Persons New To Canada
Health care providers who see persons newly arrived in Canada should review the immunization status and update immunization for these individuals, as necessary. In many countries outside of Canada, HA vaccine is in limited use.
HA vaccination should be considered for all persons from HA-endemic countries. Individuals born in HA-endemic countries are more likely to be immune to HA therefore, serologic testing for immunity before HA immunization should be considered. If persons from HA-endemic countries are not immune, they should be offered HA immunization because they are at increased risk for HA exposure through visits to their country of origin, or when receiving friends and family from their country of origin.
In addition, persons new to Canada should be tested for hepatitis C antibody and susceptible persons chronically infected with hepatitis C should be vaccinated against HA and HB. Persons new to Canada should also be tested for HB and vaccinated against HA if found to be a HB carrier. Household or close contacts of children adopted from HA-endemic countries should be immunized with HA-containing vaccine. Adults travelling to pick up adopted children from HA-endemic countries should be vaccinated before departure.
Refer to Immunization of Persons New to Canada in Part 3 for additional information about vaccination of people who are new to Canada.
History And Physical Exam
To diagnose all forms of hepatitis, your doctor will first take your history to determine any risk factors you may have.
During a physical examination, your doctor may press down gently on your abdomen to see if thereâs pain or tenderness. Your doctor may also check for any swelling of the liver and any yellow discoloration in your eyes or skin.
How Do You Prevent Hepatitis
Both hepatitis A and hepatitis B can be prevented with a vaccine. There is currently no vaccine available to prevent hepatitis C.
To prevent spreading or getting hepatitis A:
- Wash hands with soap and warm water for at least 20 seconds after using the bathroom, changing diapers, touching garbage or dirty clothes, and before preparing food and eating
- Follow guidelines for food safety
- Avoid unpasteurized milk or foods made with it
- Thoroughly wash fruits and vegetables before eating
- Keep the refrigerator colder than 40°F and the freezer below 0°F
- Cook meat and seafood until well done
- Cook egg yolks until firm
- Wash hands, knives, and cutting boards after contact with raw food
To prevent spreading or getting hepatitis B or hepatitis C:
- Practice safe sex and use a latex condom each time you have sex
- Dont share razors, toothbrushes, or any personal objects that might have blood on them
- Dont share needles or syringes
- Cover cuts and open sores with bandages
- Clean blood off of things with a mixture of bleach and water: use 9 parts bleach to one-part water
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Causes Of Noninfectious Hepatitis
Although hepatitis is most commonly the result of an infection, other factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to thickening or scarring of liver tissue and liver failure.
Other toxic causes of hepatitis include misuse of medications and exposure to toxins.
Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and attacks it. This causes ongoing inflammation that can range from mild to severe, often hindering liver function. Itâs three times more common in women than in men.
What Is The Treatment For Viral Hepatitis
Treatment of acute viral hepatitis and chronic viral hepatitis are different. Treatment of acute viral hepatitis involves resting, relieving symptoms, and maintaining an adequate intake of fluids. Treatment of chronic viral hepatitis involves medications to eradicate the virus and taking measures to prevent further liver damage.
Acute hepatitis
In patients with acute viral hepatitis, the initial treatment consists of relieving the symptoms of nausea, vomiting, and abdominal pain . Careful attention should be given to medications or compounds, which can have adverse effects in patients with abnormal liver function . Only those medications that are considered necessary should be administered since the impaired liver is not able to eliminate drugs normally, and drugs may accumulate in the blood and reach toxic levels. Moreover, sedatives and “tranquilizers” are avoided because they may accentuate the effects of liver failure on the brain and cause lethargy and coma. The patient must abstain from drinking alcohol since alcohol is toxic to the liver. It occasionally is necessary to provide intravenous fluids to prevent dehydration caused by vomiting. Patients with severe nausea and/or vomiting may need to be hospitalized for treatment and intravenous fluids.
