later decides to be vaccinated and is still in a job where exposure is possible, the employer must make vaccination available (OSHA, 2011a). The HBV vaccination is given to adults in a series of two, three, or four shots, depending on the vaccine or condition. The series gradually builds up the body’s immunity to HBV (Dorwart, 2022). Once vaccinated, a person does not need to receive the series again. People who might be carriers of hepatitis B ● An infected person can begin infecting several weeks before symptoms appear and can continue infecting others as long as the person’s body harbors the virus. ● About 1 in 10 people infected with HBV become chronic carriers and can spread the disease even if they have no symptoms. Some of these people eventually die of liver diseases, including cirrhosis—a serious scarring of the liver—and liver cancer. Infected infants and small children are very likely to become carriers of HBV. (Oakland County, Michigan, n.d.) Risk behaviors for contracting hepatitis B Practicing unsafe sex The more partners with whom a person has vaginal, anal, or oral contact, the higher the risk of becoming infected with HBV. Abstinence is the most effective way to prevent sex-related transmission. It is advisable always to use barrier protection when having vaginal, anal, or oral contact. People who have sex with multiple partners should be sure to get the HBV vaccination. Sharing needles No matter what drug is injected, sharing needles is risky. Only reputable professionals should be sought for acupuncture or tattoos. Close, frequent contact with bodily fluids Funeral professionals, like healthcare workers, should be vaccinated. People who live long-term with others who have HBV occasionally become infected. On the other hand, receiving a blood transfusion or other blood products no longer carries the threat of HBV that it once did. Today, all blood is screened for HBV before it is used. Prevention of hepatitis B The best way to avoid contracting HBV is to get vaccinated. Approximately 90% of persons who receive the injections obtain full immunity lasting more than 30 years (Dorwart, 2022). People should avoid high-risk behaviors and practice good personal hygiene when sharing food, handling human remains, and using bathrooms. They should not share razors, toothbrushes, or pierced earrings with anyone. Exposure to hepatitis B People who have not been vaccinated against HBV but are exposed to the virus can be vaccinated and, in some circumstances, treated with HBV immune globulin (HBIG) as well (CDC, 2020e). It is important to be treated and vaccinated as soon as possible after exposure. Preventing the Spread of Hepatitis B. People who have been exposed to HBV: ● Should not engage in sexual contact without a condom. ● Should not donate blood. ● Should bandage all cuts and open sores. ● Should not share anything—such as needles, razors, or toothbrushes—that could be contaminated with their blood, semen, vaginal secretions, or saliva. ● Should wash their hands well after using the toilet or handling human remains.
A pregnant patient with HBV, along with the baby, must receive HBIG and HBV vaccine within 12 hours of birth (CDC, 2020e). All pregnant women should be screened for HBV, and all babies should begin a series of HBV vaccinations within 24 hours of birth. Babies who contract HBV are likely to develop chronic HBV. Hepatitis C (HCV) HCV is the most common bloodborne infection in the United States (FDA, 2017). Between 2010 and 2018, the opioid epidemic (with its increase in injection drug use) brought about a quadrupling of acute HCV infections among people aged 18 to 39 (Maness et al., 2021). The HCV virus spreads primarily through contact with infected blood and can cause cirrhosis, liver cancer, or liver failure. HCV was formerly the major reason for liver transplants in the United States (Cleveland Clinic, 2020; Noureddin et al., 2018). The development of new drugs sent this reason for transplantation into a steep decline, with a primary diagnosis of HCV accounting for 858 (approximately 10%) of the 8,250 procedures in 2018 (HRSA, n.d.; Noureddin et al., 2018). The year 2019 saw 14,242 HCV-associated deaths in the United States (CDC, n.d.). The number of HCV-infected people may be four times the number of those infected with HIV. HCV is less likely than the other hepatitis viruses to cause serious illness at first (only one quarter of the people infected develop symptoms), but about 75% to 85% of those infected develop chronic disease (Cleveland Clinic, 2020). As of 2021, only 52% of the 3.7 million people in the United States with chronic HCV infection were aware that they had the disease, and only 37% of those infected had received treatment (Maness et al., 2021). Like HBV, HCV can be spread by contact with infected blood, and possibly semen, vaginal secretions, and saliva. In the United States, the most common means of transmission is injection of drugs. In 2019, there were an estimated 57,500 new hepatitis C infections (CDC, n.d., 2021d). Between 2013 to 2016, there may have been more than 2 million Americans living with chronic HCV. Between 2010 and 2020, the number of reported HCV infections increased fivefold, mainly because of injection drug use (HHS.gov, 2022b). HCV treatment is expensive. As of 2020, one pill could cost more than $1,000 (Myhre & Sifris, 2022). Even so, this represents a decline in costs over the past few years (CDC, 2021b). According to the CDC (2021b), the number of people with HCV who seek treatment has declined in spite of decreasing costs. Some reasons for people’s reluctance or difficulty in pursuing treatment may be Medicaid’s restrictions on provider types, patient sobriety requirements, and complicated authorization processes. The COVID-19 pandemic may have placed barriers with stay-at-home orders, reduced operation of clinics, and self-isolation. One problem with the new, highly effective, direct-acting antiviral medications (DAA) for HCV is that they can reactivate an HBV coinfection (Mavilia & Wu, 2018). Who is at risk? People are at risk who share needles; received blood during a blood transfusion or organ transplant before 1992; work with blood as a funeral director or embalmer (Hoffman & Healing, 2022); or have vaginal, oral, or anal contact without barrier protection (CDC, 2020c). All donated blood is now screened for HCV (American Red Cross, n.d.).
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