CD - Hep B-part 2, Hep C Flashcards
is there a treatment for Hep B (1)
1- no cure
are there medications that can reduce morbidity from hep B (1)
1- yes - antivirals and immunomodulators can reduce viral replication and thus reduce liver damage in chronic infection
what is the schedule for hep B vaccine (1)
1- not age-dependent per se:
3 doses at 0, 1 and 6 months (month 0 = first dose)
are booster doses required for hep B vaccine in immunocompetent people (1)
1- no
are booster doses required for hep B vaccine in those at high risk of HBV infection/complications (1)
1- high-risk people who do not develop anti-HBs titre of at least 10 IU/L after the
initial HB vaccine series should receive a second
HBV vaccine series
what is the effectiveness of hep B vaccine (1)
1- 95-100% effective in preventing chronic infection
how long is the hep B vaccine effective for (1)
1- protection against chronic disease lasts for at least 30 years following immunization - I.e. protection can last for decades
Within what timeframe do you get post-immunization serologic testing (anti-HBs titre) (1)
1- within 1-6 months after completion of vaccine series, for recommended groups
what are the groups recommended to get post-imm serologic testing (anti-HBs) titre -
‘medical condition’ - 5
‘contacts’ - 2
‘occupational’ - 1
(8)
1- immunocompromised people
2- those on dialysis or with chronic renal disease
3- advanced liver disease
4- solid organ transplant candidates and recipients
5- pregnant women at high risk of HBV infection
6- those with potential exposure (percutaneous, mucosal)
7- sexual and household contacts of acute cases and chronic carriers of HBV
8- workers who need confirmation of immunity due to potential for occupational exposure
in individuals who meet the groups recommended to get HBV post-imm serology, how long should titres be delayed from being collected if the person received HBIg PEP (1)
1- anti-HBs titre should be delayed for 6 months post HBIg PEP
what would an infant HBV vaccination program be most effective at reducing (1)
1- number of chronic carriers
why would an infant HBV vaccination program be effective at reducing the number of chronic carriers (2)
1- 90% of infants infected with HBV go on to develop cirrhosis i.e. chronic infection
2- despite targeted imms for infants born to HBV+ moms, some infants are missed and acquire HBV - universal infant program would prevent these cases
what would an adolescent HBV vaccination program be most effective at reducing (1)
1- number of acute infections
why would an adolescent HBV vaccination program be effective at reducing the number of acute infections (2)
1- most acute HBV cases occur in adolescents/adults
2- there often is a rapid drop in antibodies for the first year, so adolescents will have maximum protection at time of greatest risk if vaccine given in adolescence
what is an anamnestic reaction (1)
1- renewed rapid production of an antibody following second or later contact with the original provoking antigen/related antigens
what is a caveat with an adolescent HBV vaccine program that is more in favour of an infant program (1)
1- around 90% of 18-year olds will mount an anamnestic response after a primary infant series…so it might make more sense to do an infant program to hit both chronic carrier/acute infection numbers
in general, what is the landscape in Canada of HBV vaccination programs in terms of routine infant vs. adolescent programs (1a) and for high-risk infants (1b)
1a- inconsistent across the country - roughly half the provinces have infant program, the other half have adolescent program
1b- all provinces have programs for high-risk infants
HBV case management: what education on safe sex should you provide (1)
1- acute cases should abstain from sex OR practice safer sex until contacts have been appropriately screened and immunized
HBV case management: what kind of clinical mgmt do cases need (2)
1- test for other STIs and HIV
2- carriers to be linked with appropriate other services based on morbidity
HBV case management: what is guidance re: blood donation for cases (1)
1- acute cases and carriers of HBV cannot donate blood - cannot donate if you’ve ever tested positive for HBV
HBV contact mgmt: who would be considered HBV contact (4)
1- household contact of acute case/carrier
2- sexual contact of case/carrier
3- percutaneous or mucosal exposure to blood/bodily fluids potentially containing HBV (e.g. razor, toothbrush)
