the ABC's of Hepatitis

• In 2005, there were an estimated 42,000 Hepatitis A infections.
• Hepatitis A is the cause of 30 days of missed work and approximately $2,600 in lost wages each year.
• Medical care alone for hepatitis A can cost $2,800 for each hospitalized case.
• Approximately 100 Americans die each year from Hepatitis A.
• The annual cost associated with Hepatitis A is estimated at $200 million in the U.S.

• HBV is 100 times more infectious than HIV, the virus that can cause AIDS.
• Hepatitis B vaccine can provide immunity in over 95% of young healthy adults.
• An estimated 350 million people are infected globally with HBV.
• Approximately 1 million die each year from complications from HBV.
• 70% of new cases occur among people between the ages of 15-39.
• Every year 5,000 Americans die from cirrhosis and 1,000 from liver cancer due to HBV infections.
• 22,000 pregnant women in the U.S. are infected with HBV and can transmit it to their newborns.
• HBV can live on a dry surface for at least 7 days.

• 3% of the world's population is infected with HCV, or approximately 170 million people. 90% of HCV patients who are in need of treatment today cannot afford it.
• 80% of affected people can become chronically infected and risk serious long-term clinical disease including cirrhosis and liver cancer.
• 8 countries – Bolivia, Burundi, Cameroon, Egypt, Guinea, Mongolia, Rwanda, and Tanzania – have an HCV prevalence above 10%.
• 7 countries/areas – Gabon, Libya, Papua New Guinea, Suriname, Vietnam, Zaire, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East – have an HCV prevalence between 5 and 10%.
• In developing countries, the primary sources of HCV infection include transfusion of blood or blood products from unscreened donors; transfusion of blood products that have not undergone viral inactivation; parenteral exposure to blood through the use of contaminated or adequately sterilized instruments and needles used in medical and dental procedures; the use of unsterilized objects for rituals (e.g. circumcision, scarification), traditional medicine (e.g. blood-letting) or other activities that break the skin (e.g. tattooing, ear or body-piercing); and intravenous drug use. Household or sexual contacts of HCV-infected persons are marginally at risk.
• In developed countries, persons at risk of HCV infection include recipients of previously unscreened blood, blood products, and organs; intravenous drug users; individuals undergoing chronic hemodialysis; health care workers with percutaneous exposure from contaminated needles or sharps; persons who participate in high-risk sexual practices; and persons undergoing medical or dental procedures with inadequately sterilized instruments. Sexual and household transmission are uncommon.
  
  

• Food preparers who are infected can pass the virus on if they do not wash their hands with soap and water after having a bowel movement, especially when they prepare uncooked foods.
• Fecal contamination of food and water.
• Anal/oral contact, by putting something in the mouth that had been contaminated with infected feces.
• Diaper changing tables, if not cleaned properly or changed after each use, may facilitate the spread of HAV.
• Fecal residue may remain on the hands of people changing soiled diapers.
• Eating raw or partially cooked shellfish contaminated with HAV.

• Get an immune globulin (IG) shot. An IG shot can provide temporary immunity to the virus for 2 to 3 months when given prior to exposure to HAV or within 2 weeks after exposure.
• Ask for the HAV vaccine. The HAV vaccine, made from inactive hepatitis A virus (synthetic), is highly effective in preventing the hepatitis A infection. However, its safety when given during pregnancy has not been determined. Check with your doctor to determine how many shots you need. The vaccine provides protection for about four weeks after the first injection; a second injection protects you longer, possibly up to 20 years.

• Users of illegal drugs.
• Individuals who have chronic liver disease or blood clotting disorders (e.g., hemophilia).
• Those who have close physical contact with people who live in areas with poor sanitary conditions.
• Those who travel or work in developing countries. This includes all countries except northern and western Europe, Japan, Australia, New Zealand, and North America except Mexico.
• Men who have sex with other men.
• Children in populations that have repeated epidemics of hepatitis A (e.g., Alaska natives, American Indians, and certain closed religious communities).
• People who have chronic lever disease.
  

• Have sex with someone infected with HBV.
• Have sex with more than one partner.
• Are a man and have sex with a man.
• Live in the same house with someone who has chronic HBV infection.
• Have a job that involves contact with human blood.
• Inject illegal substances/drugs. Have hemophilia.
• Travel to areas where HBV is common (this includes all countries except northern and western Europe, Japan, Australia, New Zealand, and North America except Mexico).

• HBsAG (hepatitis B surface antigen):
  When this test is positive or reactive, you are infected with HBV and can pass it on to others.
• Anti-HBc (antibody to hepatitis B core antigen):
  When you test positive, it means you are currently infected with HBV or have been infected at some point in the past.
• Anti-HBs (antibody to HbsAg):
  When this test is positive, it means that you are immune to hepatitis B either as a result of having had the disease or from having been given the vaccine.

