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• [email protected]