Hepatitis D prevention: Difference between revisions

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==Overview==
==Overview==
Protection against hepatitis D among drug users can be accomplished by vaccinating against hepatitis B. Since HDV infection requires that the person be co-infected with HBV, vaccinating against hepatitis B also confers immunity to hepatitis D. Some 3 to 4 percent of healthy recipients have no response to the [[hepatitis B vaccine]].
[[HDV infection]] requires the person to be [[coinfection|co-infected]] with [[HBV]], therefore, [[vaccination]] against [[hepatitis B]] confers [[immunity]] against [[hepatitis D]]. Since a [[vaccine]] against [[hepatitis D]], for patients infected with [[HBV]], is not available, these individuals should prevent [[superinfection]] by avoiding risk behaviors, such as: contact with blood from infected individuals, and sharing of sharp objects.


==Prevention==
==Prevention==
Hepatitis B must be present, either in coinfection or superinfection, in order for hepatitis D to propagate. The best way of preventing hepatitis D infection is with vaccination against hepatitis B.
In order to be infected with [[hepatitis D]], a patient must be previously [[infected]] with [[HBV]] ([[superinfection]]) or be infected by [[HBV]] at the same moment of [[infection]] with [[HDV]] ([[coinfection]]). The best prevention against [[hepatitis D]] is [[vaccination]] with [[hepatitis B vaccine]].<ref name=NIH>{{cite web | title = Hepatitis D prevention | url =http://www.niaid.nih.gov/topics/hepatitis/hepatitisd/Pages/prevention.aspx }}</ref>


Since a vaccine against hepatitis D is not available for patients who already have hepatitis B, the best course of action to prevent superinfection is to avoid risk behaviors, such as:
{{For|hepatitis B vaccine|Hepatitis B vaccine}}
 
{{For|primary prevention of hepatitis B|Hepatitis B primary prevention}}
{{For|secondary prevention of hepatitis B|Hepatitis B secondary prevention}}
 
Since a [[vaccine]] against hepatitis D is not available for patients who are already infected with [[HBV]], the best course of action to prevent [[superinfection]] in these patients is to avoid risk behaviors, such as: <ref name=NIH>{{cite web | title = Hepatitis D prevention | url =http://www.niaid.nih.gov/topics/hepatitis/hepatitisd/Pages/prevention.aspx }}</ref>


*Sex with an infected partner
*Sex with an infected partner
*Contact with the blood of an infected person
*Contact with the [[blood]] of an [[infected]] person
*Sharing of needles, syringes, razors, or toothbrushes with an infected person
*Sharing of needles, syringes, razors, or toothbrushes with an infected person
*Healthcare workers who deal with sharp objects, potentially with blood from infected patients should take extra caution


It is essential to vaccinate family members of patients who are [[infected]] with [[HBV]] and [[HDV]]. Despite the common [[parenteral]] transmission of [[HDV]], the [[virus]] has been noted to be transmitted among family members, which justifies extraordinary precautions in these families.<ref name="pmid10207796">{{cite journal| author=Niro GA, Casey JL, Gravinese E, Garrubba M, Conoscitore P, Sagnelli E et al.| title=Intrafamilial transmission of hepatitis delta virus: molecular evidence. | journal=J Hepatol | year= 1999 | volume= 30 | issue= 4 | pages= 564-9 | pmid=10207796 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10207796  }} </ref>


Hepatitis B vaccination
===HIV Infected Patients===
* HBV-HDV coinfection
[[HIV]] infected persons may not develop protective [[immunity]] after receiving the [[hepatitis B vaccine]]. Hence, they remain at risk for infection with [[HBV]] and [[HDV]].<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref>
:* pre or post-exposure prophylaxis (hepatitis B immune globulin or vaccine) to prevent HBV infection
* HBV-HDV superinfection
:* education to reduce risk behaviors among persons with chronic HBV infection <ref>http://www.cdc.gov/ncidod/diseases/hepatitis/d/fact.htm</ref>
 
Special care should be taken in clinical settings to avoid accidental sticks with needles, syringes, and other sharp instruments and to follow proper sterilization or disposal procedures. Universal precautions apply for drawing blood or other medically related procedures.
 
