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Hepatitis B 101

Hepatitis B 101 . Erin M. Bachus Adult Immunization Coordinator Communicable Disease Prevention Unit San Francisco Department of Public Health. Learning Objectives. By the end of this presentation, participants will be able to: Explain the differences between Hepatitis A, B, and C

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Hepatitis B 101

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  1. Hepatitis B 101 Erin M. Bachus Adult Immunization Coordinator Communicable Disease Prevention Unit San Francisco Department of Public Health

  2. Learning Objectives • By the end of this presentation, participants will be able to: • Explain the differences between Hepatitis A, B, and C • Discuss the vaccination schedule for Hepatitis A and Hepatitis B • Understand the basic serological testing methods for Hepatitis B

  3. Hepatitis A • Transmission • Fecal-Oral transmission • Self-Limiting - does not become chronic • Infection = Protection • Who is at risk? • Men who have Sex with Men, • Travelers • all areas of the world except Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia) • Contacts of infected persons • Users of illegal drugs • Highly effective vaccine – 2 dose series, separated by 6 months

  4. Hepatitis C • Transmission • Blood transmission • Transmission through sex is possible, but not probable • Can lead to chronic illness • Who is at risk? • Users of illegal drugs • Recipients of clotting factors before 1987 • Infants of infected mothers • Hemodialysis patients • NO vaccine

  5. Hepatitis B • Transmission • Via blood and body fluids • Hep B is 100x more infections than HIV • Who is at risk? • 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 • Persons born in HBV endemic areas (see map) • Household contacts of chronically infected persons • Infants born to infected mothers • Infants/children of immigrants from areas with high rates of HBV infection • Health care and public safety workers with exposure to blood • Hemodialysis patients

  6. Hepatitis B Endemic Countries

  7. Hepatitis B • Symptoms • Experienced by 30% of people • May include: • Jaundice • Fatigue • Abdominal pain • Anorexia • Hep B can cause lifelong (chronic) infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death • Serologic testing and lifelong monitoring of chronically infected persons is essential for the prevention of severe liver disease

  8. Prevention of Hepatitis A, B, and C • Having protected sex • Avoiding drug use or using harm reduction methods while using them • i.e. not sharing needles • Good hand washing • Number one – Get vaccinated! • No vaccine for hep C

  9. Rates of Hepatitis in SF

  10. Vaccines • Hepatitis A • 2 dose series • Each dose separated by 6 months • Incredibly effective • 95-97% of people are fully protected after 1 dose! • Hepatitis B • 3 dose series • Schedule: 0,1,4-6 months • Combination hep A/hep B • Called Twinrix • 3 dose series • Schedule: 0,1,6 months *Minimum intervals only! Vaccine series never need to be restarted!*

  11. Hepatitis B and Chronic Infection • < 1% of general population develops chronic infection • Chronic infection risk decreases with age • Up to 90% of infants infected at birth • 30-50% of those infected between age 1 and 5 years • 5% of those infected as adults • Persons born in endemic countries have a much higher risk of chronic infection • 1 in 10 people! • Not related to genetics • 1 in 4 of those with chronic infection will die prematurely from cirrhosis or liver cancer • San Francisco is working on preventing this!!

  12. Serologic Testing for Hep B • Blood test used to detect: • HBsAg – determines if an active infection is present • Anti-HBs – determines if a person has immunity to the disease, either from previous infection or vaccination • Many free or low-cost places in SF to go • Very important! • Saves lives • As many as 1 in 10 Asians are infected and many of them are unaware due to a lack of symptoms

  13. MMWR Recommendations and Reports 9.19.08 • “Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection” • First ever published screening recommendations for chronic hepatitis B • Who should be tested? • Persons born in geographic regions with HBsAg prevalence of >2%. • Persons with behavioral exposures to HBV • Men who have sex with men • Users of illegal drugs • Persons receiving cytotoxic or immunosuppressive therapy • Persons with liver disease of unknown etiology

  14. What are we doing in SF?

  15. SF Hep B Free • Campaign goals • To create public and healthcare provider awareness about the importance of testing and vaccinating API for hepatitis B • To promote routine hepatitis B testing and vaccination within the primary care medical community • To ensure access to treatment for chronically infected individuals • Strategies • Public Awareness • Screening • Vaccination • Treatment / Follow-up www.sfhepbfree.org

  16. SF Hep B Free • An innovative collaboration of public/private partners • Unmatched across the country • Galvanized multiple constituents for sustainability • Effective response to major local public health concern • Partners encompass entire health care sector, universities, legislators, foundations, CBOs, and news agencies www.sfhepbfree.org

  17. Active Partners

  18. Testing & vaccination sites

  19. Provider Education • Study population • 196 PCP attendees of a university-based CME primary care Internal Medicine conferences (spring 2007) • 78% response rate • Only 45% of clinicians correctly chose HBsAg as the screening test of choice for CHB • 46% were unaware that HBV can be controlled by medications • Overestimated the relative prevalence of CHB: said other at risk groups have a higher prevalence than Chinese • HIV (40%), MSM (41%), IVDU (60%)

  20. Provider Education

  21. Hep B Free Highlights • 2007 • Board of Supervisors passes Fiona Ma’s resolution to test & vaccinate all API residents • Resolution endorsed by Health Commission. No funds allocated • Interagency Steering group established to create SF Hep B Free campaign • Planning Group with all key stakeholders established • Bus ads featuring Mayor Newsom & Assemblywoman Ma run throughout city • SFSU and CCSF commit to on campus testing & vaccination campaigns • Eight CME events reach 230 primary care providers • Seven new, low cost, public access testing & vaccination sites available • 2008 • Be a Hero public awareness campaign runs for 3 consecutive months • Co-sponsored four clinician education events • 32 organizations continue to actively participate in campaign • Five working groups contribute to success of campaign • Educated 220 staff at 15 API Health Parity Coalition agencies about hepatitis B • Screened over 4000 people for chronic hepatitis B • Raised over $400,000 in grant funds from for public awareness, evaluation, and staff support • Replication of Hep B Free begun in multiple communities • Diagnostic flowchart developed and distributed

  22. Public awareness campaign launched in SF in September 2008 • Kickoff with gala fundraising dinner and press conference unveiling first ever screening guidelines for hepatitis B • Ran for 3 consecutive months • Billboard, Muni, Print, Radio, and TV Ads

  23. Questions? • My contact information • Erin Bachus, Adult Immunization Coordinator San Francisco Dept of Public Health (415) 554-2830 erin.bachus@sfdph.org

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