Hepatitis

Hepatitis A – viral – spread person to person via feces.

Pre-exposure prophylaxis

• Vaccines are available.
  • Children are routinely vaccinated between their first and second birthdays.
  • People who should consider vaccine –
    • are traveling to countries where hepatitis A is common,
    • are a man who has sex with other men
    • use illegal drugs,
    • have a chronic liver disease such as hepatitis B or hepatitis C,
    • are being treated with clotting-factor concentrates,
    • work with hepatitis A-infected animals or in a hepatitis A research laboratory
    • have occupational risks (sewer workers, food handlers)
    • expect to have close personal contact with an international adoptee from a country where hepatitis A is common
• Immune fab (IG) also available
  • Pre-exposure prophylaxis with the immune fab is only recommended in children less than 1-year-old or travelers who don’t have four weeks for full protection from vaccine.
• Post-exposure prophylaxis
  • HepA vaccine or IG should be administered within 14 days to all previously unvaccinated persons who have been exposed or are at risk of exposure due to close personal contacts of persons with serologically confirmed hepatitis A (i.e., through a blood test), including:
    • household and sex contacts and
    • persons who have shared injection drugs with someone with hepatitis A
    • caretakers not using appropriate personal protective equipment
    • Consideration should also be given to providing IG or hepatitis A vaccine to persons with other types of ongoing, close personal contact with a person with hepatitis A (e.g., a regular babysitter or caretaker).
  • Can get the immune globin if 12 months to 40 years old and it is within 2 weeks of exposure.
  • If a food handler receives a diagnosis of hepatitis A, post-exposure prophylaxis should be administered to other food handlers at the same establishment and identfied patrons during the time the food handler was symptomatic and worked, though transmission to patrons is rare.

Hepatitis B – viral HBV, passed in bodily fluids (blood, semen, saliva, vaginal fluids)

• Vaccine available, recommended for:
  • Newborns
  • Children and adolescents not vaccinated at birth
  • Those who work or live in a center for people who are developmentally disabled
  • People who live with someone who has hepatitis B
  • Health care workers, emergency workers and other people who come into contact with blood
  • Anyone who has a sexually transmitted infection, including HIV
  • Men who have sex with men
  • People who have multiple sexual partners
  • Sexual partners of someone who has hepatitis B
  • People who inject illegal drugs or share needles and syringes
  • People with chronic liver disease
  • People with end-stage kidney disease
  • Travelers planning to go to an area of the world with a high hepatitis B infection rate
• Post-exposure
  • Interferon
  • Reverse transcriptase inhibitors (lamivudine, adefovir, entecavir, telbivudine, tenofovir)\
  • Can give immune globin up to 7 days after exposure

Hepatitis C – mostly blood born

• Ribavirin, protease inhibitors (simeprevir), polymerase inhibitors (sofosbuvir)
• First two weeks of therapy can cause hemolysis, sclerel icterus, rapid decline in hematocrit, fatigue and elevated indirect bilirubin (hemolytic anemia) from ribavirin.

Alcoholic hepatitis

• Maddrey Discriminant Function (MDF) = 4.6 (pt PT – control PT) + total bilirubin
• >32 is poor prognosis.  Can do 4-week steroid and taper in this case.