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

2. 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

3. 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

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

5. 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)

6. 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

7. 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

8. 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.

9. 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

10. 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)

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

12. 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

13. Hepatitis B Prevention

14. 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 ***

16. 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

17. 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

18. References
Center for Disease Control & Prevention. Retrieved February 27,
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,
Pasadena Public Health Department. Retrieved February 28,

19. Questions?