Hepatitis

Based on discussions with a doctor on signs and symptoms, the doctor would take a sample and run tests. The test run detects antibodies in the blood produced by the immune system of the individual in response to the hepatitis A infection. The doctor would also check for high levels of liver enzymes in the blood.

The hepatitis A virus is found in the stool and the blood of people who are infected with the hepatitis A virus. HAV is usually spread when an individual who is not infected with the virus ingests the virus through the following ways:

• Person to person contact: HAV can be spread through close personal contact with someone who is infected with the virus. This kind of contact includes having sex with an infected person (especially anal sex), caring for someone who is ill or using drugs with others. It is very contagious and individuals can spread the virus even before they fall sick.
• Eating contaminated food or drink is another way whereby one can get infected with the hepatitis A virus. Food can get contaminated with the Hepatitis A virus at any point, during the growing, harvesting, processing or handling process. It can even get contaminated after cooking. It is more common to see food and water contamination with the virus in areas of the world where the hepatitis A virus is common. In the United States, it is uncommon for individuals to be infected with HAV but it has happened when people consumed fresh and frozen food products that were imported.

The hepatitis A virus can be prevented with a safe and effective vaccine. This vaccine consists of a series of shots that typically consists of two shots that are given 6 months apart. It is important to get both shots because that will provide the best protection against infection with the hepatitis A virus.

The vaccine is recommended for the following groups of people:

• All children at the age of 1 year
• Travelers to countries where hepatitis A is common
• Family or caregivers of adoptees from countries where hepatitis A is common
• Men who have sex with men (MSM)
• People who use or inject drugs (PWID)
• People with chronic or long-term liver disease, including hepatitis B or hepatitis C
• People with clotting factor disorders
• People with direct contact with others who have HAV
• People experiencing homelessness
• People who have HIV

The practice of good hygiene is important in the prevention of hepatitis A virus. This practice can be as simple as practicing thorough hand washing techniques with soap and warm water after using the bathroom, changing diapers, and before preparing or eating food. This is very important in preventing hepatitis A virus infection.

Before travelling to a region with high prevalence of HAV, it is advised that you talk to your doctor about getting vaccinated with the hepatitis A vaccination. People travelling to urban areas, resorts, and luxurious hotels in places where hepatitis A is common are still at risk. In fact, there have been reports of infection occurring among people who reportedly washed their hands regularly and were careful about what they ate and drank.

While there is no treatment for the hepatitis A virus, doctors typically would treat the symptoms that an individual exhibits. This is called supportive therapy. They would also carry out periodic tests to see how a person's liver is fairing and so that they are sure that the body is healing like it should. Doctors would usually recommend rest and adequate nutrition and fluids.

The perinatal hepatitis B prevention program (PHBPP) began in 1990. Congress recognized the need to foster efforts to prevent perinatal (occurring at or shortly after birth) hepatitis B virus (HBV) transmission and made resources available to develop and implement programs.   

An estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women each year in the United States.  When a pregnant woman is infected with the HBV, it poses a serious risk that her newborn will contract the infection. Of the infants infected with HBV, 90% will develop chronic HBV infection.  Twenty-five percent of infants or young children that are chronically infected with the HBV will die prematurely from cirrhosis or liver cancer. 

All pregnant women should be tested for HBsAg during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been vaccinated or tested previously. Testing those pregnant women known to be chronically infected with HBV provides documentation of the positive HBsAg test result obtained during pregnancy and helps to ensure that their infants will be identified for timely prophylaxis.

All HBsAg-positive pregnant women should be tested for HBV DNA to guide the use of maternal antiviral therapy during pregnancy for the prevention of perinatal HBV transmission.

A negative test for the virus means either that there is no current infection or there is not yet a sufficient amount of the antigen to be detected. If a woman participates in high-risk activities that may transmit the HBV (such as unprotected sexual contact or intravenous drug use), retesting later in the pregnancy is generally advised.

The state of Oklahoma requires all birthing hospitals to administer the birth hepatitis B vaccine to all live infants (unless an exemption is completed) within 12 hours of birth and document it in the Oklahoma State Immunization Information System (OSIIS) (TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH-CHAPTER 667 HOSPITAL STANDARD SUBCHAPTER 13-INFECTION CONTROL § 310:667-13-5).

Many people who are infected with the hepatitis B virus do not have any symptoms. Those that do develop symptoms may experience fever, tiredness, lack of appetite, upset stomach, vomiting, dark urine, grey-colored stool, joint pain, and yellow skin and eyes. With an acute infection, if symptoms occur, they would be within 3 months of exposure to the virus and can last up to 6 months. If symptoms occur with a chronic infection, they can take years to develop and can be a sign of advanced liver disease.

This refers to a short-term infection that occurs within 6 months after someone is infected with the virus. Some people are able to clear the disease from their system without having any symptoms and without needing any treatment or hospitalization. People who clear the virus from their system without requiring treatment get immune to the hepatitis B virus and cannot get infected with the virus again.

This refers to the lifelong infection with the hepatitis B virus. The chances that a person will be chronically infected with the hepatitis B virus is dependent on their age, at which the person gets infected with the virus. More than 90% of infants that are infected with the hepatitis B virus will develop a chronic infection compared to 5% of adults that will become chronically infected with the hepatitis B virus. 15%-25% of chronically infected persons will develop chronic liver disease. As time progresses, the hepatitis virus can cause serious health issues including liver damage, cirrhosis, liver cancer and even death. An estimated 3,000 people in the United States die from HBV-related illness per year.

Getting tested for the virus is the only way that you can know if you are infected. Typically, blood tests are able to determine if an individual has been infected and cleared the virus, or if that individual is currently infected or has never been infected.

The hepatitis B virus is usually spread when blood, semen and other body fluids from a person that is infected with the hepatitis B virus enters the body of an individual who is not infected with the hepatitis B virus. The virus can spread through the following means;

• Sex with an infected person: the virus can spread when someone who does not have the hepatitis B virus has sexual contact with a person that is infected with the virus.
• Injection drug use: sharing needles, syringes, or other drug-injection equipment with someone who is infected with the hepatitis B virus is a way that an uninfected person can get infected with the virus.
• Needle sticks or other sharp instrument injuries: this is seen among health care workers and people who work with such equipment.
• Birth: Hepatitis B infection can be passed from an infected mother her baby during delivery, at birth. Around the world, most people who are infected with the illness were infected as infants.

Note: Hepatitis B virus is not spread through breastfeeding, sharing eating utensils, hugging, kissing, holding hands, coughing, or sneezing. Hepatitis B virus is also not spread through contaminated food or water unlike some other forms of hepatitis virus.

The best way to prevent hepatitis B virus is to get vaccinated against the virus. The vaccine is usually given as a series of three shots over a period of six months. The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B (HepB) vaccination among all adults aged 19–59 years and adults > 60 years with risk factors for hepatitis B or without identified risk factors but seeking protection.

For long-term protection, the entire series is required. If at risk, get vaccinated for HBV. HBV vaccination is recommended in certain high-risk settings such as:

• Sexually transmitted disease treatment facilities
• Facilities that provide drug-abuse treatment and prevention services
• HIV testing and treatment facilities
• Correctional facilities
• Health Care settings with services for injection drug users
• Health Care services with services targeting men who have sex with men
• Chronic hemodialysis facilities as well as programs for people with end stage liver disease
• Nonresidential day care facilities for people with development disabilities as well as institutions for this purpose

For acute hepatitis B virus infections, doctors usually recommend rest, adequate nutrition, fluids and close medication monitoring. Some people may need to be hospitalized.

If diagnosed with chronic hepatitis B it is important to note that people with chronic hepatitis B can live a long and healthy life. While there is no complete cure for the illness, decisions made by an individual to protect their liver can go a long way. Such decisions involve, avoiding the use of alcohol and tobacco, regular visits to a liver specialist or health care provider, and eating healthy. While there are approved drugs for both adults and children, it is important to note that not everyone who is diagnosed with chronic hepatitis B virus needs to be on medication. This is because current treatments for the virus are seen to be effective in people who show signs of active liver disease.

It is very important that individuals who have been diagnosed with hepatitis B are seen by a liver specialist regardless of if they are on medication or not. The recommendation is for them to be seen every 6 months.

If an uninfected, unvaccinated person or anyone who does not know their hepatitis B status comes in contact with blood from a hepatitis B positive person, post exposure prophylaxis, if administered in a timely manner could prevent infection and development of a chronic infection or liver disease.

CDC Materials:

• Patient Education Resources
• Hepatitis B

In people who develop symptoms, the average time from exposure to symptom onset is 2–12 weeks, but can range up to 26 weeks (approximately 6 months).

Many people who have hepatitis C do not exhibit any symptoms, and, as a result do not know, that they are infected with the virus. If symptoms do occur, they include: fever, tiredness, lack of appetite, upset stomach, vomiting, dark urine, grey-colored stool, joint pain, and yellow skin and eyes. 

