1. Adult Viral Hepatitis Update Roxanne Ereth, MPH, BS Hepatitis C Program Manager Adult Viral Hepatitis Prevention Coordinator

2. Why are collaboration and integration across HIV, VH and STD prevention important?* 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. –AbstinenceCondoms –Clean needles / syringesHealth Education –(Vaccination!!!) *original slide from 2008 National STD Prevention Conference by NASTAD (blue inserts are my comments)

3. What is Hepatitis? Inflammation of the liver –Causes Viruses Toxins Genetic Disorders Bacteria Parasites Unknown causes

4. Hepatitis A Virus Virus found in feces ~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

5. Hepatitis A Impact 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

6. Hepatitis A Impact 11%--22% of persons with hepatitis A are hospitalized. 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.

7. Hepatitis A Infection Persons at Increased Risk 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 infection

8. Hepatitis A Vaccine Recommendations MSM Users of injection and noninjection drugs Occupational risk Clotting factor disorders Chronic liver disease Close personal contact

9. Hepatitis B Virus Blood, semen, vaginal and other body fluids Transmission –Sexual –Perinatal –Percutaneous –Transfusions, organ transplants or blood products prior to 1992

10. Hepatitis B Impact 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

11. Persons at Increased Risk of Hepatitis B Infection 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

12. Persons at Increased Risk of Hepatitis B Infection Household contacts of chronically infected persons Infants born to infected mothers Health-care and public safety workers with exposure to blood Hemodialysis patients

13. Hepatitis B Vaccine Recommendations Universal vaccination of adults who receive care in: –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

14. Adult Hepatitis B Vaccine Initiative Regardless of insurance status Hepatitis B Vaccine: –All who present at STD clinic Twinrix: –Illicit drug use –Chronic liver disease –HIV and/or HCV infected

15. Adult Hepatitis B Vaccine Initiative To participate –Contact Immunization Coordinator –Complete VFA Program Enrollment Agreement –Complete 2008 Adult Provider Profile –Complete Program Provider/ASIIS Information –Forward forms to Roxanne

16. Questions? Roxanne Ereth, MPH Adult Viral Hepatitis Prevention Coordinator Hepatitis C Program Manager 602-364-3655 erethr@azdhs.gov