THE TEXAS GUIDE TO SCHOOL HEALTH PROGRAMS 473 Hepatitis Chart Hepatitis A1 Hepatitis B2 Hepatitis C3 Hepatitis D4 Hepatitis E 5 WHAT IS IT? A virus causing A virus causing Most common bloodborne A virus causing A virus causing inflammation of the liver, it inflammation of the liver, it inflammation of the viral infection in the US; inflammation of the is rare in the US and is not associated with a does not lead to chronic liver, it can cause liver 60% to 70% develop liver, it only infects chronic state. disease. cell damage leading to chronic hepatitis; cirrhosis those with hepatitis cirrhosis and cancer. develops in 10% to 20% B. with chronic hepatitis C over 20-30 yrs; hepatocellular carcinoma (liver cancer) in 1% to 5%; INCUBATION 15 to 50 days. Average 30 4 to 25 weeks. Average 2 to 25 weeks, Avg 7- 4 to 26 weeks Avg 40 days; Range 15-60 days PERIOD days 8 to 12 weeks 9wks. HOW IS IT Fecal/oral route, through Contact with infected Contact with infected Contact with Transmitted primarily by the fecal-oral route. SPREAD? close person-to-person blood, seminal fluid and blood, contaminated IV infected blood, Fecally contaminated drinking water is the contact or ingestion of vaginal secretions. Sex needles, razors, contaminated most commonly documented vehicle of contaminated food and contact, contaminated tattoo/body piercing, and needles. Sexual transmission. Person-to -person transmission water. needles, tattoo/body other sharp instruments. contact with is uncommon., nosocomial transmission piercing and other sharp Infected mother to hepatitis D infected presumably by person- to-person contact, has instruments. Infected newborn. Not easily person. occurred. Virtually all cases in the US have mother to newborn, transmitted through sex been reported among travelers returning from human bite. high HEV -endemic areas. SYMPTOMS Abdominal pain, anorexia, May have no symptoms. Same as Hepatitis B Same as Hepatitis B Similar to those of other types of viral dark urine, fever, nausea, Some people have mild hepatitis and include abdominal pain vomiting, diarrhea, fatigue, flu-like symptoms, dark anorexia, dark urine, fever, hepatomegaly, jaundice. urine, light stools, jaundice, malaise, nausea, and vomiting. jaundice, fatigue, fever. Other less common symptoms include arthralgia, diarrhea, pruritus, and urticarial rash. TREATMENT No chronic disease Interferon effective in .A combination of alpha- Interferon effective No chronic disease OF CHRONIC up to 45% of those interferon and ribavirin with varying DISEASE treated currently is the most success. effective VACCINE Two doses to those over 2 Three doses to anyone None None None years THE TEXAS GUIDE TO SCHOOL HEALTH PROGRAMS 474 1 2 4 5 Hepatitis A Hepatits B Hepatitis C 3 Hepatitis D Hepatitis E WHO IS AT Household or sexual Infant born to infected Persons who ever IV drug users, Most commonly recognized to occur in large RISK? contact with an infected mother, those having homosexual and outbreaks, also accounts for >50% of acute injected illegal drugs, person or living in an area sex with infected bisexual men, those sporadic hepatitis in both children and adults including those who with outbreak. Travelers to person or multiple injected once or a few who have sex with in some high endemic areas. Risk factors for developing countries, partners, IV drug users, hepatitis D infected infection among persons with sporadic cases times many years ago; homosexu al and bisexual emergency responders, person of hepatitis E have not been defined. persons who had a blood men, IV drug users. healthcare workers, transfusion or organ homosexual and transplant before July bisexual men, 1992; or clotting factor hemodialysis patients. concentrates before 1987; hemodialysis patients; children born to HCV-positive women; healthcare workers after needlesticks, sharps, or mucosal exposures to HCV-positive blood; persons with evidence of chronic liver disease. PREVENTION Immune globulin, or Vaccination and safe Safe sex. Clean up Hepatitis B vaccine Avoid drinking or using contaminated water. vaccination. Wash hands sex, clean up infected spilled blood with to prevent infection. Avoiding drinking water (and beverages with after using toilet. Clean blood with bleach and bleach. Wear gloves Safe sex. ice) of unknown purity, uncooked shellfish, surfaces contaminated with wear protective gloves. when touching blood. and uncooked fruits or vegetables that are not feces such as infant Avoid sharing razors Avoid sharing razors or peeled or prepared by the traveler. IG changing tables. and toothbrushes. toothbrushes. prepared from plasma collected in non-HEV- endemic areas is not effective in preventing clinical disease during hepatitis E outbreaks and the efficacy of IG prepared from plasma collected in HEV-endemic areas is unclear. 1, 2, 4 Palmer, E. (1998). Hepatitis found in several forms. TDH Pulse Monitor. Austin, TX: Texas Department of Health; 3 CDC, (2001) Hepatitis C, Division of Viral Hepatitis, National Center for Infectious Diseases. [On-line] Available: http://www.cdc.gov/ncidod/diseases/hepatitis/e/index.htm 5CDC, (2001) Hepatitis E, Division of Viral Hepatitis, National Center for Infectious Diseases. [On-line] Available: http://www.cdc.gov/ncidod/diseases/hepatitis/e/index.htm .