Community Knowledge And Awareness
The committee has found that knowledge and awareness about hepatitis B and hepatitis C are lacking in members of the public and, most important, in members of specific at-risk populations. Lack of knowledge and awareness about hepatitis B and hepatitis C in the community often leads to misinformation, missing of opportunities for prevention and treatment, and stigmatization of infected populations. The consequences for members of at-risk communities are important in that missing opportunities for prevention can lead to infection of additional people with HBV and HCV. Once infected, they frequently are unaware of their infection and so run the risk of unknowingly infecting others and of not receiving appropriate medical management. Although there have been no large-scale, population-based, controlled studies of community knowledge about hepatitis B and hepatitis C, all published surveys have shown that knowledge about these diseases is sparse.
How Can You Prevent Hepatitis B And Hepatitis C
Hepatitis B: Vaccination is the best way to prevent all the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. The hepatitis B vaccine is now recommended for all infants, children and adults ages 19-59, as well as adults ages 60+ at high risk for infection. There is a 3-dose series of hepatitis B vaccine given over 6 months, and a 2-dose series given over 1 month. Additionally, there is a 2-dose combination vaccine that protects against both hepatitis A and hepatitis B.
Hepatitis C: No vaccine exists for HCV and no effective pre- or post-exposure prophylaxis is available. Injection drug use is one of the risk factors for hepatitis C. For people who inject drugs, the best way to prevent hepatitis C infection is to always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment. Community-based prevention programs, such as medication-assisted treatment and syringe services programs provide support and services aimed at preventing and reducing the transmission of HCV. Although the risk of sexual transmission of HCV is considered to be low, avoiding unprotected sexual exposure by using condoms has been shown to reduce the chance of sexually transmitted infections.
What Are The Risk Factors For Hepatitis B And C
Hepatitis B: Although most commonly acquired early in life, adults can also contract it. Hepatitis B is largely transmitted through bodily fluids. It can be passed at birth from a hepatitis B-infected mother or through exposure in early childhood to body fluids, blood or contaminated medical instruments. Hepatitis B can also be transmitted through intranasal and injection drug use as well as infected tools used during tattooing and body piercing.
Hepatitis C: The key risk factors are also intranasal and injection drug use, tattoos and body piercings, high-risk sexual contact, blood transfusions before 1992 and organ transplantation.
Another key risk factor for hepatitis C is being born from 1945 to 1965, during the baby-boom years. Eighty percent of all people who currently have hepatitis C in the United States were born in that timeframe.
Although the reasons that baby boomers are more likely to have hepatitis C than others arent entirely understood, its believed that most were infected in the 1970s and 1980s, when rates of hepatitis C were at their peak.
The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend that all U.S. adults born from 1945 to 1965 undergo a one-time screening test for hepatitis C. Connecticut is one of several states that has written this recommendation into law. In Connecticut ,the law requires that primary care clinicians screen all adults born within those years.
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What Occupations Have Increased Risk Of Hepatitis B
In general, occupational groups with increased risk include:
- Health-care workers repeatedly exposed to blood or blood products or those who are at risk of needlestick injury.
- Pathologists, laboratory personnel, or embalmers.
- Dentists, dental assistants, and dental hygienists.
- Certain staff members of institutions for the developmentally handicapped.
- Staff of institutions where workers may be exposed to aggressive, biting residents.
Travellers to regions with intermediate or high rates of endemic HBV infection may also consider being vaccinated.
What Is Hepatitis B
Hepatitis B is an infectious liver disease. It is caused by the hepatitis B virus . Infections of hepatitis B occur only if the virus is able to enter the blood stream and reach the liver. Once in the liver, the virus reproduces and releases large numbers of new viruses into the bloodstream.
To combat the disease, the body has several defenses. White blood cells, which protect the body from infections, attack and destroy the infected liver cells. The body also produces antibodies which circulate in the blood to destroy the virus and protect against future infections of hepatitis B. During the infection and recovery process, the liver may not function normally causing illness that affects the entire body.
For reasons that are not completely understood, 10 percent of people who develop hepatitis B become carriers of the disease. Their blood remains infected for months, years, sometimes for life. Seventy percent of carriers develop chronic persistent hepatitis B. Most do not appear to be ill. The remaining 30 percent of carriers experience continuous liver disease. This condition often progresses to cirrhosis and then, after 30 to 40 years, possibly to liver cancer. At present, there is no way of curing carriers. The risk of becoming a chronic carrier is related inversely with a person’s age when infected. For example, the risk of an infant becoming a carrier is 90-95% whereas the risk of an adult becoming a carrier is 3-10%.