4- infants born to HBV+ mother
HBV contact mgmt: what is PEP for non-sexual household contacts (1)
1-
HBV vaccine ONLY (no HBIg)
HBV contact mgmt: what is the timeline for offering immunoprophylaxis as part of PEP (2)
1-
within 7 days of a percutaneous/mucosal exposure
2-
within 14 days of sexual exposure
HBV contact mgmt: what is the timeline for offering immunoglobulin as part of PEP (1)
1-
within 48h of exposure but up to 7 days of perc/mucosal exposure, or up to 14 days of sexual exposure
HBV contact mgmt: what is PEP for sexual household contacts (2)
1- HBV vaccine
2- HBIg
HBV contact mgmt: what is PEP for percutaneous/mucosal exposure (2)
1- HBV vaccine
2- HBIg
HBV contact mgmt: what is PEP for infants born to HBV+ mother (2)
1- HBV vaccine
2- HBIg
what is the agent for hepatitis C (1)
1- hepatitis C virus (HCV)
what are risk factors for hep C virus acquisition -
SDoH - 5
Nosocomial/medical condition - 3
Lifestyle/travel - 3
(11)
1- current/hx of IVDU
2- hx of incarceration
3- those who are marginally housed
4- high-risk sexual behaviours with HCV+ person
5- intranasal/inhalational drug use with HCV+ person
6- received healthcare when no universal precautions (e.g. non-sterile equipment)
7- received blood products/transfusion, organ transplant before 1992 in Canada
8- hemodialysis
9- born, travelled or resided in HCV-endemic countries
10- those who have had needle-stick injuries
11- tattooing/piercing/sharing sharp (personal hygiene) instruments with HCV+ person
what is the reservoir for HCV (1)
1- humans
what is the mode of transmission for HCV (1, and 2 less likely)
1- blood-borne (e.g. needles, transfusion)
2- sexual/vertical transmission less likely
what is the incubation period for HCV - range (1)
1- range: 2 weeks to 6 months
what is the period of communicability for HCV (1)
1-
1-2 weeks after exposure, may persist indefinitely in chronic carriers
can HCV cases be asymptomatic (1)
1- YES - 20-30% of cases are asymptomatic
if symptomatic, what is the clinical presentation of HCV infection - JAFNA (5)
SLOW, GRADUAL ONSET OF
1- jaundice
2- anorexia
3- fatigue
4- nausea/vomiting
5- abdominal pain
what is the clinical outcome if acute HCV infection goes without treatment (1)
1- 75-85% of acute infections will become chronic and can lead to cirrhosis, liver failure, hepatocellular carcinoma
what does HCV RNA indicate as a test (1)
1- measure of viral load and detectable only during active infection (not with past/resolved infections)
what does anti-HCV antibody indicate as a test (1)
1- is positive in current and past infections, including resolved infections
is there a treatment for hep C (1) and how does it compare to older treatments (1)
1- yes - direct-acting antiviral (DAA) tablets achieve permanent cure in > 90% of cases
2- fewer side-effects and shorter treatment regimens with DAAs than interferon (defunct) and ribavirin
HCV case management: what do you do for case investigation (3)
1- determine risk factors
2- determine possible source of infection
3- test anti-HCV-positive people for HCV RNA
HCV case management: can a HCV case (past or present) donate blood
1- NO do not donate blood or blood products
HCV case management: what vaccines should HCV cases receive (1)
1- publicly-funded Hep A and B vaccines for those with chronic liver disease including those with hepatitis (consult provincial immunization manual)
HCV contact mgmt: when is contact notification recommended (1)
1- notify contacts for cases whose HCV RNA status is positive or unknown, and contacts meet defined criteria (see groups)
HCV contact mgmt: what are groups who would be considered contacts (3)
1- those who have shared drug equipment with a case
2- those who have shared personal-use items with a case (e.g. razor, toothbrush)
3- sexual partners with high-risk sexual behaviour, blood-to-blood contact, long term partners
HCV contact mgmt: what is the timeframe to conduct contact follow-up (1)
1- outer limit to identify contacts is onset of risky behaviour, or previous negative antibody result (whichever is more recent)
screening for hep C (hot topic) - what is the guidance from CASL (Canadian association for the study of the liver) (1)
1- 2018 guideline recommends targeted screening in those at high risk, and also those born from 1945 to 1975
screening for hep C (hot topic) - what is the guidance from CTFPHC (Canadian task force) (1)
1- 2017 guideline recommends against screening for HCV in adults who are not at elevated risk
