Viral Hepatitis Disease and Vaccine Information
Viral hepatitis is a disease caused by a virus that infects the liver. There are many types of viral hepatitis, the most common being hepatitis A, B and C. Currently a vaccine is only available against Hepatitis A, B but there is no vaccine to protect against Hepatitis C disease. It is important to understand the mode of transmission and how best to avoid acquiring these viruses.
The Hepatitis A and B vaccine are so important that all children in the US are now given these two vaccines as part of their childhood vaccination. However, most adults who did not receive them in childhood may consider receiving them, especially if they are traveling international to developing countries or, often, as part of the requirements of entering the health and medical field.
Vaccination is the Best way to prevent getting Hepatitis A and B.
Introduction to Hepatitis A
Hepatitis A Virus (HAV) is spread through contaminated food and water. It is rarely fatal but can cause severe disease and loss of work lasting anywhere from a few days to over a month.
How do I become infected with HAV?
HAV is spread through the “fecal-oral” route. Typically someone who is infected with HAV does not wash their hands after using the toilet and then prepares uncooked food or an unchlorinated community water source. The virus can live outside the body for several days waiting to be eaten by another person. It then invades the intestinal lining and settles in the liver where it reproduces.
What is the disease like?
After 3-6 weeks HAV has reproduced in the liver causing inflammation and dysfunction. The infected person becomes yellow (jaundiced), nauseous and generally low on energy and feels sick. The liver can be enlarged and easily bruised or traumatized. Even before symptoms occur a person can transmit the virus; transmission can continue during the symptomatic period. Once the disease is resolved a person is generally immune for life.
How Can I prevent Hepatitis A?
The best way to prevent Hepatitis A is to get vaccinated. The vaccine is given on day 0 and again 6 months later. If not vaccinated, risk can be reduced by drinking only boiled water and eating food that is well cooked while traveling. Hepatitis A can also be transmitted by sexual intercourse involving the anus and mouth. This should be avoided if one is not immunized.
Download pdf for hepatitis A HERE
Introduction to Hepatitis B
Hepatitis B Virus (HBV) is a disease spread through human blood and body fluids.
It is thought that that virtually any body fluid from an infected person can contain (shed) HBV such as: perspiration, urine, semen, mucous, blood and more. In order to become infected the virus must come in contact with a mucous membrane, usually one that is inflamed or otherwise compromised, or broken skin, or somehow be injected into the blood stream commonly via a needle ( Tattoo, IV Drug use, unclean hospital practice, etc). The virus finds it’s way to the liver where it is able to infect liver cells and multiply. Approximately 5% of people infected with HBV are never able to clear the infection from their body and become Chronic Carriers of the disease and often die within a few years from liver disease depending upon treatment and response.
Disease Symptoms and Incubation
Once a person becomes infected they usually do not fall ill or show signs of disease anywhere between 6 weeks to 6 months. During this incubation time the infected person is capable of shedding the virus even though they do not feel ill. At one point the viral load in the liver becomes extensive and the liver becomes inflamed and painful. The person becomes jaundiced (turns yellow) and can have multiple organ dysfunctions. At this point the person can die from acute liver failure. Generally, most people survive the disease and become immune to further infection. However, about 5% never get rid of the virus which continues to live and destroy liver cells. These people are termed Chronic Active carriers of HBV and require medical treatment to contain the virus. In some cases the virus cannot be contained and the person may suffer early death from chronic liver failure (cirrhosis) or liver cancer.
Prevention and Vaccination
HBV can be prevented by protecting oneself from contact with the virus. Measures of protection include:
- Using a condom or other barrier method when having sexual intercourse
- Using gloves when handling human waste such as urine, feces or mucous
- Using an approved sharpes disposal unit for things like needles and scalpel blades
- Washing your hands to avoid transfer of virus whenever contact has occurred
- Wearing eye protection during surgical procedures
- Avoiding high risk activity like IV drug use or questionable tattoo establishments
- (For a more complete list of protective measures please visit CDC.gov )
Despite all best efforts, exposure to blood and body fluids still occurs. That is why optimum protection is to become vaccinated against HBV. The vaccine is administered in 3 doses starting on day 0 then 1 month and 4-6 months later. For most people this 3 dose regimen is enough. Some occupations require proof of immunity after vaccination.
Blood test after vaccination
A blood test for the antibody to the surface antigen of HBV (anti-HBs) can be done by virtually any laboratory for a reasonable price. If the anti-HBs antibody is negative after the first 3 doses, the entire 3 dose series should be repeated. If it is still negative a final single dose of the vaccine is given and no further attempts at proving immunity are currently recommended. This does not necessarily mean the person is NOT immune to HBV; but rather, a precise determination cannot be made by current lab methods.
People with the following conditions should either postpone or not get the HBV vaccine:
- Anyone with a life-threatening allergy to Baker’s Yeast
- Anyone that has had a life-threatening allergic reaction to a previous dose of Hepatitis B vaccine
- Females in the first trimester of pregnancy
- Anyone who has a demonstrable illness such as fever, vomiting, dysentery, etc.
Download pdf for hepatitis B HERE
(no vaccine available)
Infection with Hepatitis C Virus (HCV) can be similar to that of Hepatitis B above with the following exceptions:
- Hep C does not seem to be transmitted as easily as Hep B through exposures such as medical, surgical, or dental procedures, tattooing, acupuncture or ear piercing.
- Getting HCV via a mucous membrane exposure or broken skin contact seems to be very unlikely with the exception of infected blood that was splashed into the eye or nasal exposure through cocaine use.
- Rick factors for Hep C infection are predominately sexual intercourse, IV drug use and accidental hospital worker exposure.