Chronic hepatitis
Medications for chronic hepatitis C infection include:
- oral daclatasvir
Medications for chronic hepatitis B infection include:
- oral entecavir
- oral tenofovir
Fulminant hepatitis
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Accelerated Us Children And Adult Hepatitis B Vaccine Schedules
*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.
4-Dose Vaccine Series for Children and Adults
Engerix-B is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.
4-Dose Combination Hepatitis A and B Vaccine Series
Twinrix is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those travelling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.
2-Dose Vaccine Series
The Role Of Liver Biopsy In Aih
Liver biopsy is recommended by the American Association for the Study of Liver diseases and the European Association for the Study of the Liver guidelines to help establish the diagnosis, exclude other causes of liver disease, and guide treatment choice ,.
The diagnostic criteria for AIH have been codified in 1993, revised in 1999 by the International Autoimmune Hepatitis Group , and more recently simplified for clinical use . In the simplified system, as in the previous ones, liver histology is included among the parameters required to confirm clinical diagnosis of AIH. Indeed, the system comprises four parameters: autoantibodies, serum IgG, results of viral hepatitis work-up and AIH histology, which is coded as absent, typical or compatible .
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Us Children And Adult Hepatitis B Vaccine Schedules
*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.
3-Dose Vaccine Series for Children and Adults
The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.
There are four, 3-dose vaccine brands approved in the U.S.
- PreHevbrio PreHevbrio is only approved for adults age 18 and over.
2-Dose Vaccine Series
Enhancing Healthcare Team Outcomes
The diagnosis and management of autoimmune hepatitis are complex and best done by an interprofessional team that includes a gastroenterologist, pharmacist, internist, and hepatologist. Specialized gastrointestinal nurses assist in the care, education of the patient and family, and coordination of the treatment and follow-up. It is now well established that the use of corticosteroids leads to complete remission and in most cases improves mortality. The American Association for the Study of Liver Diseases recommends monotherapy with prednisone or combination therapy with prednisone and azathioprine. The pharmacist should educate the patients on all the potential complications of steroids and when to seek medical help. At the same time, the primary care provider and nurse practitioner should thoroughly examine the patient for worsening of the liver condition.
The prognosis for most patients with autoimmune hepatitis is guarded. While survival has improved over the past 2 decades, it still is low. Relapse of the condition is common and some patients may benefit from a liver transplant.
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General Information About Vaccination Outside The Us
In developing countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases, diphtheria, pertussis, tetanus, Hib and hepatitis B, may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of GAVI, the vaccine alliance. Check the GAVI country hub to see the resources and immunizations that may be available:
For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from vertical or horizontal transmission of hepatitis B. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent , birth dose of the vaccine, as it is not a GAVI provided immunization. This is particularly important to women who are positive for hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!
*WHO does not recommend a birth dose of HBIG, which may not be available in all countries. Talk to your doctor if you have questions.
People Are Also Reading
James Hamlin, a Roanoke County man, died Oct. 8 from hepatitis A complications. A second victim, who has not been identified by the health department, also died from hepatitis A. Dianne Vest and her husband Larry Vest died Oct. 26 and Dec. 24, respectively. Larry Vest had been infected, but his death has not been confirmed to be related to the outbreak.
Famous Anthonys has had the privilege of serving this community for over 35 years, owners said in a statement. This unforeseen hepatitis A exposure at two of our restaurants has impacted many in our close knit community including many loyal customers, employees and their families.
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Hepatitis In The Western Pacific
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis , cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances , and autoimmune diseases can also cause hepatitis.
There are five main hepatitis viruses, referred to as types A, B, C, D and E. These 5 five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
Hepatitis B and C infections lead to chronic liver disease in hundreds of millions of people. They are the most common causes of liver cirrhosis and liver cancer.
Technical links
Hepatitis B And Your Liver
The liver is such an important organ that we can survive only one or two days if it completely shuts down – if the liver fails, your body will fail, too. Fortunately, the liver can function even when up to 80% of it is diseased or removed. This is because it has the amazing ability to regenerate – or create – itself from healthy liver cells that still exist.
