Adult Viral HepatitisUpdate

Roxanne Ereth, MPH, BS

Hepatitis C Program Manager

Adult Viral Hepatitis Prevention Coordinator

Why are collaboration and integration across HIV, VH and STD prevention important?*

• There are common determinants that lead to transmission of HIV, VH and STD. – Unprotected sex– Injection drug use (and non-injection!!)

• Interactions between health concerns increase potential for negative health outcomes.– Untreated STD increase risk of HIV infection.– HIV infection increases the infectiousness of STD (and VH!).

• Common strategies can help prevent HIV, VH and STD infection.– Abstinence Condoms– Clean needles / syringes Health Education– (Vaccination!!!)

*original slide from 2008 National STD Prevention Conference by NASTAD (blue inserts are my comments)

What is Hepatitis?

• Inflammation of the liver– Causes

• Viruses• Toxins• Genetic Disorders • Bacteria• Parasites• Unknown causes

Hepatitis A Virus

• Virus found in feces• ~30% of US population have been

infected (32,000 new cases in 2006)• Transmitted

– Contaminated food and/or water– Direct contact with infected persons feces

• Resolves-does not become chronic• Can lead to fulminant hepatitis with

chronic liver disease

Hepatitis A Impact

• Infection typically is symptomatic in adults, with jaundice occurring in >70% of patients.

• Signs and symptoms typically last <2 months

• Relapses possible for 6 months (15%)• Virus shed for 1 – 3 weeks

– Most likely 1 -2 weeks before onset– Minimal 1 week after

Hepatitis A Impact

• 11%--22% of persons with hepatitis A are hospitalized.

• The average duration of work loss estimated at 15.5 days for nonhospitalized patients and 33.2 days for hospitalized patients.

• Estimates of the annual direct and indirect costs of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.

Hepatitis A InfectionPersons at Increased Risk

• Travelers to countries with high or intermediate endemicity of hepatitis A virus infection

• Men who have sex with men • Users of injection and non-injection illegal

drugs • Persons with clotting factor disorders • Persons working with nonhuman primates

susceptible to hepatitis A virusinfection

Hepatitis A Vaccine Recommendations

• MSM

• Users of injection and noninjection drugs

• Occupational risk

• Clotting factor disorders

• Chronic liver disease

• Close personal contact

Hepatitis B Virus

• Blood, semen, vaginal and other body fluids

• Transmission– Sexual– Perinatal– Percutaneous– Transfusions, organ transplants or blood

products prior to 1992

Hepatitis B Impact

• Estimated 1.25 million Americans have chronic hepatitis B: major cause of liver cancer

• In 2006, an estimated 46,000 persons were newly infected. – Rates are highest among adults, particularly males

aged 25–44 years. – 4,000-5,000 deaths annually– $658 million in medical costs and lost wages each

year– Up to 10% with HIV infected with HBV

• Hepatitis B virus is 100 times more infectious than HIV

Persons at Increased Risk of Hepatitis B Infection

• Persons with multiple sex partners or diagnosis of a sexually transmitted disease

• Men who have sex with men

• Sex contacts of infected persons

• Injection-drug users

Persons at Increased Risk of Hepatitis B Infection

• Household contacts of chronically infected persons

• Infants born to infected mothers

• Health-care and public safety workers with exposure to blood

• Hemodialysis patients

Hepatitis B Vaccine Recommendations

• Universal vaccination of adults who receive care in:– Sexually transmitted disease treatment facilities – HIV testing and treatment facilities – Facilities providing drug-abuse treatment and prevention

services – Health-care settings targeting services to injection-drug users – Correctional facilities – Health-care settings targeting services to men who have sex

with men – Chronic hemodialysis facilities and end-stage renal disease

programs – Institutions and nonresidential day care facilities for

developmentally disabled persons

Adult Hepatitis B Vaccine Initiative

• Regardless of insurance status• Hepatitis B Vaccine:

– All who present at STD clinic

• Twinrix:– Illicit drug use– Chronic liver disease– HIV and/or HCV infected

Adult Hepatitis B Vaccine Initiative

• To participate– Contact Immunization Coordinator– Complete VFA Program Enrollment

Agreement– Complete 2008 Adult Provider Profile– Complete Program Provider/ASIIS

Information– Forward forms to Roxanne

Questions?

• Roxanne Ereth, MPHAdult Viral Hepatitis Prevention CoordinatorHepatitis C Program Manager

• 602-364-3655• erethr@azdhs.gov