viral hepatitis overview and prevention Flashcards
HAV: source
oral
HBV: source
blood/blood-derived, body fluids
HCV: source
blood/blood-derived
HAV transmission route
fecal-oral
HBV transmission route
percutaneous, permucosal
HCV transmission route
percutaneous, permucosal
HAV: chronic infxn?
no
HBV: chronic infxn?
yes
HCV: chronic infxn?
yes
HAV: acute liver failure?
yes
HBV: acute liver failure?
yes
HCV: acute liver failure?
no
HAV: general prevention?
pre/post-exposure immunization, immune globulin
HBV: general prevention?
pre/post-exposure immunization, immune globulin
HCV: general prevention?
donor screening, risk behavior modification
signs of acute liver dysfunction
yellow eyes/skin, abdominal pain, pale stools, dark urine
hepatitis A risk factors
travel to endemic areas, sexual contact, contaminated food, contact with infected people, handling non-human primates, homelessness. highest risk: injecting or non injecting drug use, unstable housing/homeless, MSM, incarceration, liver disease
HBV risk factors
IV drug users, blood transfusions, household contact with infected individuals, healthcare workers, patients undergoing dialysis
HCV risk factors
blood transfusions, healthcare workers, multiple sex partners, IV drug users, healthcare workers, piercing/tattooing
chronic complications of viral hepatitis if left untreated
hepatocellular carcinoma, end stage liver disease
viral hepatitis risk reduction
hygiene, universal precautions, needle exchange
adult vaccination for hepatitis A
non-IVDU, homelessness, work-related, contact with international adoptee, settings, HIV, MSM, chronic liver disease, travel, pregnancy, IVDU
adult vaccination for hepatitis B
all adults 19-59 should get vaccinated. adults 60+ with risk factors should get vaccinated. adults 60+ may get vaccinated without known risk factors.
hepatitis A childhood immunization
> 12 months. 2 dose series, 6 months apart
hepatitis B childhood immunization
birth, 1-2 mo, 6-18 mo (0,1,6)
HAV pre exposure prophylaxis: when should you get VACCINE for travel
healthy, >6 months of age, any time pre-departure
special note for infants 6-12 months in HAV pre exposure prophylaxis
pre-exposure vaccine does not count towards standard childhood immunization.
when should you get IMMUNOGLOBULIN for travel HAV pre exposure prophylaxis
infants <6 months
when should you get immunoglobin + vaccine for travel HAV exposure pre prophylaxis
> 40 years old, CLD, immunocompromised, travel in <2 weeks
dose of IG for <1 month of travel
0.1 mL/kg IM
dose of IG for 1-2 months of travel
0.2 mL/kg IM
dose of IG for >2 months of travel
0.2 mL/kg IM, repeat q2months
when to initiate drugs in pregnancy to prevent HBV transmission based on a number
HBV DNA >200,000
when to start drugs in pregnancy to prevent HBV transmission based on time
28-32 weeks gestation
which drugs for pregnancy to prevent HBV transmission
lamivudine, telbivudine, tenofovir DF
how long to continue HBV medications post partum
0-3 months, breastfeeding is not contraindicated. monitor every 3 months post DC for 6 months
how soon to give IG or vaccine for HAV post exposure
2 weeks
when to give IG for HAV post exposure
<12 months, >40 years, immunocompromisd, CLD, vaccine allergy
dose of IG for HAV post exposure
0.1 mL/kg IM
when to give vaccine for HAV post exposure
12 months-40 years old, healthy, single dose
when to give HBV post exposure prophylaxis
perinatal, sexual, health care worker
infants born to HBV infected mothers should receive ____
HBIG and HBV vaccine both within 12 hours of birth. should additionally receive vaccine at 1 and 6 months
people exposed to HBV through sexual contact should receive what prophylaxis
HBIG within 14 days, HBV vaccine at 0, 1, 6 months
HCW exposed to HBV should receive what prophylaxis
HBIG within 24 hours, HBV vaccine within 7 days, complete series or 2nd dose of HBIG
risks for HBV reactivation
chemo, stem cell transplant, immunosuppression, HCV DAA therapy
for moderate and high risk groups to HBV reactivation, how long to give prophylactic treatment
6-12 months
which agents are preferred for HBV reactivation prophylaxis
tenofovir and entecavir
which immunosuppression drugs have a high risk of HBV reactivation
B-cell depleting: rituximab
which immunosuppression drugs have a moderate risk of HBV reactivation
TNF alpha inhibitors: adalimumab
which immunosuppression drugs have a low risk of HBV reactivation
oral steroids <1 week, prednisone <10 mg for >4 weeks, intra-articular steroids. no prophylaxis indicated.
what is a black box warning for all HCV medications
HBV reactivation
hepatitis C prevention?
avoidance, monitoring.
