatitis Foundation International, and the Center for the Study of Asian American Health; and

`(H) the public, including--

`(i) individuals infected with hepatitis B; and

`(ii) advocates concerned with issues related to hepatitis B.

`(c) Biennial Update of the Plan-

`(1) IN GENERAL- The Secretary shall conduct a biannual assessment of the plan developed under subsection (a) for the purposes of--

`(A) incorporating into such plan new knowledge or observations relating to hepatitis B (such as knowledge and observations that may be derived from clinical, laboratory, and epidemiological research and disease detection, prevention, and surveillance outcomes); and

`(B) addressing gaps in the coverage or effectiveness of the plan.

`(2) PUBLICATION OF NOTICE OF ASSESSMENTS- Not later than October 1 of the first even numbered year beginning after the date of enactment of this part, and October 1 of each even numbered year thereafter, the Secretary shall publish in the Federal Register a notice of the results of the assessments conducted under paragraph (1). Such notice shall include--

`(A) a description of any revisions to the plan developed under subsection (a) as a result of the assessment;

`(B) an explanation of the basis for any such revisions, including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan; and

`(C) in the case of a determination by the Secretary that the plan does not need revision, an explanation of the basis for such determination.

[此贴子已经被作者于2006-5-27 5:30:34编辑过]

askajy

`SEC. 399BB. ELEMENTS OF PROGRAM.

`(a) Immunization, Prevention, and Control Programs-

`(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the integration of activities described in paragraph (2) into existing clinical and public health programs at State, local, and tribal levels (including Asian and non-Asian community health clinics, programs for the prevention and treatment of HIV/AIDS, sexually transmitted diseases, and substance abuse, and programs for individuals in correctional settings).

`(2) ACTIVITIES-

`(A) VOLUNTARY TESTING PROGRAMS-

`(i) IN GENERAL- The Secretary shall establish a mechanism by which to support and promote the development of State, local, and tribal voluntary hepatitis B testing programs to screen the high chronic hepatitis B prevalence populations (such as Asian Americans, new immigrants or foreign-born United States residents, and persons with one or both foreign-born parents) to aid in the early identification of chronically infected individuals.

`(ii) CONFIDENTIALITY OF THE TEST RESULTS- The Secretary shall prohibit the use of the results of a hepatitis B test conducted by a testing program developed or supported under this subparagraph for any of the following:

`(I) Issues relating to health insurance.

`(II) To screen or determine suitability for employment.

`(III) To discharge a person from employment.

`(B) COUNSELING- The Secretary shall support State, local, and tribal programs in a wide variety of settings, including those providing primary and specialty health care services in the private and public sectors, to--

`(i) provide individuals with ongoing risk factors for hepatitis B infection with client-centered education and counseling which concentrates on--

`(I) promoting testing of family members and their sexual partners; and

`(II) changing behaviors that place individuals at risk for infection;

`(ii) provide individuals chronically infected with hepatitis B with education, health information, and counseling to reduce their risk of--

`(I) dying from end stage liver disease and liver cancer; and

`(II) transmitting viral hepatitis to others; and

`(iii) provide women chronically infected with hepatitis B who are pregnant or in their child bearing age with culturally appropriate health information to alleviate their fears of becoming pregnant or raising a family.

`(C) IMMUNIZATION- The Secretary shall support State, local, and tribal efforts to expand the current vaccination programs to protect every child in the country and all susceptible adults, particularly those from the high-prevalence ethnic populations and other high risk groups, from the risks of acute and chronic hepatitis B infection by--

`(i) ensuring continued funding for hepatitis B vaccination for all children 19 years of age or under through the Vaccines for Children Program;

`(ii) ensuring that the recommendations of the Advisory Committee on Immunization Practices are followed regarding hepatitis B vaccinations for newborns;

`(iii) requiring proof of hepatitis B vaccination for entry into public or private day care, preschool, elementary school, secondary school, and institutions of higher education;

`(iv) expanding the availability of vaccines for all susceptible adults to protect them from becoming acutely or chronically infected, including ethnic populations with high prevalence rates of chronic hepatitis B infection; and

`(v) expanding the availability of vaccines for all susceptible adults, particularly those in their reproductive age (women and men less than 45 years of age), from the risk of hepatitis B infection.