- In the past blood transfusion and organ transplant were a source of new HCV infection but at this time this risk is nearly zero.
At this point in time HCV is far less as widespread as HBV. However the frequency with which HCV becomes a chronic active case (>60%) is much higher than HBV and carriers of HCV are much more likely to be unaware that they have a disease! Currently, there is no vaccine against Hepatitis C, and treatments to control the disease are extremely limited and expensive.
Persons with acute HCV infection typically are either asymptomatic or have a mild clinical illness; 60%-70% have no discernible symptoms; 20%-30% might have jaundice; and 10%-20% might have nonspecific symptoms (e.g., anorexia, malaise, or abdominal pain). The average time period from exposure to symptom onset is 6-7 weeks, whereas the average time period from exposure to detection in the blood is typically 8-9 weeks. Rarely, seroconversion might be delayed until 9 months after exposure.
Screening for HCV
The only tests currently approved by the U.S. Food and Drug Administration (FDA) for diagnosis of HCV infection are those that measure antibody (anti-HCV) that your body has made against the virus. These tests detect anti-HCV in greater than or equal to 97% of infected patients, but do not distinguish between acute, chronic, or resolved infection.
What is the new Hepatitis C testing recommendation?
CDC is recommending that everyone born during 1945 through 1965, also known as baby boomers, get a blood test for Hepatitis C. This recommendation calls for one-time testing of baby boomers.
Download pdf for hepatitis C HERE
Vaccination against Hepatitis B will also prevent infection with Hepatitis D Virus
- In order to get Hepatitis D virus one must either be a Hepatitis B carrier or be infected with Hep D at the same time they were infected with Hep B.
- Hepatitis D virus cannot exist independent from hepatitis B. Its dependence of HBV to provide an envelope coating qualifies it to be classed as a satellite virus
- HDV infection may occur in two ways: coinfection with HBV/HDV or superinfection of HDV in an HBV carrier. Both are usually severe infections and can lead to chronic carrier type infection with both HBV and HDV.
- Hepatitis D is a very rare disease in comparison to Hep A,B and C.
- There is no vaccine for Hepatitis D
- Hepatitis D can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination.
Blood titers For Hepatitis
Currently we can check your blood titers for Hepatitis A and B
Titers are blood tests that check your immune status to vaccinations you may have received in the past. If your titers results are positive, it means that you have received the vaccine in the past and have adequate immunity to a particular infectious disease. Therefore, you do not need to get that particular vaccine.
- Many healthcare schools or certain healthcare jobs may require proof that you have been vaccinated in the past for certain infectious agents. There are two ways to prove your vaccination history. Vaccination records from your physician will be adequate in most cases. When those records are not available, having your blood titers drawn will provide the documentation your school or work may need.
- If your titers are positive you may have already been exposed to that disease or may have received the vaccine in the past.
- If however your titer results are negative, you may have to get the vaccinations your school or work requires.
- While there is generally no harm in getting re-vaccinated, the blood titer is generally more cost effective.
For more info on blood titers please go to Bloodtiter.com
How To Save Money And Get Better Service By Choosing The Right Travel Medicine Clinic:
- Only go to clinics that offer both vaccines and prescriptions. For many itineraries, including Central or South America, Africa, the Middle East, and Asia, CDC guidelines require both vaccinations as well as prescriptions. For your trip, you may need prescriptions for malaria, travelers’ diarrhea, jet lag, and high-altitude illness prevention. Some vaccine clinics do NOT offer prescriptions. Always ask the clinic if they do both. Otherwise, you may have to pay for two office visits or administrative fees, not to mention the time and inconvenience of having to make two trips to two clinics. Worse yet, you may go on your trip without knowing you need a prescription.
- Only go to clinics that carry all the vaccines available in the United States. Ask the clinic if they carry hard to find vaccines such as Oral Typhoid, Japanese Encephalitis, or Rabies vaccine. Often, some clinics do not carry all vaccines, or they special order them once they find a client. The Vaccine Center has all vaccines available in the United States in stock.
- Only go to clinics that offer you access to a physician if you need it. Ask the clinic if there is a physician you can talk to if you need to. Sometimes people have complex medical issues that require physician input. The Vaccine Center offers access to board- certified physicians if needed.
- Only go to clinics that can offer you in-house blood tests to check your immunity to vaccines you know you already had, or have been exposed to in your life. Always ask the clinic if they offer blood titer testing on premise. In some cases, you may not need the vaccine. A blood test (blood titer) can cost a fraction of getting the vaccine again. Further, The Vaccine Center blood titer testing prices are a fraction of most major labs and we do the blood draw right in our clinic.
- Only go to clinics that focus only in vaccine medicine. Many so called “vaccine clinics” also do urgent care, primary care, occupational medicine, or other unrelated medical services. The Vaccine Center does no primary care or other unrelated medical services.
- Only go to clinics that offer the Yellow Fever vaccine every day. Some clinics offer this only once every week or two. Ask the clinic if they offer Yellow Fever vaccines every day. Since Yellow Fever is required for entry in many countries, this vaccine may be mandatory for your trip. Also ask the clinic if they are qualified to give you a formal “Yellow Fever Exempt Letter” if you have contraindications to getting the Yellow Fever vaccine.
- Only go to clinics that do not charge an administrative fee for follow up visits for vaccines in a series. Always ask if there is an administrative / office fee for subsequent visits. All Vaccine Center follow-up visits for vaccines in a series are not assessed an administrative or office visit fee.
The Vaccine Center and Travel Medicine Clinic has ALL the recommended and/or required vaccines needed for your travel:
|Hepatitis B||TD/Tdap (Tetanus)|
|Hepatitis A/B||Typhoid IM|