报告确定到2030年前美国预防90,000例乙型和丙型肝炎死亡的计

StephenW

     
Report Defines Plan to Prevent 90,000 Hepatitis B and C Deaths in US by 2030
by Daniela Semedo, PhD

With better strategies on prevention, screening, treatment, and creative financing for medications, the U.S. could eradicate hepatitis B and C as public health problems, preventing nearly 90,000 deaths by 2030, according to a report from the National Academies of Sciences, Engineering, and Medicine.

The report is titled "A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report."

"Viral hepatitis is simply not a sufficient priority in the United States," Brian Strom, chair of the committee that carried out the study and chancellor and professor, Rutgers Biomedical and Sciences, Rutgers University in New Jersey, said in a news release.

"Despite being the seventh leading cause of death in the world — and killing more people every year than HIV, road traffic accidents, or diabetes — viral hepatitis accounts for less than 1 percent of the National Institutes of Health research budget," Strom said.

Chronic hepatitis B affects approximately 1.3 million Americans, while around 2.7 million are living with chronic hepatitis C. Both infections increase the risk for liver cancer, which has seen an increase of 38 percent in the country between 2003 and 2012. The deaths caused by liver cancer increased 56 percent in the same period, primarily due to viral hepatitis. However, these deaths are preventable.
Fewer deaths from hepatitis

The hepatitis B vaccine can prevent infection, and advances in treatment can cure people of the disease. According to the new report, hepatitis B-related deaths could be cut in half by 2030, if 90 percent of the country's patients with chronic hepatitis B are diagnosed and treated.

The experts estimated that in this way, over 60,000 deaths could be avoided, and the rates of cirrhosis and liver cancer from hepatitis B could be reduced by approximately 45 percent.

At the same time, treating all people with chronic hepatitis C would lessen new infections by 90 percent by 2030, and decrease deaths from hepatitis C by 65 percent over the same period. The panel of experts believes that such actions would prevent 28,800 hepatitis C deaths by 2030.
Prevention is important

To eliminate hepatitis B and C as public health problems, prevention is key. Therefore, experts recommend that states should:

    Expand access to the adult hepatitis B vaccine, eliminating obstacles for free immunization in pharmacies and other accessible settings;
    Expand syringe exchange programs for people who inject drugs;
    Offer unrestricted treatment for everyone with hepatitis C.

Currently there is no vaccine for hepatitis C, so prevention should be done by limiting exposure to the virus. People who inject drugs account for 75 percent of the approximately 30,500 new cases of hepatitis C annually in the U.S. Reach these people is necessary to end transmission of the disease. The committee suggests strategies combining both safer injection and treatment for the underlying addiction.

The U.S. Food and Drug Administration (FDA) has approved a few new antiviral medicines to treat hepatitis C in the last two years. These therapies can completely clear the virus from a patient’s body in as little as eight weeks with a single daily pill. However, these treatments are expensive.
Licensing agreement

In the new report, the experts recommended a voluntary licensing agreement between the federal government and a patent-holding pharmaceutical company as a way to make the drug more affordable for Medicaid beneficiaries and other underserved patient populations.

A licensing deal could cost taxpayers an estimated $2 billion, and the medications would then be used to treat about 700,000 neglected patients. But in comparison, under the status quo, it would cost about $10 billion over the next 12 years to treat only 240,000 of the same group of patients.

While unlimited access to hepatitis C treatment is necessary to eliminate the disease as a public health problem by 2030, there will be no direct-acting agents off patent before 2029. Delaying mass treatment until generic medicines are available would result in tens of thousands of deaths and billions of dollars in wasted medical costs.

People at risk for hepatitis B and C are often difficult to reach and are not always engaged in care services. To address this challenge, the committee recommended the U.S. Department of Health and Human Services should work with states to create a comprehensive system of care and support.

Experts also noted that the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America should partner with primary care providers to develop the capacity to treat hepatitis B and C within primary care settings.

StephenW

报告确定到2030年前美国预防90,000例乙型和丙型肝炎死亡的计划
作者：Daniela Semedo博士

根据美国国家科学院工程研究所的一份报告，美国可以通过更好的预防，筛选，治疗和创意融资策略来消除乙型和丙型肝炎作为公共卫生问题，从而在2030年之前阻止近9万人死亡。医学。

报告题目为“消除乙型肝炎和丙型肝炎国家战略：二期报告”。

新泽西州罗格斯大学的罗茨格大学研究和校长，罗格斯生物医学与科学学院教授，​​主任Brian Strom表示：“病毒性肝炎在美国根本不是一个充分的优先事项。

斯特罗姆说：“尽管世界上是第七大死因，每年杀死更多的艾滋病毒，道路交通事故或糖尿病 - 病毒性肝炎占国家卫生研究机构研究预算的不到1％。”

慢性乙型肝炎影响约130万美国人，而大约270万人患有慢性丙型肝炎。这两种感染增加了肝癌的风险，在2003年至2012年期间，该国增加了38％。肝脏造成的死亡同期癌症增加56％，主要是由于病毒性肝炎。然而，这些死亡是可以预防的。
肝炎死亡人数减少

乙型肝炎疫苗可以预防感染，治疗进展可以治愈疾病。根据新的报道，到2030年，乙型肝炎相关死亡人数可能会减少一半，如果全国90％的慢性乙型肝炎患者被诊断和治疗。

专家估计，这样可以避免6万多人的死亡，乙型肝炎的肝硬化和肝癌的发病率可以降低约45％。

同时，治疗所有慢性丙型肝炎患者，到2030年将新感染减少90％，同期丙肝死亡人数降低65％。专家小组认为，这样的行动将在2030年之前阻止28,800例丙型肝炎死亡。
预防是重要的

为了消除乙型和丙型肝炎作为公共卫生问题，预防是关键。因此，专家建议国家应：

    扩大成人乙型肝炎疫苗的接触程度，消除药房和其他无障碍设施免费免疫的障碍;
    为注射毒品者扩大注射器交换计划;
    为丙型肝炎患者提供无限制的治疗。

目前没有丙型肝炎疫苗，因此应通过限制暴露于病毒来进行预防。注射毒品的人每年在美国约30,500例新型丙型肝炎病例中占75％。接触这些人是有必要终止传播疾病。该委员会提出的战略是结合更安全的注射和治疗的基础成瘾。

美国食品和药物管理局（FDA）在过去两年中已经批准了几种新的抗病毒药物来治疗丙型肝炎。这些疗法可以在短短八个星期内用单次每日药丸，彻底清除患者身体的病毒。然而，这些治疗是昂贵的。
许可协议

在新的报告中，专家们建议联邦政府和专利药物制药公司之间签署自愿许可协议，以此作为使医疗救助金和其他服务不足的患者人群更加负担得起的药物。

许可协议可能会使纳税人估计有20亿美元，然后将药物用于治疗约70万被忽视患者。但相比之下，在现状下，在接下来的12年中，只需要花费约100亿美元来治疗同一组患者中只有24万人。

尽管在2030年之前无需获得丙型肝炎治疗就可以将疾病消除为公共卫生问题，但在2029年之前就不会有专利代理人脱离专利。延误大规模治疗直到仿制药物可以造成成千上万的死亡数十亿美元浪费医疗费用。

乙型和丙型肝炎的风险往往难以达到，并不总是从事护理服务。为了应对这一挑战，委员会建议美国卫生与人类服务部与国家合作，共同创建一个全面的照顾和支持体系。

专家们还指出，美国肝脏疾病研究协会和美国传染病学会应与初级保健机构合作，开发在初级保健机构中治疗乙型和丙型肝炎的能力。