What is Hepatitis?
Viral Hepatitis A, B, and C
Elizabeth A. Bancroft, MD, SM
Acute Communicable Disease
Control
County of Los Angeles
Department of Public Health
What is the Liver?
Liver
Symptoms of Hepatitis
„ Acute
„ Nausea/vomiting/diarrhea
„ Yellowing of skin/eyes
„ Fever/chills
„ Belly pain
„ Extreme tiredness
„ Change in color of stool
or urine, or:
„ Nothing at all!
„ Hepatitis means inflammation of the liver
„ Can be caused by a variety of exposures
„ Hepatitis viruses (A, B, C, D, and E)
„ Toxins
„ Drugs
„ Bacteria
„ Parasites
„ Can be both acute and chronic
Healthy Liver vs. Sick Liver
This is a healthy liver This is a sick, scarred
„ The liver is a part of liver (cirrhosis)
the digestive system
„ The liver has four
main functions:
„ Purification
„ Synthesis
„ Storage
„ Transformation
Types of Viral Hepatitis-
Hepatitis-Fecal/Oral
A
„ Chronic
Source of virus Feces
„ Nausea/vomiting/diarrhea
„ Yellowing of skin/eyes Virus transmission Fecal-oral
„ Fever/chills
„ Belly pain Incubation period 15-50 days
„ Extreme tiredness
Chronic infection No
„ Change in color of stool
or urine, or: Pre/Post Prophylaxis Pre and Post
„ Nothing at all! (vaccine and IG)
Prevention Ensure safe drinking
water; risk behavior
modification
1
 Disease Severity Hepatitis A Trends
„ Vaccine was introduced in 1995
„ Children: 70% have no symptoms „ The rate of acute hepatitis A in US and LAC
„ Adults: 30% have no symptoms has steadily decreased since 1996

„ 25% of adults need to be hospitalized

Hepatitis A

„ <1% die from hepatitis A Incidence Rates by Year

LAC and US, 1996–2006

1.8% in >50 years

20

„ 18

Casesper 100,000
16

No chronic infection
14

„
12
10
8

~65% of adults >50 years are immune

6

„ 4
2
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ye ar

LAC US

Risk Factors in Persons with

Preventing Hepatitis A
Acute Hepatitis A
Risk Factor % of „ Hygiene (e.g., hand washing)
cases „ Sanitation (e.g., clean water sources)
Sexual/household contact 11.0 „ Hepatitis A vaccine (pre and post
International travel 17.5 exposure)
MSM 2.5 „ Immune globulin (pre and post
Injection drug use 22.7 exposure)
Day care 13.3
Suspected food/water outbreak 10.2
No risk factor identified 55.4

Pre-Exposure Interventions Post-Exposure Interventions

(within 14 days)
„ Vaccine is recommended for
„ Children under 19 years old
„ Immune Globulin
„ Travelers to countries with high rates of „ Household and other intimate contacts
hepatitis A „ Vaccination
„ Drug users „ Household and other intimate contacts <40
„ MSM years
„ IG is recommended for
„ Travelers to countries with high rates of
hepatitis A who are leaving in < 2 weeks

2
Types of Viral Hepatitis- Bloodborne
B C

Source of virus Blood/body Blood/body

Virus
fluids
Percutaneous,
fluids
Percutaneous,
Hepatitis B
transmission permucosal permucosal

Incubation 45-180 days 14-180 days

period
Chronic Yes Yes

Pre/Post Pre and Post None

Prophylaxis
Prevention Donor screening; Donor screening;
risk behavior risk behavior
modification modification

Places Where Hepatitis

Disease Severity B Is Common
Alaska & Canada

„ 70% are jaundiced

„ 40% hospitalized
Asia &
„ 0.5% death from acute disease S.E. Asia
Pacific Islands
Central/

„ 2-10% get chronic disease South America Mid-

East

„ 90% if acquired at birth Africa

Areas with Hepatitis B Infection

„ 15-25% of those with chronic infection ≥8% - High
2-7% - Intermediate
can get liver failure/cancer <2% - Low
www.lapublichealth.org/ip/
County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM

Hepatitis B Trends Risk Factors for Acute Hepatitis B

„ Since 1996, the rate of acute hepatitis B in
US and Los Angeles County have decreased
Hepatitis B
Incidence Rates by Year
LAC and US, 1996–2006
4.5
4
Casesper100,000

3.5
3
2.5
2
1.5
1
0.5
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Ye ar

LAC US

3
 Hepatitis B Outbreaks in LAC Pre-Exposure Prophylaxis
„ 4 Hepatitis B „ Universal vaccination of infants
outbreaks in LAC
„ Required vaccination for school
since 1999
„ Skilled nursing „ Vaccination also recommended for:
facilities and „ MSM
retirement centers „ Injection drug users
„ All associated with „ Health care workers
contaminated „ Dialysis patients
diabetic equipment
„ STD clinic attendees

Post-Exposure Interventions Treatment

„ Persons exposed to blood of an
infected person, regular sexual
partners, household and other
intimate contacts
„ Hepatitis B Immune Globulin (HBIG)
(within 7 days)
„ Vaccination
„ ~8% cured
„ ~45% of selected individuals are
improved
„ Treatment can have serious and
unpleasant side effects

Disease Severity
Hepatitis C
„ 70-80% get chronic disease
„ 20-30% of those with chronic infection
can lead to cirrhosis, liver failure, and
liver cancer
„ Most common reason for liver
transplant

4
 Estimated Incidence of Acute Hepatitis C
United States, 1982-2000 Hepatitis C Trends
Surrogate testing of
blood donors
20 Anti-HCV test „ The incidence rate of acute hepatitis C
18 (1st generation)
licensed in LAC has been very low:
Cases per 100,000

16
14 „ Five confirmed cases in 2004
12
Anti-HCV test
10 (2ndgeneration) „ Three confirmed cases in 2005
8 licensed
6 „ Four confirmed cases in 2006
4 Decline among Decline among
transfusion recipients injection drug users
2
0
93
82

86
87
88
89
90
91

94
95

99
83
84
85

92

96
97
98

00
20
Source: CDC

Hepatitis C Trends –cont. Risk Factors for Acute Hepatitis C

„ 1.6% of the population with “chronic”
„ ~5 million in US

„ ~160,000 in LAC

„ Most newly diagnosed cases are chronic

cases
„ Exposed 20/30 years ago ( ex: blood
transfusion)
„ Newly presenting with symptoms

Healthcare Transmission
„ Recognized primarily in context of Prophylaxis- NONE!
outbreaks
„ Chronic hemodialysis „ No prophylaxis at this time
„ Hospital and doctor’s offices „ Offer vaccination against hepatitis
(procedures) A and B to protect liver
„ Unsafe injection practices
„ Modify risk behaviors
„ Reuse of syringes and needles
„ Contaminated multiple dose medication
vials

5
 Treatment
„ Depending on the type of hepatitis C virus
that you have, the treatment has a 40% to

„
80% chance of getting rid of the virus
For people infected with the most common
Thank You
type of hepatitis C (genotype 1) in the United
States, treatment is successful in 50% of
cases
„ Studies show that African Americans have a
much lower success rate with treatment—only
28%

American Liver Foundation