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Adult Viral Hepatitis Update. Roxanne Ereth, MPH, BS Hepatitis C Program Manager Adult Viral Hepatitis Prevention Coordinator. There are common determinants that lead to transmission of HIV, VH and STD. Unprotected sex Injection drug use (and non-injection!!)

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Adult Viral HepatitisUpdate

Roxanne Ereth, MPH, BS

Hepatitis C Program Manager

Adult Viral Hepatitis Prevention Coordinator


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There are common determinants that lead to transmission of HIV, VH and STD.

Unprotected sex

Injection drug use (and non-injection!!)

Interactions between health concerns increase potential for negative health outcomes.

Untreated STD increase risk of HIV infection.

HIV infection increases the infectiousness of STD (and VH!).

Common strategies can help prevent HIV, VH and STD infection.

Abstinence Condoms

Clean needles / syringes Health Education

(Vaccination!!!)

Why are collaboration and integration across HIV, VH and STD prevention important?*

*original slide from 2008 National STD Prevention Conference by NASTAD (blue inserts are my comments)


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Inflammation of the liver HIV, VH and STD.

Causes

Viruses

Toxins

Genetic Disorders

Bacteria

Parasites

Unknown causes

What is Hepatitis?


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Virus found in feces HIV, VH and STD.

~30% of US population have been infected (32,000 new cases in 2006)

Transmitted

Contaminated food and/or water

Direct contact with infected persons feces

Resolves-does not become chronic

Can lead to fulminant hepatitis with chronic liver disease

Hepatitis A Virus


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Infection typically is symptomatic in adults, with jaundice occurring in >70% of patients.

Signs and symptoms typically last <2 months

Relapses possible for 6 months (15%)

Virus shed for 1 – 3 weeks

Most likely 1 -2 weeks before onset

Minimal 1 week after

Hepatitis A Impact


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11%--22% of persons with hepatitis A are hospitalized. occurring in >70% of patients.

The average duration of work loss estimated at 15.5 days for nonhospitalized patients and 33.2 days for hospitalized patients.

Estimates of the annual direct and indirect costs of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.

Hepatitis A Impact


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Travelers to countries with high or intermediate endemicity of hepatitis A virus infection

Men who have sex with men

Users of injection and non-injection illegal drugs

Persons with clotting factor disorders

Persons working with nonhuman primates susceptible to hepatitis A virus

Hepatitis A InfectionPersons at Increased Risk

infection


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MSM of hepatitis A virus infection

Users of injection and noninjection drugs

Occupational risk

Clotting factor disorders

Chronic liver disease

Close personal contact

Hepatitis A Vaccine Recommendations


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Blood, semen, vaginal and other body fluids of hepatitis A virus infection

Transmission

Sexual

Perinatal

Percutaneous

Transfusions, organ transplants or blood products prior to 1992

Hepatitis B Virus


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Estimated 1.25 million Americans have chronic hepatitis B: major cause of liver cancer

In 2006, an estimated 46,000 persons were newly infected.

Rates are highest among adults, particularly males aged 25–44 years.

4,000-5,000 deaths annually

$658 million in medical costs and lost wages each year

Up to 10% with HIV infected with HBV

Hepatitis B virus is 100 times more infectious than HIV

Hepatitis B Impact


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Persons with multiple sex partners or diagnosis of a sexually transmitted disease

Men who have sex with men

Sex contacts of infected persons

Injection-drug users

Persons at Increased Risk of Hepatitis B Infection


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Household contacts of chronically infected persons sexually transmitted disease

Infants born to infected mothers

Health-care and public safety workers with exposure to blood

Hemodialysis patients

Persons at Increased Risk of Hepatitis B Infection


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Universal vaccination of adults who receive care in: sexually transmitted disease

Sexually transmitted disease treatment facilities

HIV testing and treatment facilities

Facilities providing drug-abuse treatment and prevention services

Health-care settings targeting services to injection-drug users

Correctional facilities

Health-care settings targeting services to men who have sex with men

Chronic hemodialysis facilities and end-stage renal disease programs

Institutions and nonresidential day care facilities for developmentally disabled persons

Hepatitis B Vaccine Recommendations


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Regardless of insurance status sexually transmitted disease

Hepatitis B Vaccine:

All who present at STD clinic

Twinrix:

Illicit drug use

Chronic liver disease

HIV and/or HCV infected

Adult Hepatitis B Vaccine Initiative


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To participate sexually transmitted disease

Contact Immunization Coordinator

Complete VFA Program Enrollment Agreement

Complete 2008 Adult Provider Profile

Complete Program Provider/ASIIS Information

Forward forms to Roxanne

Adult Hepatitis B Vaccine Initiative


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Roxanne Ereth, MPH sexually transmitted disease

Adult Viral Hepatitis Prevention Coordinator

Hepatitis C Program Manager

602-364-3655

[email protected]

Questions?


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