Hepatitis A, B, C Direct Inoculation Kristen Anderson, Natalie Beal, Lisa Cabrera Azusa Pacific University GNRS 587

What is Hepatitis? Inflammation of the liver Refers to viral infections of the liver Most common types: Hepatitis A, Hepatitis B & Hepatitis C Viral Hepatitis is the leading cause of liver cancer and liver transplant Symptoms: loss of appetite, N/V, dark urine, fatigue, fever, grey-colored stool, abdominal pain, joint pain, & jaundice

Similarities and Differences Viral Infection Acute vs. Chronic Transmission Vaccination Hepatitis A (HAV) Acute condition—usually last weeks to several months and resolves itself Oral-Fecal Vaccination available: Series began in early childhood & rec. before travel to specific countries Hepatitis B (HBV) Can be both Acute (lasting a few weeks) or Chronic (leading to cirrhosis or liver cancer) Bodily Fluids—sharing of needles and sexual intercourse Vaccination available: recommended to begin vaccination series in early infancy Hepatitis C (HCV) Chronic condition—can lead to cirrhosis and liver cancer No Vaccination

Mention how if they did not receive Hep A/B vaccines as a child they can follow the CDC catch-up schedules!

Incubation Period Hepatitis A Hepatitis B Hepatitis C 15 to 50 days (average is 28 days) Hepatitis B 45 to 160 days (average is 120 days) Virus can survive outside of body for 7 days Hepatitis C 14 to 180 days (average is 45 days)

Issues with Carrier State? Continued presence of the Hepatitis virus without symptoms, but with the ability to transmit Asymptomatic carriers unaware they can pass on virus Often do not seek treatment → continued spread of virus Hepatitis virus carriers are source of new infection May be more chronic carriers of Hep. C due to lack of vaccination Increased incidence rate in developing countries Lack of access to vaccinations and treatment

Public Health Nursing Roles (PHN) Reportable diseases & Confidential Morbidity Report (CMR) form Hep A (Acute) within 1 working day Hep B & C (Specify Acute/Chronic) within 7 days Population-based surveillance Assessment Client education on prevention Assurance Policy Development Health Promotion & preservation

PHN Roles 1. Conduct notifiable disease surveillance and investigations, including implementation of disease control measures. Monitor cases of hepatitis A. Perform case investigations for chronic hepatitis B and C using assigned protocols. Perform thorough, accurate and organized documentation of outbreaks. Prepare written recommendations describing disease prevention and control measures for the public in collaboration Medical Epidemiologist.

PHN Roles 2. Assist in developing disease investigation protocols and in assuring that questionnaires and educational material are current, complete, accurate, and reflect best practices. Assist in monitoring the quality of processes involved in notifiable disease reporting protocols and procedures. Assist in creating and updating educational materials. Prepare written recommendations for prevention and control measures

PHN Roles 3. Participate in standardized evaluations of outbreak and disease response measures to identify areas for improvement and collaborate with other departmental partners. ( DOH)

Client Education and Prevention Hepatitis A: Educate about strict hand- washing and improve all over personal hygiene Hepatitis A vaccine

Client Education and Prevention Hepatitis B: Vaccinations important for: Babies People with multiple partners IV drug users HIV diagnosed people Travelers to 3rd world countries

Hepatitis B Prevention

Client Education and Prevention Hepatitis C Do not share personal items that may have come into contact with another person’s blood of body fluids- toothbrush, razor, nail clippers, and needles. Do not get tattoos or body piercing. Cover open sores or other skin breaks. Practice safe sex. Routine screening. •*** No vaccination currently available ***

Population-based Surveillance Principal means of assessing population’s health status Ongoing assessment, collection, analysis & interpretation of data Collaborative effort Monitor disease Estimate the magnitude and detect epidemics Protocols or programs effective? Main goal: reduce mortality & morbidity, improve health

Prevention & Control Primary → Vaccination, education on hygiene, safe sex, sanitary conditions, safe food-handling, avoid IV drug use Secondary → post-exposure immunoglobulins, partner notification, screenings for high-risk individuals Tertiary → chronic liver disease and cancer GOAL: reduce prevalence, eventually eliminate & eradicate communicable disease

References Center for Disease Control & Prevention. Retrieved February 27, 2015. http://www.cdc.gov Stanhope, M. & Lancaster, J. (2014). Foundations of nursing in the community: Community-oriented practice (4th ed.). St. Louis, MO: Elsevier. World Health Organization. Retrieved Februrar 28, 2015 http://www.who.int/en/ Pasadena Public Health Department. Retrieved February 28, 2015. http://cityofpasadena.net/publichealth/

Questions?