They're the overlooked viruses: Hepatitis B and C together infect three to five times more Americans than the AIDS virus does, and most don't know it.
In the next 10 years, these two liver-damaging infections will kill about 150,000 people in the U.S. alone, says a new report Monday from the prestigious Institute of Medicine.
It calls for a major public health push to decrease the stigma of these simmering viruses, which are to blame for nearly half the liver transplants performed every year.
"We have allowed gaps in screening, prevention and treatment to go unchecked," said report chairman R. Palmer Beasley of the University of Texas, Houston.
Some people can fight off hepatitis B or C, but it becomes a chronic, incurable infection in anywhere from 3.5 million to 5.3 million Americans, the report estimates. While anyone can be infected, the viruses disproportionately affect blacks, Asians and Pacific Islanders.
Among the report's recommendations:
— Wider use of a vaccine for hepatitis B. Three states — Alabama, Montana and South Dakota — don't require hepatitis B vaccination before entering day care or school. Also, about 1,000 babies born to infected mothers each year develop hepatitis B themselves. Vaccinating at-risk newborns in the delivery room, instead of within 12 hours of birth as is done today, might protect more of them.
— Improve public awareness. People at highest risk for hepatitis B include those born in parts of Asia and Africa where the virus is particularly widespread, infants born to infected mothers, sexual partners of the infected, and injecting drug users. At-risk adults can seek vaccination. Those at highest risk for hepatitis C include current or former injecting drug users and people who received a blood transfusion before 1992.
— Increase research into a vaccine for hepatitis C.
— Improve health services for hepatitis patients and encourage more testing of the at-risk, with special attention to stigma. Immigrants in particular may be reluctant to seek testing given attitudes in their home countries; in China, for example, hepatitis patients face strong job and social discrimination.