If your body were an automobile, your liver would be considered the engine. It does hundreds of vital things to make sure everything runs smoothly:
- Stores vitamins, sugar and iron to help give your body energy
- Controls the production and removal of cholesterol
- Clears your blood of waste products, drugs and other poisonous substances
- Makes clotting factors to stop excessive bleeding after cuts or injuries
- Produces immune factors and removes bacteria from the bloodstream to combat infection
- Releases a substance called “bile” to help digest food and absorb important nutrients
The word hepatitis actually means inflammation of the liver. Thus, hepatitis B refers to inflammation of the liver caused by the hepatitis B virus. With early detection and appropriate follow-up medical care, people living with a chronic hepatitis B infection can expect to enjoy a long and healthy life.
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Hepatitis C Virus Genotypes
An important variable for all patients with chronic hepatitis C virus is the”genotype” of HCV with which they are infected. This is the strain of the virus towhich they were exposed when they were infected, often many years prior to theirevaluation, and it is determined by a simple blood test. Genotypes of HCV aregenetically distinct groups of the virus that have arisen during its evolution. Approximately 75% of Americans with HCV have genotype 1 of the virus, and 20-25% have genotypes 2 or 3, with small numbers ofpatients infected with genotypes 4, 5, or 6. Most patients with HCVare found to have only one principal genotype, rather than multiple genotypes. Genotype 4 is much more common in Africathan in many other parts of the world, genotype 6 is common in Southeast Asia, andeach area of the world has its own distribution of genotypes.
What Do Doctors Do
A doctor who thinks someone may have hepatitis may ask questions like these:
- Has the person been around anyone who works in health care or childcare?
- Did the person stick himself or herself with a dirty needle or get a tattoo with a dirty needle?
- Did the person have contact with the bodily fluids of someone who has hepatitis?
- Did the person have a blood transfusion as a baby?
- Have any of the person’s family members had hepatitis?
- Could the person have eaten food that was contaminated with hepatitis A?
The doctor can order a blood test to see if someone has hepatitis and which type, then help the person get the right care.
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Who Is At Risk For Infection
Anyone who is not immune to hepatitis A can get hepatitis A infection. Food-borne outbreaks occur sporadically throughout the USA. Certain groups of people do have a higher risk of developing HAV infection and should be vaccinated:
- Persons experiencing homelessness
- People who eat raw or under-cooked shellfish
What Is Hepatitis A
For kids, hep A is the most common type of hepatitis to get. The virus lives in poop from people who have the infection. That’s why it’s so important to wash your hands before eating and after going to the bathroom. If you don’t, and then go make yourself a sandwich, hep A virus might end up on your food, and then in you!
Vegetables, fruits, and shellfish also can carry hepatitis if they were harvested in contaminated water or in unsanitary conditions. Hepatitis A affects people for a short time, and when they recover, it does not come back.
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Why Does It Matter That I Have Genotype 2
Knowing that you have genotype 2 offers important information about your treatment options and how likely they are to be effective.
Based on the genotype, doctors can narrow down which treatments are most likely to be effective and how long you should take them. This can prevent you from wasting time on the wrong therapy or taking medications longer than you have to.
Some genotypes respond differently to treatment than others. And how long you need to take medicine can differ based on your genotype.
However, the genotype cant tell doctors how quickly the condition will progress, how severe your symptoms might get, or if an acute infection will become chronic.
15 to 25 percent of people clear the hepatitis C infection without any treatment. Since there isnt a way of knowing who falls into this category, in an acute infection, your doctor will recommend waiting for 6 months to treat the virus, since it may clear spontaneously.
Hepatitis C is treated with antiviral drugs that clear your body of the virus and prevent or lessen damage to your liver. Often, youll take a combination of two antiviral drugs for 8 weeks or longer.
Theres a good chance youll have a sustained virologic response to oral drug therapy. In other words, its highly curable. The SVR rate for many of the new hepatitis C drug combinations is as high as 99 percent.
When choosing drugs and deciding how long you should take them, your doctor will usually consider the following factors: