Hepatitis A infections are contracted by a fecal-oral route.  Infected people often spread the virus by neglecting to wash their hands after eliminating solid body waste.  The virus can be transmitted by close person-to-person contact with an infected person, sexual contact with an infected person, or ingestion of contaminated food or drinks.  Persons most at risk of contracting an HAV infection include travelers to regions with intermediate or high rates of Hepatitis A, sex contacts of infected persons, household members or caregivers of infected persons, and men who have sex with men.

 

Most adults and older children will be symptomatic (70-80%), while younger children (< 14 years of age) will not. Acute illness is rarely fatal and so, most people recover with no lasting liver damage.  Therefore, there is no potential for chronic infection.

 

A hepatitis A vaccination has been available in the U.S. since 1995.

 

MD Form DHMH 4677:
Hepatitis A screen: A hepatitis A IgM test.  Testing is only recommended for individuals to confirm/detect acute HAV infections.  This test will not determine immunity status. 

 

The principle ways of spreading the hepatitis B virus include intimate contact with infected people or exposure to body fluids from these individuals by contact with infectious blood, semen, and other body fluids, primarily by birth to an infected mother, sexual contact with an infected person, sharing of contaminated needles, syringes or other injection drug equipment, and needle sticks or other sharp instrument injuries.

 

Some adults and children will be symptomatic (30-50%).  Acute illness is rarely fatal and most will recover with no lasting liver damage. However, there is a potential for chronic infection (>90% of infants, 25-50% of children 1-5 years of age, 6-10% of older children and adults).

 

15%–25% of the chronically infected people will develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.

 

Maryland has a childhood vaccination mandate for Hepatitis B.  Children are required to obtain the vaccination prior to entry into daycare/elementary school.  The vaccine confers long-term protection against clinical illness and chronic Hepatitis B virus infection. Studies indicate that immunologic memory remains intact for at least 20 years among healthy vaccinated individuals who initiated Hepatitis B vaccination >6 months of age. Cellular immunity appears to persist even though antibody levels might become low or decline below detectable levels.

 

Testing is recommended for:
•All pregnant women
• Persons born in regions with intermediate or high rates of Hepatitis B (HBsAg prevalence of ≥2%)
• U.S.–born persons not vaccinated as infants whose parents were born in regions with high rates of Hepatitis B (HBsAg prevalence of ≥8%)
• Infants born to HBsAg-positive mothers
• Household, needle-sharing, or sex contacts of HBsAg-positive persons
• Men who have sex with men
• Injection drug users
• Patients with elevated liver enzymes (ALT/AST) of unknown etiology
• Hemodialysis patients
• Persons needing immunosuppressive or cytotoxic therapy
• HIV-infected persons
• Donors of blood, plasma, organs, tissues, or semen

 

MD Form DHMH 4677:
Hepatitis B Screen: to detect acute or chronic HBV infections. (Hepatitis B surface antigen)
Hepatitis B panel: to detect acute/chronic HBV infections as well as immunity status. (Hepatitis B surface antigen, Hepatitis B surface antibody)
Hepatitis B post: to determine the patient’s immunity status. (Hepatitis B surface antibody)

 

Transmission of hepatitis C virus is primarily through contact with blood of an infected person by sharing of contaminated needles, syringes, or other injection drug equipment.  HCV can also be spread by piercing of the skin by contaminated instruments such as those used for tattooing, ear piercing, and acupuncture, dental or medical procedures.  It is less commonly transmitted by sexual contact with an infected person, birth to an infected mother, or needle stick or other sharp instrument injuries.

 

Few newly infected people will be symptomatic (20-30%). Those who do develop acute illness recover with no lasting liver damage. However, there is a large potential for chronic infection (75-85%)

 

60%–70% of chronically infected persons develop chronic liver disease. 5%–20% develop cirrhosis over a period of 20–30 years and 1%–5% will die from cirrhosis or liver cancer.

 

Currently, there is NO vaccination available for Hepatitis C.

 

Testing is recommended for:
•Persons born from 1945–1965
• Persons who currently inject drugs or who have injected drugs in the past, even if once or many years ago
• Recipients of clotting factor concentrates before 1987
• Recipients of blood transfusions or donated organs before July 1992
• Long-term hemodialysis patients
• Persons with known exposures to HCV (e.g., healthcare workers after needle sticks, recipients of blood or organs from a donor who later tested positive for HCV)
• HIV-infected persons
• Children born to infected mothers (do not test before age 18 mos.)
• Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
• Donors of blood, plasma, organs, tissues, or semen

 

If the antibody test is reactive, an additional blood test is needed to determine if a person is currently infected with Hepatitis C. This test is called a RNA test (PCR).

 

MD Form DHMH 4677:
Hepatitis C screen:  HCV antibody.