Acute Hepatitis C is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. If symptoms occur with an acute infection, they may take decades to develop. Only 20-30% of newly infected people develop symptoms of acute disease. An acute infection can range in severity from a very mild illness with the person experiencing no symptoms, to a very serious condition in which the individual would have to be hospitalized. About 20% of people are able to "clear" the virus without receiving treatment in the first 6 months. The reason why this happens to some people is not well known. Most people however are not able to clear the infection by their body’s response and about 70%-85% of people who become infected with the hepatitis C virus go on to develop a "chronic" or lifelong infection.

Chronic Hepatitis C is a long-term illness that occurs when the Hepatitis C virus remains in a person's body. When symptoms occur in a chronic case, it is usually a sign of liver disease that is now advanced including liver damage, cirrhosis, liver failure, or liver cancer.

Doctors would usually perform a blood test that is called the Hepatitis C Antibody test which is intended to look for the antibodies released by the body in response to the hepatitis C virus. If a person clears the virus from their system, the antibodies still remain in the blood. Therefore, a positive antibody test means that a person has been infected with HCV at a certain point in time. This does not necessarily mean that a person has an active HCV infection. An RNA test needs to then be carried out to determine if the individual has an active or current HCV infection or not. The HCV RNA test is a molecular diagnostic test that specifically tests for hepatitis C RNA. This process is called Nucleic Acid Test (NAT) or Nucleic Acid Amplification Test (NAAT). This test becomes positive 1-2 weeks after an initial HCV infection occurs. It is therefore a test that should be done once the antibody test result turns positive.

CDC recommends ALL adults be tested for HCV at least once, and every pregnant women be tested during every pregnancy.

The only way that one can know if they have hepatitis C is if to get tested. HCV testing is recommended for any anyone who is at increased risk of HCV infection. Such people include:

• Persons born from 1945 through 1965 (estimated to account for 3/4 of the HCV infections in the U.S.)
• Persons who have ever injected illegal drugs, including those who injected only once, many years ago
• Persons who received clotting factor concentrates that were made before 1987
• Recipients of blood transfusions or solid organ transplants before July 1992
• Patients who have ever received long-term hemodialysis treatment
• Persons with known exposures to HCV, such as health care workers after a needle stick involving HCV positive blood and recipients of blood or organs from a donor who later tested positive for HCV
• All persons with HIV

Hepatitis C is usually spread when blood from an individual that has been infected with the hepatitis C virus enters the body of an individual that is not infected. Many of the 2.7-3.9 million people who are infected with HCV are either unaware of their status and have not sought treatment, or those who do know they are infected often do not know how and/or when they got infected. Today, most people become infected with hepatitis C virus by:

• Sharing needles, syringes, or other equipment used to inject drugs
• Needle stick injuries in health care settings
• Being born to a mother that is hepatitis C positive
• Another way that hepatitis C virus can be spread is through getting tattoos and body piercings in facilities that are not licensed, in informal settings or with equipment that are not sterile
• About 6% if infants that born to mothers that are infected with hepatitis C will get the virus. This transmission occurs at birth and there is no prophylaxis available to prevent it from happening.

Hepatitis C can survive outside the body at room temperature on environmental surfaces for at least 16 hours but no longer than four (4) days.

Before widespread screening of the blood supply began in 1992, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Although uncommon, outbreaks of Hepatitis C have occurred from blood contamination in medical settings.

It is rare for hepatitis C to be transmitted through sexual contact, although not impossible. The risk of transmission is low at about 0-3%. Having a sexually transmitted disease or HIV, having sex with multiple partners, or having rough sex increases the risk a person has of acquiring hepatitis C virus through sexual contact. Practice of safer sex using latex, polyurethane (plastic), barriers for oral sex, is highly encouraged.

Although there is currently no vaccine to prevent Hepatitis C, research is being conducted to develop one. There are however numerous treatment options available to achieve a "Sustained Virologic Response" or cure. The best way to prevent a HCV infection is to avoid high-risk behaviors, like sharing needles.

• National Viral Hepatitis Action Plan 2017-2020
• CDC Hepatitis C
• You have a client with Hep C, now what?
• You have been diagnosed with Hep C, now what?

The OSDH Sexual Health and Harm Reduction Service provides hepatitis B & C prevention activities, including but not limited to, education, vaccination and Perinatal hepatitis B prevention activities.