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Benefits Of Early Detection Or Treatment
The USPSTF found no direct evidence on the benefits of HCV screening vs no screening on health outcomes or the effects of prenatal HCV screening on the risk of vertical transmission.1 Treatment studies focused on populations without cirrhosis who are more likely to be asymptomatic and identified by screening. Of the trials of DAA regimens , 14 were multinational 11 were conducted in the US or Canada and the remainder were conducted in New Zealand, Egypt, France, or Asia. In 29 trials, 60% to 100% of patients were white.1 The trials evaluated a variety of DAA regimens recommended in current guidelines. Treatment duration was 12 weeks in all but 2 trials, which allocated patients to either 8 or 12 weeks of treatment. Eleven trials were of good quality and 22 were of fair quality. Forty-nine trials found DAA regimens to be associated with pooled SVR rates ranging from 95.5% to 98.9% across genotypes. Evidence was greatest for genotype 1 infection , the most frequent genotype in the US.1 Sustained virologic response rates were similar in trials that stratified patients according to age, sex, race/ethnicity, or treatment experience with non-DAA regimens.1
Recent Increases In Hepatitis C Infections
Between 2013 and 2020, the reported number of acute HCV infections more than doubled. High rates of new infections were predominantly among young adults aged 20-29 years and aged 30-39 years. The number of cases continues to increase, in 2020 an estimated 66,700 new HCV infections occurred in the United States. For the most recent surveillance data visit CDC Viral Hepatitis Surveillance.
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Blood Transfusion/receipt Of Blood Products
Early case-control studies of patients with newly acquired, symptomatic non-A, non-B hepatitis found a significant association between disease acquisition and a history six months prior to illness of blood transfusions, injection drug use, health care employment with frequent exposure to blood, personal contact with others who had hepatitis, multiple sexual partners or low socioeconomic status. Today, HCV is rarely transmitted by blood transfusion or transplantation of organs due to thorough screening of the blood supply for the presence of the virus and inactivation procedures that destroy bloodborne viruses. In the last several years, blood banks have instituted techniques that utilize nucleic acid amplification of the hepatitis C virus, which will detect the presence of virus even in newly-infected patients who are still hepatitis C antibody-negative. These techniques are estimated to have prevented 56 transfusion-associated HCV infections per year in the U.S. since 1999, and have lowered the current risk of acquiring HCV via transfused blood products to 1 in 2 million.
All Are True Regarding Hepatitis C Infection Except Medicine Mcq
All are true regarding hepatitis C infection except?A. Serum transaminase level is a good predictor of the level of liver fibrosisB. Telaprevir is effective in managementC. 3% risk of vertical transmissionD. Sharing toothbrushes is a risk factor for transmission
Correct answer : A. Serum transaminase level is a good predictor of the level of liver fibrosis
Hepatitis C virus electron microscopic image
- Serum transaminase level in hepatitis C is not a good predictor of the level of liver fibrosis.
- A liver biopsy is required to assess the degree of liver damage.
- There is 3% risk for acquisition of chronic hepatitis C by vertical transmission.
- Sharing of toothbrushes and razors is another risk factor.
Ref: Davidsons Principles and Practice of Medicine, 22nd edition, p955Image credits: Center for the Study of Hepatitis C, The Rockefeller University. https://commons.wikimedia.org/wiki/File:HCV_EM_picture_2.png
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Pregnancy And Hepatitis C
Should pregnant women be tested for HCV antibodies?
Yes. All pregnant women should be screened for anti-HCV during each pregnancy, except in settings where the prevalence of HCV infection is < 0.1% . Pregnant women with known risk factors should be tested during each pregnancy, regardless of setting prevalence. Any pregnant women testing positive for anti-HCV should receive a PCR test for HCV RNA to determine current infection status.
Can a mother with hepatitis C infect her infant during birth?
The overall risk of an infected mother transmitting HCV to her infant is approximately 4%8% per pregnancy . Transmission occurs during pregnancy or childbirth, and no prophylaxis is available to protect the newborn from infection. The risk is significantly higher if the mother has a high HCV viral load, or is coinfected with HIV with which the rate of transmission ranges from 8%15% . Most infants infected with HCV at birth have no symptoms.
Should a woman with hepatitis C be advised against breastfeeding?
When should children born to HCV-infected mothers be tested to see if they were infected at birth?
What Is The Treatment For Hepatitis B
Prevention is recommended by receiving a vaccine for HBV.
Receiving an injection of the hepatitis B immune globulin within 12 hours of coming in contact with the virus may help prevent the development of the disease.
At present, there is no specific treatment for patients with acute hepatitis B. Acute infection is usually short and will often resolve on its own. Your health care provider may recommend rest, and adequate nutrition and fluids to help your body fight the infection. Hospitalization may be required for patients who suffer from severe vomiting and who are unable to maintain adequate nutritional levels. It may also be required to prevent the development of complications.
While chronic infection cannot be cured, there are two standard treatments in Canada that may control the virus and prevent further damage to the liver.
- Antiviral medications can fight the virus and slow damage to the liver.
- Interferon which may be given for short periods and if effective, results in suppression of the virus.
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Facts About Hepatitis C
Hepatitis C is a liver disease caused by infection with the hepatitis C virus . HCV can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness that lasts only a few weeks to a serious, lifelong illness resulting in cirrhosis and liver cancer.
The virus is mainly acquired by contact through broken skin with infectious blood. In Europe, the main route of HCV transmission is via injecting drug use as a result of sharing contaminated needles. More rarely, the virus can be transmitted sexually, in healthcare settings due to inadequate infection control practices or perinatally from an infected mother to the baby.
