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Recommendations for Hepatitis B, Vaccination and Care

by Bidita Debnath on November 21, 2017 at 11:58 PM
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Recommendations for Hepatitis B, Vaccination and Care

Hepatitis B is a virus that infects the liver. Sometimes the virus causes a long-term infection, called chronic hepatitis B. Reducing chronic hepatitis B infections by screening at-risk adults, increasing hepatitis B vaccination rates, and linking infected persons to care is a public health priority.

The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) advise in a new paper published in Annals of Internal Medicine. "The majority of persons at risk for or infected with the hepatitis B virus do not get screened, vaccinated, or linked to care," said Dr. Jack Ende, president, ACP. "Hepatitis B vaccination and screening are cost-effective interventions to reduce the burden of chronic hepatitis B infection. Utilization, however, remains low."

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Hepatitis means inflammation of the liver and it is most often caused by a virus. Hepatitis B is caused by the hepatitis B virus (HBV). Hepatitis B is transmitted when blood, semen, or another body fluid from a person infected with HBV enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth. About two of every three persons chronically infected with HBV are unaware of their infection, contributing to ongoing transmission.

For some people, hepatitis B is a short-term illness. For others, it can become a long-term, chronic infection. Between 15 and 40 percent of persons with chronic hepatitis B will develop cirrhosis, hepatocellular carcinoma, or liver failure and 25 percent will die prematurely from these complications.
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ACP and the CDC advise physicians to vaccinate against HBV in all unvaccinated adults, including pregnant women, at risk for infection due to sexual, skin, or mucous exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease, including hemodialysis patients, or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.

"Hepatitis B vaccination is the most effective measure to prevent HBV infection and its complications," said Winston Abara, MD, PhD, medical epidemiologist, CDC. "Because of HBV transmission risk and low hepatitis B vaccination coverage, increasing hepatitis B vaccination coverage among unvaccinated adults is essential."

ACP and the CDC also advise physicians to screen for HBV in high-risk persons, including persons born in countries with 2 percent or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease, including hemodialysis patients, blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels, incarcerated persons, all pregnant women, and infants born to HBV-infected mothers.

Physicians should provide or refer all patients identified with HBV for post-test counseling and hepatitis B-directed care, ACP and the CDC advise. All patients with chronic hepatitis B should be routinely evaluated for hepatocellular carcinoma and treatment eligibility through a history and physical exam.

The paper also discusses the barriers that contribute to low rates of hepatitis B vaccination, HBV screening, and linkage to care and offers evidence-based strategies to overcome them.

Other Types of Hepatitis

In the United States, the most common types of viral hepatitis are Hepatitis A, B, and C. Hepatitis A is usually transmitted person-to-person through the fecal-oral route or consumption of contaminated food or water. Most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs.

Source: Eurekalert
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