6.13 – Hepatitis

Policy

All admissions to Open Door residential sites will be screened for Hepatitis B upon admission or as soon as possible.  All employees will be made aware of Universal Precautions.

Hepatitis A

Reporting Information:

• Class B
• Report within 24 hours
• Confidential Case Report Card or Telephone

Agent: Hepatitis A virus (HAV)

Signs and Symptoms

Hepatitis A characteristically has an abrupt onset.  Symptoms may include fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, clay-colored stools and jaundice.  May infections are mild, without jaundice.

Epidemiology

• Sources:  The source of transmission of HAV is the stool of infected persons
• Occurrence:  Incidence appears higher in persons of lower socio-economic status and cases occur most frequently among children and young adults.  Over half of all Americans over age 40 have had Hepatitis A and are immune to reinfection
• Mode of Transmission:  Infection is acquired by ingesting the virus; thus the mode of transmission is via the fecal-oral route.  HAV is spread primarily by close person-to-person contact, or through contaminated food.  Common-source outbreaks from contaminated water supplies are extremely rare in Ohio.  In rare cases, hepatitis A can be spread through sexual contact or contact with blood from a person who has the virus circulating in his/her bloodstream.  The virus is present in the blood before symptoms appear.  Transmission through blood transfusions, while possible, seldom occurs.
• Period of Communicability and Carrier State: Peak viral shedding occurs during the two week period prior to the onset of symptoms and decreases rapidly thereafter.  Infected persons are generally considered non-infectious by the tenth day after onset of symptoms.  A chronic carrier state has not been demonstrated and Hepatitis A does not cause chronic liver disease
• Incubation Period: The incubation period ranges from two to six weeks and averages 28 to 30 days

Diagnosis

Hepatitis A is not diagnosed by attempting to isolate the virus in the Individual’s stool.  Infection is confirmed by detection in the serum of acute-phase (IGM) antibody to the Hepatitis A virus (anti-HAV IGM)

Precautions

Individuals and staff should be instructed to exercise good personal hygiene during the period of communicability, with an emphasis on thorough hand washing in conjunction with Universal Precautions.  Diapers and other fecally-contaminated articles should be handled with care.  The usual enteric precautions should be used until 10 days after the onset of symptoms.

Contact

For exposure to occur, the contact must ingest particles of the patient’s feces, either directly or through contaminated food.  Persons classified as case contacts are those who potentially have exposure to the infected person’s stool, although these exposures may be in-apparent and inadvertent.

Case contacts should receive an injection of immune globulin (IG).  Immune globulins used in medical practice are sterile solutions of anti-bodies from human plasma.  Immune globulin is not vaccine and provides only temporary protection which lasts for approximately three months.

Hepatitis B

Reporting Information: 

• Class B
• Report within 24 hours using individual case report card

Agent: Hepatitis B virus (HBV)

Signs and Symptoms

Variable clinical presentation ranging from in-apparent illness (common) to fulminate Hepatitis.  Symptomatic cases have an incubation period of 2 to 6 months and typically present with a history of insidious onset of fever, fatigue, headache, anorexia, nausea, vomiting, abdominal pain, jaundice, diarrhea, dark yellow urine, light colored stools

Epidemiology

Hepatitis B virus is found in blood and blood products, saliva and semen.  The principle modes of transmission are (1) direct percutaneous inoculation of infected blood or blood products, most commonly through contaminated needles; (2) non-needle, percutaneous transfer or infective serum or plasma such as may occur through minute cuts or abrasion (3) introduction of infective serum or plasma through inadvertent contact with buccal or ocular surfaces, such as mouth pipetting in a laboratory; (4) introduction of infective secretions, such as serum or saliva, into mucosal surfaces, as through sexual contact; (5) indirect transfer or serum or plasma via vectors or inanimate environmental surfaces in areas of heavy blood contamination, such as hemodialysis units; (6) getting a tattoo or body piercing with dirty tools and (7) sharing a toothbrush or razor with an infected person

Serologic Diagnosis of Hepatitis B

The diagnosis of Hepatitis B is confirmed by the detection of specific serologic markers associated with Hepatitis B virus (HBV).

Three specific viral antigens have been identified.  These are the surface antigen (HBsAg) – formerly called the Australia Antigen, the core antigen (HBcAg) and the e antigen (HBeAg).  Antibodies to these antigens have also been identified; i.e., anti-HBs, anti-HBc and anti-HBe.

Precautions

As Hepatitis B is transmitted only through percutaneous or per mucosal inoculation of HBV, “Isolation” of infected persons is unnecessary and inappropriate.  Universal Precautions are used for all individuals in a program operated by Open Door refer to Policy and Procedure 6.14 and 6.14.1.

Groups Recommended for Pre-Exposure Vaccination

• Persons with occupational risk involving direct contact with blood or blood-contaminated body fluids
• Clients and staff of institutions for the developmentally disabled as well as clients and staff who live or work in smaller residential settings with known HBV carriers
• Hemodialysis patients
• Sexually active homosexual men
• Users of illicit injectable drugs
• Recipients of certain blood products
• Household and sexual contacts of HBV carriers
• Adoptees from countries of high HBV endemicity
• Inmates of long-term correctional facilities
• Sexually active heterosexual persons
• International travelers

Vaccine Procedure

Any employee at Open Door may receive the Hepatitis Vaccine Series at the recommendation of their primary personal physician.  Open Door will pay for the series of three injections.  The employee may bring in the bill(s) to the Executive Director at their convenience.  All new employees may receive the series of three injections from the Open Door nursing staff, during their first week of employment or within 15 days of their initial work assignment.

Post-Exposure Prophylaxis in Non-Vaccinated employees

• Exposure Incident is defined as a specific eye, mouth or other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious material
• Following the report of an exposure incident, the exposed employee will be provided with a confidential medical evaluation and follow up, including but not limited to:
  • Documentation of the route of exposure under which the incident occurred
  • Identification and documentation of the source individual (individual involved in the exposure incident)
  • Source individuals blood will be tested for HBV and HIV to determine infectivity and results of testing will be made available to the exposed employee.
  • The exposed employee’s blood will be collected and tested as soon as feasible after consent is obtained.
    • If the exposed employee consents to baseline blood collection but does not give consent at the time for HIV serologic testing, the sample will be preserved for at least 90 days.  If during this time the employee elects to have the blood tested this will be done as soon as possible.
  • Post exposure prophylaxis when medically indicated will be provided as recommended by the U.S. Public Health Service
  • The exposed employee will be provided counseling and appropriate evaluation of reported illness
• The following information will be provided to the Medical Services Coordinator/designee responsible for the post exposure evaluation and follow up procedures.  The Medical Director for Open Door will be the responsible professional.
  • A complete copy of the Federal Register 29CFR Part 1910-1030 Occupational Exposure to Blood-borne Pathogens
  • A description of the exposed employees duties as they relate to the exposure incident
  • Documentation of the route of exposure and circumstances under which the exposure occurred
  • Results of the source individuals blood testing
  • All medical records relevant to the appropriate treatment of the employee including his/her vaccination status
• The exposed employee will be provided with a copy of the Medical Director’s written opinion within 15 days of the completed evaluation
  • The written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for the employee and if the employee has received such vaccination
  • The written opinion will be limited to the following post exposure evaluation and follow up
    • That the employee has been informed of the results for the evaluation
    • That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment
    • All other finding and diagnosis shall remain confidential and shall not be included in the written report

Hepatitis C (HCV)

Agent: Hepatitis C (HCV)

Signs and Symptoms

• Constant tiredness (fatigue)
• Sore Muscles
• Headache
• Widespread abdominal discomfort or discomfort that is concentrated in the upper right quadrant of the abdomen
• Nausea
• Dark urine or light (clay-colored) stools
• Loss of appetite or weight loss
• Aversion to some foods, particularly those that are fatty or fried or high in protein
• Less commonly, yellowing of the skin and the whites of the eyes (jaundice)

Epidemiology

• Source
  • The source of transmission of HCV is the blood
• Mode transmission:
  • The hepatitis C virus (HVC) spreads through contact with blood, most commonly by sharing needles and other equipment used to inject illegal drugs.  Health care workers face a risk (although low, less than 2%) of infection from accidental needle sticks and other occupational exposures.
  • The virus can spread through sexual contact, but the risk is low, especially for long-term monogamous couples.  Risk increases for those who have multiple sex partners.  Having a sexually transmitted disease or being infected with HIV may increase the risk of becoming infected with HCV.
  • In the past, the virus was spread through infected blood used in transfusion and infected solid organs used in transplantation.  However, the risk of infection from these procedures is not extremely low. An infected mother can spread the virus to her baby at birth.  The transmission rate is about 6% and can be higher if the mother also is infected with HIV.

Diagnosis

Blood tests are done to look for signs of liver inflammations, antibodies to the hepatitis C virus, and the virus’s genetic material.

A liver biopsy may be done to see whether the liver has been damaged by the virus and, later, to see whether treatment is successful. People with mild to moderate liver damage tend to respond better to treatment than those who have more extensive damage.

Treatment

Chronic HCV infection may be treated with medications that fight viral infections.  Standard treatment combines two antiviral medications; interferon and ribavirin.  However, this treatment is not an option for everyone because of significant side effects.  Response rates to treatment are about 40% to 50% overall, depending on individual circumstances.

Outcome

The outcome of HCV infection varies widely:

• The acute state, which occurs 2 weeks to 6 months after infection, usually is so mild that most people don’t know they are sick.
• About 80% of people who become infected with HCV develop chronic infection, which they often have for the rest of their lives.  However, the majority of people with chronic HCV infection will not develop severe liver damage.
• Although it may take many years, up to 20% of people who have chronic HCV infection develop severe liver scarring, (cirrhosis).  Of these people, 1% of 4% also develop liver cancer every year.
• If liver failure or cancer develops, liver transplantation usually is the only way to prolong life.  HCV infection is the most common reason for liver transplantation in the United States.

Screening for Hepatitis A, B and C

All individuals participating in a program operated by Open Door will be screened prior to admission and as part of their admission blood work and physical

Last Revised: 6/6/22