• Sexual contact with an infected person.
• Living in the same household with an infected individual.
• Contact with infected blood or seminal fluid and contaminated needles, including tattoo/body piercing instruments.
• HBV-infected mother to her newborn at time of delivery (prenatal blood tests for HBV should always be done if there is a suspicion of HBV).

• Practice safe sex (use latex condoms).
• Don't share anything that could have an infected person's blood on it, i.e. toothbrushes, razors, nail clippers, body piercing instruments.
• Don't share drug needles, cocaine straws or any drug paraphernalia.
• Cover all sores and rashes and do not touch them.
• Clean up any blood spills with a 10% solution of household bleach. Infected persons should not pre-chew food for babies.
• If exposed to hepatitis B, get an HBIG (hepatitis B immune globulin) injection within 14 days following exposure.

• All individuals living in the same household with a chronically infected individual.
• All newborns and children up to the age of 19.
• Those who are in positions where they are exposed to blood at work, through drug use, or who have multiple sex partners.
• Individuals with hepatitis C and other chronic liver diseases.

• Intravenous (IV) drug users – even IV use in the distant past.
• Those with multiple sex partners or sex with partners who have other sexually transmitted diseases.
• Those with tattoos or body piercing done with unsterile instruments. Anyone who has had a blood transfusion prior to 1992 or clotting factors produced before 1987.
• Hemodialysis (diabetes) patients.
• The potential for transmission from an HCV-infected mother to her newborn appears to be about 5%.

• Injection drug use is the primary risk for HCV infection. Injection drug use accounts for about 60% of all new cases of hepatitis C and is a major risk factor for infection with hepatitis B virus. Among frequent drug users, 50-80% are infected by HCV within the first 12 months of beginning injecting.
• Straws shared in snorting drugs are also a potential source of infection of HCV. The hepatitis C virus is found mainly in blood.
• HCV is not spread through kissing or casual contact.
• In relationships where there is one steady partner, sexual transmission is exceedingly unusual, less than 3% over decades in sexually active couples.  Transmission from HCV RNA negative individuals has never been reported.  Sexual transmission may be more common among those with multiple sex partners or where there is a history of sexually transmitted disease but this remains controversial and unconfirmed.
• HCV may be transmitted by using razors, needles, toothbrushes, nail files, a barber's scissors, tattooing equipment, body piercing or acupuncture needles if these items are contaminated by blood of an infected person.
• Healthcare workers have a 2% risk of acquiring HCV after a needle stick contaminated with HCV-positive blood.
• There is no evidence indicating that HCV is transmitted through breast milk.
• The current transmission rate through blood transfusions is estimated at less than 1 per 1,000,000 units transfused.

• There are three types of interferon, plus a combination of interferon and ribavirin, used to treat hepatitis C. Blood tests and liver biopsy findings may determine the need for treatment.
• Interferon must be given by injection, and may have a number of side effects, including flu-like symptoms – headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.
• Ribavirin, given by mouth, can have additional side effects including depression, severe anemia and especially birth defects. Women or the male partners of women, who are pregnant or who are planning pregnancy, should not take ribavirin. Pregnancy should not be attempted until six months after treatment is ended. Ribavirin may also interfere with the production of red blood cells and platelets by depressing bone marrow. Patients should be monitored frequently.
• While 50-60% of patients respond to treatment initially, sustained response occurs in up to 40%.
• Treatment of children with HCV is under investigation.
• Researchers are re-examining when treatment should begin, for how long it should continue, and its effectiveness.
• Many pharmaceutical companies and NIH are conducting research to find more effective treatments and cures.
• Currently, almost 1/2 of all liver transplants in the US are performed for end-stage hepatitis C. However, re-infection of the transplanted liver by the virus usually occurs and may require a second transplant.
• Try to maintain as normal a life as possible, eating a well-balanced diet, exercising and keeping a positive attitude. Avoid depressing or overwhelming tasks and learn how to pace yourself. Rest when you feel tired. Plan physically exhausting tasks in the morning when your energy level is at its peak.

• There is NO vaccine to prevent HCV.Vaccines for Hepatitis A and B do not provide immunity against hepatitis C. There are various genotypes of HCV and the virus undergoes mutations making it difficult to develop a vaccine.
• Avoid handling anything that may have the blood of an infected person on it, such as razors, scissors, toothbrushes, nail clippers or files, tampons or sanitary napkins, etc. Detergent and a 10% solution of household bleach is believed to kill the virus.
• Don' t share drug needles, cocaine straws or any drug paraphernalia.
• Practice safe sex (use latex condoms).
• Notify your physician and dentist that you have hepatitis .
• Get vaccinated against hepatitis A and B.
• Those infected with hepatitis C should not drink alcohol, as it accelerates the liver damage.

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