Educating the Stakeholders to Eliminate Transmission of Hepatitis B

Epidemiological Aspects of Hepatitis B in Community-Based Health

Educating About Hepatitis B

Overview of Hepatitis B Epidemiology

Hepatitis B is caused by infection with the Hepatitis B virus (HBV) ("CDC," 2012). The highest concentrations of HBV are found in blood, while other body fluid, such as semen, vaginal secretions, and wound exudates, show lower concentrations ("CDC," 2012). HBV infection can be either chronic or self-limited ("CDC," 2012). The incubation period can range from 6 weeks to 6 months from the time of initial exposure to the onset of symptoms ("CDC," 2012).

Roughly half of newly acquired HBV infections in adults are symptomatic. Acute liver failure and eventual death occurs in 1% of all reported cases ("CDC," 2012). The age of infection shows an inverse relationship to chronic infection. Accordingly, 2 to 6% of adults suffer from chronic infection, while 30% of children five years and under and 90% of infants become chronically infected ("CDC," 2012). Chronic HBV infection increases the risk for premature death from cirrhosis or hepatocellular carcinoma at a rate of 15 to 25% ("CDC," 2012).

Transmission of HBV is efficient through percutaneous or mucous membrane exposure to blood itself or to body fluids that contain blood ("CDC," 2012). Infection of HBV is primarily associated with these risk factors: Illegal drug use that involves injection; unprotected sex with an infected partner; unprotected sex with more than one partner; borne by an infected mother; men having sex with other men (MSM); and a history of previous or other STD ("CDC," 2012).

Public Health National Strategy

The Centers for Disease Control and Prevention (CDC) heads the national strategy to eliminate the transmission of HBV infection. A multi-pronged approach focuses on prenatal screening and a widespread vaccination program. Specifically, the CDC strategy includes the following:

Routine screening for HBsAg of all pregnant women;

Routine screening for immuniprophylaxis of all infants born to mothers who are hepatitis B surface antigen (HBsAg)-positive;

Routine screening of all infants born to others with unknown hepatitis B surface antigen (HBsAg) status;

Routine vaccination of infants;

Vaccination of all previously unvaccinated children and adolescents through 18 years of age;

Vaccination of adults who at-risk of infection and are previously unvaccinated.

Outcomes To Date of CDC Eradication Strategy

Incidence rates for acute Hepatitis B in infants and adolescents have declined following high vaccination coverage rates. However, the same cannot be said for high-risk adult groups. High-risk adult groups are: men who have sex with other men (MSM), injection drug users, and people who have engaged in sex with more than one partner in the previous six months. Vaccination coverage for the majority of high-risk adults has continued at low rates. Consequently, most new infections occur in the high-risk adult groups. Services targeted to high-risk adults are provided in STD clinics and other similar settings, as these have proven to be ideal situations in which to provide education about HBV infection and to provide Hepatitis B vaccination to high-risk adults. Clinicians are advised to assume that all unvaccinated adults seeking or in need of services in STD and similar purpose clinics are at risk for HBV infection and should be given the Hepatitis B vaccination without delay.

Post-exposure Prophylaxis Treatment Recommendations

For people who have been exposed to HBV as a result of a discrete and identifiable exposure to blood or body fluids that contain blood (i.e., infants born to mothers who test positive for the following recommendations have been published by CDC MMWR.

For HBsAg-positive source persons, the CDC recommends the following:

Unvaccinated persons or persons known not to have responded to a complete hepatitis B vaccine series should receive both hepatitis B immune globulin (HBIG) and hepatitis B vaccine as soon as possible after exposure (preferably

Persons who are in the process of being vaccinated but who have not completed the vaccine series should receive the appropriate dose of HBIG and should complete the vaccine series.

Children and adolescents who have written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing should receive a single vaccine booster dose.

Source with Unknown HBsAg Status

Unvaccinated persons should receive the hepatitis B vaccine series with the first dose initiated as soon as possible after exposure, preferably

Persons who are not fully vaccinated should complete the vaccine series.

Children and adolescents with written documentation of a complete hepatitis B vaccine series require no further treatment.

Insurance Providers Education Initiative

It is important to convey to the HBV infection at-risk youth and adult population that a major cause of liver cancer deaths is cirrhosis of the liver caused by chronic HBV infection. In addition to the affect of the disease on patients and their families, the fiscal implications for health insurance providers are significant. It is not necessary for health insurance providers to reinvent resources and materials suitable for public education about HBV infection. The Centers for Disease Control and Prevention (CDC) has developed and freely disseminates education materials for the general public and for all stakeholders engaged in the elimination of transmission of HVB infections. Moreover, a substantial number of the education materials intended for use with the general public are printed in many different languages.

For example, a comprehensive case management program outline to prevent perinatal hepatitis B virus infection includes the following recommendations:

Test all pregnant women for hepatitis B surface antigen (HBsAg);