`(D) MEDICAL REFERRAL- The Secretary shall support State, local, and tribal programs that support--

`(i) referral of persons chronically infected with hepatitis B--

`(I) for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer; and

`(II) for regular monitoring of liver function and screening for liver cancer; and

`(ii) referral of persons infected with acute or chronic hepatitis B for drug and alcohol abuse treatment where appropriate.

`(3) INCREASED SUPPORT FOR HEPATITIS B COORDINATORS- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall provide hepatitis B coordinators to State, local, and tribal health departments in order to enhance the additional management, networking, and technical expertise needed to ensure successful integration of hepatitis B prevention and control activities into existing public health programs.

`(b) Education and Awareness Programs- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Administrator of the Substance Abuse and Mental Health Services Administration, and in accordance with the plan developed under section 399AA, shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis B. Such programs shall include--

`(1) the conduct of culturally and language appropriate health education, public awareness campaigns, and community outreach activities (especially to the ethnic communities with high rates of chronic hepatitis B and other high-risk groups) to promote public awareness and knowledge about the value of hepatitis B immunization, risk factors, the transmission and prevention of hepatitis B, and the value of screening for the early detection of hepatitis B infection;

`(2) the promotion of immunization programs that increase awareness and access to hepatitis B vaccines for susceptible adults and children;

`(3) the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis B in certain adult ethnic populations, and the importance of prevention, detection, and medical management of hepatitis B and of liver cancer screening;

`(4) the development and distribution of health education curricula (including information relating to the special needs of individuals infected with hepatitis B, such as the importance of prevention and early intervention, regular monitoring, and appropriate treatment and liver cancer screening) for individuals providing hepatitis B counseling;

`(5) support for the implementation curricula described in paragraph (4) by State and local public health agencies; and

`(6) the provision of grants for the inclusion of viral hepatitis and liver wellness education curricula in elementary and secondary school health education programs.

`(c) Epidemiological Surveillance-

`(1) IN GENERAL- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the establishment and maintenance of a national chronic and acute hepatitis B surveillance program, in order to identify--

`(A) trends in the incidence of acute and chronic hepatitis B;

`(B) trends in the prevalence of acute and chronic hepatitis B infection among groups that may be disproportionately affected by hepatitis B; and

`(C) liver cancer and end stage liver disease incidence and deaths, caused by chronic hepatitis B in the various ethnic populations.

`(2) SEROPREVALENCE AND LIVER CANCER STUDIES- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall prepare a report outlining the population-based seroprevalence studies currently under way, future planned studies, the criteria involved in determining which seroprevalence studies to conduct, defer, or suspend, and the scope of those studies, the economic and clinical impact of hepatitis B, and the impact of hepatitis B on quality of life. Not later than one year after the date of enactment of this part, the Secretary shall submit the report to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate.

`(3) CONFIDENTIALITY- The Secretary shall not disclose any individually identifiable information identified under paragraph (1) or derived through studies under paragraph (2).

`(d) Research- The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Director of the National Cancer Institute, and the Director of the National Institutes of Health, shall--

`(1) conduct community-based research to develop, implement, and evaluate best practices for hepatitis B prevention especially in the ethnic populations with high rates of chronic hepatitis B and other high-risk groups;

`(2) conduct research on hepatitis B natural history, pathophysiology, improved treatments, and non-invasive tests that helps to predict the risk of progression to liver cirrhosis and liver cancer; and

`(3) conduct research that will lead to better non-invasive or blood tests to screen for liver cancer, and more effective treatments of liver cancer caused by chronic hepatitis.

`(e) Expanded Support for Underserved and Disproportionately Affected Populations Chronically Infected With HBV- In carrying out this section, the Secretary shall give priority to individuals with limited access to health education, testing, and health care services and groups that may be disproportionately affected by hepatitis B, including populations such as Asian Americans with a high incidence of chronic hepatitis B and liver cancer.'.
END

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