The basic facts on hepatitis Viral hepatitis
HAV, which is spread sometimes by contact with blood but mainly by contact with feces (Mayo Clinic, 2022a), is not considered a threat on the same level as HBV or HCV. It will therefore not be discussed in detail in this course. Hepatitis B (HBV) In the United States, in 2019, an estimated 20,700 people were acutely infected with HBV. That same year saw 1,662 HBV-associated deaths. An estimated 580,000 to 2.4 million persons in the United States are living with HBV infection, and two thirds of them may be unaware that they are infected (Conners et al., 2023). Despite the vaccine and public awareness campaigns, progress toward the elimination of this disease has been slow (HHS.gov, 2022a). “Hepatitis” means “inflammation of the liver,” and as its name implies, hepatitis B is a virus that infects the liver. This disease is transmitted through blood-to-blood contact and initially causes inflammation of the liver. Ultimately, it can lead to more serious conditions, such as cirrhosis and liver cancer (Mayo Clinic, 2022b; NIDDK, 2020). There is no “cure” or specific treatment for HBV, but many people who contract the disease will develop antibodies, which help them get over the infection and protect them from getting it again. (Infection with HBV will not stop someone from getting another type.) Treatment can involve antiviral medications and interferon injections. Other drugs are currently in development. The HBV virus is very durable, and it can survive in dried blood for up to seven days (CDC, 2023b). For that reason, this virus is the primary concern for employees such as housekeepers, funeral directors, custodians, laundry personnel, and other employees who may come into contact with blood or potentially infectious materials in a non-first-aid or medical care situation. Symptoms HBV symptoms begin with a sense of fatigue, possible stomach pain, loss of appetite, and even nausea (Cleveland Clinic, 2022a; Mayo Clinic, 2022b). As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes) and darkened urine often appear. However, people who are infected with HBV will often show no symptoms for some time. Symptoms begin an average of 90 days after exposure, with a range of 60 to 150 days. However, many people have no symptoms at all (CDC, 2022f). Hepatitis B vaccine For 5% to 10% of adults who contract HBV, infection is lifelong. Among infants, 90% of those infected develop chronic HBV. Up to 50% of children between the ages of 1 and 5 who have HBV develop chronic infection. The vaccine should be given to infants between 12 and 24 hours after birth (Hepatitis B Foundation, n.d.a). The OSHA Bloodborne Pathogens Standard requires that employers “offer the vaccination series to all workers who have occupational exposure” to HBV. Morticians are listed among the examples of workers who may have occupational exposure. The standard goes on to say that “the vaccine and vaccination must be offered at no cost to the worker and at a reasonable time and place” (OSHA, 2011a). The vaccination is to be offered after the worker is trained and within 10 days of beginning to work on the job that might involve exposure to HBV. The vaccination is not required if the worker has already been vaccinated, or if antibody testing has shown that the worker is immune, or if the vaccine is medically contraindicated. A worker may decline vaccination but must sign a declination form. If the worker
Hepatitis is an inflammation that can have many causes. However, when health professionals talk about viral hepatitis, they usually mean hepatitis caused by the hepatitis A, hepatitis B, or hepatitis C virus. When they talk about bloodborne hepatitis, they usually mean HBV and HCV (CDC, 2019). The differences between hepatitis A, B, and C Although HAV, HBV, and HCV have similar symptoms, the viruses themselves are quite different. HAV is most commonly spread through the ingestion of stool and is much more rarely spread through contact with blood. Acute symptoms are not followed by the chronic problems that HBV and HCV can cause. HBV and HCV can infect a person whose mucous membranes or blood are exposed to an infected person’s blood, saliva, wound exudates, semen, or vaginal secretions. Like HIV, HBV and HCV can be spread by sharing hypodermic needles. HCV can be acquired from improperly sanitized tattooing needles. Symptoms appear more gradually than in HAV. Unlike HAV, HBV and HCV can stay in the body—sometimes for a lifetime—and eventually cause chronic, serious liver diseases. The symptoms of viral hepatitis Early symptoms of viral hepatitis include: ● Fatigue. ● Tenderness in the upper right abdomen. ● Sore muscles and joints. ● Loss of appetite. ● An altered sense of taste and smell. ● Nausea, vomiting, and diarrhea. ● Low-grade fever. ● Malaise. Other symptoms can include jaundice—abnormally yellow skin and eyes caused by bile entering the blood—as well as darkened urine and light-colored or gray stool (Kahn, 2021; Mayo Clinic, 2022b). Diagnosis of hepatitis Although health providers use information about symptoms, health history, and behaviors to help in diagnosis, only blood tests can confirm the diagnosis and pinpoint which type of hepatitis a person has (CDC, 2020d; Hepatitis B Foundation, n.d.b). Treatments for viral hepatitis There is no medication that can treat the initial illness that viral hepatitis causes. Health professionals manage symptoms and try to help the body’s immune system fight the infection. A patient may be told to: ● Avoid alcohol and other drugs, large doses of vitamins, and prescription drugs metabolized by the liver (sometimes including birth control pills). ● Drink high-calorie fluids such as fruit juices and eat a balanced diet; to control nausea, several smaller meals are advisable. ● Limit activity if hepatitis is symptomatic; this typically means bed rest at first, progressing to normal activity as symptoms disappear. A patient may be hospitalized in cases of severe vomiting or in the absence of improvement after several weeks. Researchers are making gains in treating the chronic liver disease associated with HBV and HCV. New oral treatment regimens offer cure rates in more than 90% of patients with HCV (FDA, 2017; Mayo Clinic, 2021). Effective treatments also exist for patients with chronic HBV, although in most cases the treatments will need to be lifelong (Mayo Clinic, 2022b).
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