===Children:===
 
A child with known hepatitis D should be excluded if he or she exhibits any of the following:<ref>http://www.ndhealth.gov/disease/documents/faqs/hepatitis%20d.pdf</ref>
* Weeping sores that cannot be covered
* Biting or scratching behavior
* A bleeding problem
* Generalized [[dermatitis]] that may produce wounds or weepy tissue fluids
* Unable to participate in routine activities, needs more care than can be provided by staff, or meets other
exclusion criteria, such as fever with behavioral change
 
The child can be readmitted to a group setting when skin sores are dry or covered, when the child is cleared to
return by a health professional, or when the child is able to participate in activities.
 
===HIV Infected Patients:===
 
HIV-infected persons may not develop protective immunity after receiving hepatitis B vaccine. They therefore remain at risk for infection with HBV and HDV.<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref>
 
===Pregnant Patients:===


Pregnant women should be screened for [[hepatitis B]] infection. If the woman is at risk for HBV infection, she should be vaccinated. The current recommendations of the American College of Pediatrics and the Centers for Disease Control and Prevention are that all infants be immunized against hepatitis B.<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref>
===Pregnant Patients===
Pregnant women should be screened for [[hepatitis B]] [[infection]]. If a woman is at risk for [[HBV infection]], she should be [[vaccinated]]. The current recommendations of the American College of Pediatrics and the Centers for Disease Control and Prevention are that all infants be immunized against [[hepatitis B]].<ref>Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.</ref>


==References==
==References==


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[[Category:Disease]]
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[[Category:Emergency mdicine]]
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[[Category:Infectious disease]]
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[[Category:Hepatology]]
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Latest revision as of 22:06, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Jolanta Marszalek, M.D. [3]

Overview

HDV infection requires the person to be co-infected with HBV, therefore, vaccination against hepatitis B confers immunity against hepatitis D. Since a vaccine against hepatitis D, for patients infected with HBV, is not available, these individuals should prevent superinfection by avoiding risk behaviors, such as: contact with blood from infected individuals, and sharing of sharp objects.

Prevention

In order to be infected with hepatitis D, a patient must be previously infected with HBV (superinfection) or be infected by HBV at the same moment of infection with HDV (coinfection). The best prevention against hepatitis D is vaccination with hepatitis B vaccine.[1]

Since a vaccine against hepatitis D is not available for patients who are already infected with HBV, the best course of action to prevent superinfection in these patients is to avoid risk behaviors, such as: [1]

  • Sex with an infected partner
  • Contact with the blood of an infected person
  • Sharing of needles, syringes, razors, or toothbrushes with an infected person
  • Healthcare workers who deal with sharp objects, potentially with blood from infected patients should take extra caution

It is essential to vaccinate family members of patients who are infected with HBV and HDV. Despite the common parenteral transmission of HDV, the virus has been noted to be transmitted among family members, which justifies extraordinary precautions in these families.[2]

HIV Infected Patients

HIV infected persons may not develop protective immunity after receiving the hepatitis B vaccine. Hence, they remain at risk for infection with HBV and HDV.[3]

Pregnant Patients

Pregnant women should be screened for hepatitis B infection. If a woman is at risk for HBV infection, she should be vaccinated. The current recommendations of the American College of Pediatrics and the Centers for Disease Control and Prevention are that all infants be immunized against hepatitis B.[4]

References

  1. 1.0 1.1 "Hepatitis D prevention".
  2. Niro GA, Casey JL, Gravinese E, Garrubba M, Conoscitore P, Sagnelli E; et al. (1999). "Intrafamilial transmission of hepatitis delta virus: molecular evidence". J Hepatol. 30 (4): 564–9. PMID 10207796.
  3. Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.
  4. Center for Substance Abuse Treatment. Screening for Infectious Diseases Among Substance Abusers. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 6.) Chapter 15 - Viral Hepatitis D.

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