Prevention of Viral Hepatitis

Primary prevention of infection with HAV and HBV can be achieved through immunization. For HCV, primary prevention of infection activities includes screening and testing of blood donors, virus inactivation of plasma-derived products, risk reduction counseling and services (e.g., substance abuse treatment) for injection-drug users, and implementation and maintenance of infection control practices to prevent exposure to blood. Identification of persons with chronic HBV and HCV infection provides an opportunity to initiate primary prevention activities including vaccination of household, sex, and needle-sharing contacts of persons with chronic HBV infection and counseling to reduce risks for transmitting HBV and HCV to others. In addition, persons with chronic HBV and HCV infection can be provided medical management that can reduce the progression of chronic liver disease. This section summarizes current information, practices, and recommendations to prevent infection with hepatitis viruses.

Prevention of HAV Infection

Vaccination

Vaccination is the most effective means to prevent HAV infection and reduce disease incidence. Since 2006, hepatitis A vaccination has been recommended for all children at age 1 year (Fiore et al., 2006). In addition, vaccination is recommended for adults at risk (e.g., users of injection and noninjection drugs, MSM) and those who may have a severe outcome after infection (e.g., persons with chronic liver disease) (Table 9.1).

Table 9.1 Viral Hepatitis prevention and control recommendations for inmates in correctional settings.

Activity HAV HBV HCV

Table 9.1 Viral Hepatitis prevention and control recommendations for inmates in correctional settings.

Vaccination

• Vaccinate adults at risk of infection (MSM, IDU and non-IDU drug users) and those with chronic liver disease

• All unvaccinated inmates (Table 9.3)

• Not applicable

Screening

• Prevaccination screening for anti-HAV may be considered if cost-effective (Box 3)

• Prevaccination testing may be considered if cost-effective (Box 3)

• Consider routine testing for hepatitis B surface antigen of all long-term inmates or at-risk inmates (IDU, HIV infection, persons bom in countries with high endemnicity of infection)

• All inmates should be assessed for risk factors for HCV infection (IDU, recipients of clotting factors before 1987 and blood transfusions before 1992); those reporting risk factors should be tested for anti-HCV

Preventing transmission

• If a case of acute hepatitis A is identified, conduct an investigation to identify source and to identify pe sons who need postexposure prophylaxis (Box 2)

• All pregnant women should be tested for HBsAg, infants born to HBsAg-positive mothers should receive postexposure prophylaxis

• If a case of acute hepatitis B is identified, conduct investigation to identify source and to identify contacts at risk from the source

• If a case of acute hepatitis C is identified, conduct an investigation to identify the source of infection and to identify contacts at risk from the source

Postexposure prophylaxis

• Unvaccinated or known close contacts of a person with acute hepatitis A should receive postexposure prophlaxis (Box 2)

• Begin postexposure prophylaxis for unvaccinated person after any percutaneous or mucosal exposure to blood or body fluids from an HBsAg-positive source or a source of unknown HBsAg status (Table 9.4)

• After a percutaneous or mucosal exposure to blood, test source person for anti-HCV

• If source is anti-HCV-positive, test the exposed person for anti-HCV and ALT at baseline and 4-6 months later or test for HCV RNA at 4-6 weeks

Treatment

• Supportive management of clinical illness

• Evaluate persons with chronic HBV infection for liver disease and eligibility for therapy

• Evaluate persons with chronic HCV infection for liver disease and eligibility for therapy

• Administer hepatitis A and hepatitis B vaccine if chronic liver disease is present

Table 9.2 Hepatitis A vaccination dosages and schedule.

Vaccine and

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