A silent disease with no symptoms
Most people with acute HCV infection do not have any symptoms. Those who develop chronic infection are often asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.
Around 30% of people with chronic hepatitis C suffer from liver damage and a small number of those develop cancer. Hepatitis C is considered to be one of the leading causes of liver cancer and liver transplants in Europe.
HCV: no vaccine but a cure
The infection can be cured, especially if it is detected and treated with the appropriate antiviral drug combinations. Antiviral treatment can now cure over 90% of persons with HCV infection.
Acute Hepatitis C2020 Case Definition
The CDC 2020 Case Definition for Acute Hepatitis C infection includes clinical and laboratory criteria , along with a case classification as probable or confirmed. Of note, a patient can have a confirmed case of acute hepatitis C based on laboratory data alone . Symptomatic cases often go unreported and for multiple reasons, including many persons with symptomatic acute HCV do not seek medical care, the diagnosis may be missed, and medical providers may fail to report diagnosed cases. It is important not to report cases that have already been reported. A more detailed discussion of the Acute Hepatitis C 2020 Case Definition is included in the lesson Diagnosis of Acute HCV Infection.
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What Laboratory Tests Are Available For Hepatitis B
Tests are available to detect the types of antigens used to identify the hepatitis B virus. The tests determine if the virus is present in the body tissue or blood. The amount of each type of antigen present indicates how advanced the disease is and how infective the individual has become.
Other tests are available to detect the body’s reaction to the viral infection or the body’s reaction to vaccination against the virus. These tests work by measuring the number of antibodies present in the blood.
Receipt Of Transfusion Of Blood Products
In the 1960s, the risk of acquiring HCV from a blood transfusion was approximately 33%. The universal screening of blood and organ donors with routine use of second-generation HCV antibody tests in 1992 nearly eliminated subsequent risk of transfusion-associated HCV. In the mid-1990s, the risk of acquiring HCV from a blood transfusion had declined to less than 0.3%. The estimated risk of acquiring HCV from a blood transfusion decreased further following the introduction, in 1999, of HCV nucleic acid testing as a supplement to HCV antibody testing of blood products. Blood banks in the United States now use a combination of the third-generation enzyme-linked immunosorbent assay and NAT screening of mini-pool testing . The current estimated risk of acquiring HCV from a transfusion in the United States is approximately 1 in 2 million.
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Newly Reported Chronic Hepatitis C Cases
In 2019, the CDC reported 137,713 persons in the United States with a new diagnosis of chronic HCV. Cases were clustered in a biphasic age distribution, with a primary peak in persons aged 20-39 years and a second apex among persons aged 55-70 years . Among the newly reported chronic HCV cases, 64% were male and 36% female.
How Are Hepatitis B And C Diagnosed
Hepatitis B is diagnosed by a series of blood tests. The test may show an ongoing infection or antibodies that indicate that the patient is protected against hepatitis B. In patients who have a positive screening test that suggests the possibility of ongoing infection, further testing is done to determine the levels of the virus in the bloodstream.
Hepatitis C is diagnosed via a blood test called a Hepatitis C Antibody Test. A positive result means that hepatitis C antibodies are present in the blood. But a positive antibody test doesnt necessarily mean a person has hepatitis C. A further blood test is needed to confirm the diagnosis. This second blood test quantifies the amount of the virus or the viral load in the liver and the bloodstream.
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Chronic Hepatitis C Virus Infection2020 Case Definition
The CDC 2020 Case Definition for Chronic Hepatitis C includes clinical and laboratory criteria , as well as a case definition. These cases pertain to persons with current hepatitis C infection and do not represent persons who spontaneously cleared hepatitis C infection. Also, it is important not to report cases that have already been reported.
Perinatal Infection Hepatitis C Infection2018 Case Definition
The CDC 2018 Case Definition for Hepatitis C, Perinatal Infection includes clinical criteria, laboratory criteria for diagnosis, criteria to distinguish a new case from an existing case, and a case definition. A confirmed case definition requires the following:
- Infant who has a positive test for HCV RNA nucleic acid amplification test , HCV antigen, or detectable HCV genotype at 2 months and 36 months of age and is not known to have been exposed to HCV via a mechanism other than perinatal.
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Symptoms Of Hepatitis C
Hepatitis C often does not have any noticeable symptoms until the liver has been significantly damaged.
This means many people have the infection without realising it.
When symptoms do occur, they can be mistaken for another condition.
Symptoms can include:
- feeling and being sick
The only way to know for certain if these symptoms are caused by hepatitis C is to get tested.
Hepatitis B Virus And Hepatitis C Virus Dual Infection
Correspondence to: Giovanni Raimondo, MD, Professor, Chief, Division of Clinical and Molecular Hepatology, Department of Internal Medicine, University Hospital of Messina, Via Consolare Valeria 1, 98124 Messina, Italy.
Telephone: +39-90-2212392 Fax: +39-90-2213594
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