I 
112TH CONGRESS 
1ST SESSION H. R. 3381 
To amend the Public Health Service Act to revise and extend the program 
for viral hepatitis surveillance, education, and testing in order to prevent 
deaths from liver cancer, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 4, 2011 
Mr. CASSIDY (for himself, Mr. HONDA, Mr. JOHNSON of Georgia, Mr. DENT, 
and Mr. BILBRAY) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to revise and extend 
the program for viral hepatitis surveillance, education, 
and testing in order to prevent deaths from liver cancer, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Viral Hepatitis Testing 
Act of 2011’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Approximately 5,300,000 Americans are 
chronically infected with the hepatitis B virus (re-
ferred to in this section as ‘‘HBV’’), the hepatitis C 
virus (referred to in this section as ‘‘HCV’’), or 
both. 
(2) In the United States, chronic HBV and 
HCV are the most common cause of liver cancer, 
one of the most lethal and fastest growing cancers 
in the United States. Chronic HBV and HCV are 
the most common cause of chronic liver disease, liver 
cirrhosis, and the most common indication for liver 
transplantation. Chronic HCV is also a leading 
cause of death in Americans living with HIV/AIDS, 
many of whom are coinfected with chronic HBV, 
HCV, or both. At least 15,000 deaths per year in 
the United States can be attributed to chronic HBV 
and HCV. 
(3) According to the Centers for Disease Con-
trol and Prevention (referred to in this section as 
the ‘‘CDC’’), approximately 2 percent of the popu-
lation of the United States is living with chronic 
HBV, HCV, or both. The CDC has recognized HCV 
as the Nation’s most common chronic bloodborne 
virus infection and HBV as the deadliest vaccine- 
preventable disease. 
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(4) HBV is easily transmitted and is 100 times 
more infectious than HIV. According to the CDC, 
HBV is transmitted through percutaneous (i.e., 
puncture through the skin) or mucosal contact with 
infectious blood or body fluids. HCV is transmitted 
by percutaneous exposures to infectious blood. 
(5) The CDC conservatively estimates that in 
2008 approximately 18,000 Americans were newly 
infected with HCV and more than 38,000 Americans 
were newly infected with HBV. 
(6) There were 10 outbreaks reported to CDC 
for investigation in 2009 related to healthcare ac-
quired infection of HBV and HCV. There were an-
other 6,748 patients potentially exposed to one of 
the viruses. 
(7) Chronic HBV and chronic HCV usually do 
not cause symptoms early in the course of the dis-
ease, but after many years of a clinically ‘‘silent’’ 
phase, CDC estimates show more than 33 percent of 
infected individuals will develop cirrhosis, end-stage 
liver disease, or liver cancer. Since most individuals 
with chronic HBV, HCV, or both are unaware of 
their infection, they do not know to take precautions 
to prevent the spread of their infection and can un-
knowingly exacerbate their own disease progression. 
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(8) HBV and HCV disproportionately affect 
certain populations in the United States. Although 
representing only 5 percent of the population, Asian 
and Pacific Islanders account for over half of the 
1,400,000 domestic chronic HBV cases. Baby 
boomers (those born between 1945 and 1965) ac-
count for more than 75 percent of domestic chronic 
HCV cases. In addition, African-Americans, Latinos 
(Latinas), and American Indian/Native Alaskans are 
among the groups which have disproportionately 
high rates of HBV infections, HCV infections, or 
both in the United States. 
(9) For both chronic HBV and chronic HCV, 
behavioral changes can slow disease progression if 
diagnosis is made early. Early diagnosis, which is 
determined through simple diagnostic tests, can re-
duce the risk of transmission and disease progres-
sion through education and vaccination of household 
members and other susceptible persons at risk. 
(10) Advancements have led to the development 
of improved diagnostic tests for viral hepatitis. 
These tests, including rapid, point of care testing 
and others in development can facilitate testing, no-
tification of results and post-test counseling, and re-
ferral to care at the time of the testing visit. In par-
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ticular, these tests are also advantageous because 
they can be used simultaneously with HIV rapid 
testing for persons at risk for both HCV and HIV 
infections. 
(11) For those chronically infected with HBV 
or HCV, regular monitoring can lead to the early de-
tection of liver cancer at a stage where a cure is still 
possible. Liver cancer is the second deadliest cancer 
in the United States however, liver cancer has re-
ceived little funding for research, prevention, or 
treatment. 
(12) Treatment for chronic HCV can eradicate 
the disease in approximately 75 percent of those cur-
rently treated. The treatment of chronic HBV can 
effectively suppress viral replication in the over-
whelming majority (over 80 percent) of those treated 
thereby reducing the risk of transmission and pro-
gression to liver scarring or liver cancer even though 
a complete cure is much less common than for HCV. 
(13) To combat the viral hepatitis epidemic in 
the United States, in May 2011, the Department of 
Health and Human Services released, Combating the 
Silent Epidemic of Viral Hepatitis: Action Plan for 
the Prevention, Care & Treatment of Viral Hepa-
titis. The Institute of Medicine of the National 
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Academies produced a 2010 report on the Federal 
response to HBV and HCV titled: Hepatitis and 
Liver Cancer: A National Strategy for Prevention 
and Control of Hepatitis B and C. The recommenda-
tions and guidelines provide a framework for HBV 
and HCV prevention, education, control, research, 
and medical management programs. 
(14) The annual health care costs attributable 
to viral hepatitis in the United States are signifi-
cant. For HBV, it is estimated to be approximately 
$2,500,000,000 ($2,000 per infected person). In 
2000, the lifetime cost of HBV—before the avail-
ability of most of the current therapies—was ap-
proximately $80,000 per chronically infected person, 
or more than $100,000,000,000. For HCV, medical 
costs for patients are expected to increase from 
$30,000,000,000 in 2009 to over $85,000,000,000 
in 2024. Avoiding these costs by screening and diag-
nosing individuals earlier—and connecting them to 
appropriate treatment and care will save lives and 
critical health care dollars. Currently, without a 
comprehensive screening, testing and diagnosis pro-
gram, most patients are diagnosed too late when 
they need a liver transplant costing at least 
$314,000 for uncomplicated cases or when they have 
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