Sage Journals: Discover world-class research

Abstract

Hepatitis B and C present clinicians with many challenges. This article reviews the epidemiology of hepatitis, along with its prevention through vaccination, diagnosis and treatment, especially in relation to approaching the exposure of healthcare workers to at-risk patients. The role of prevention, diagnosis and treatment with interferon agents and protease inhibitors is discussed. The treatment of hepatitis B and C is advancing and the intensivist should be aware of the options for healthcare workers exposed to its risk on the intensive care unit.

Keywords

hepatitis healthcare-associated infection needlestick injury

References

Perz

Armstrong

Farrington

The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45: 529–38.

Hou

Liu

Epidemiology and Prevention of Hepatitis B Virus Infection. Int J Med Sci 2005;2: 50–57.

Health and Safety Executive. Hepatits B virus (HBV). Available at http://www.hse.gov.uk/biosafety/blood-borne-viruses/hepatitis-b.htm Accessed 28 Feb 2014.

Pendleton

Wilson-Webb

. Rising Curve: Chronic Hepatitis B Infection in the UK. Hepatitis B Foundation UK 2007: 21–23.

World Health Organization. Hepatitis C. Updated July 2013. Available at http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed March 2014.

Yun

Kim

High prevalence of HBV and HCV infection among intravenous drug users in Korea. J Med Virol 2008;80: 1570–75.

Health Protection Agency. Hepatits C in the UK. 2011 Report. HPA; Colindale. July 2011. Available at http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1309969906418 Accessed March 2014.

Centre for Disease Control and Prevention. Chronic Hepatitis B and Asian and Pacific Islanders. August, 2011. Available at http://www.cdc.gov/Features/ChronicHepatitisB/.

Chi-Jen

Shou-Dong

. Hepatitis B virus/hepatitis C virus coinfection: Epidemiology, clinical features, viral interactions and treatment. J Gastroenterol Hepatol 2008;23: 512–20.

10.

Szmuness

Stevens

Zang

A controlled clinical trial of the efficacy of the hepatitis B vaccine (heptavax B): A final report. Hepatology 1981;1: 377–85.

11.

National Network for Immunization Information. Hepatitis B. January 2009 Available at http://www.immunizationinfo.org/vaccines/hepatitis-b Accessed March 2014.

12.

British Medical Association. Hepatitis B vaccination in childhood. 2010. Available at: http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/DRRVQ7H7H1KT8EUQLXJSGT9K7VPP2C.pdf Accessed March 2014.

13.

Grebely

Prins

Hellard

Hepatitis C virus clearance, reinfection, and persistence, with insights from studies of injecting drug users: towards a vaccine. Lancet Infec Dis 2012;12: 408–14.

14.

National Institute for Health and Care Excellence. PH43 Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection.

NICE

London; 2012.

15.

The American Association for the Study of Liver Diseases. Viral hepatitis prevention, screening, and treatment. 2013. Available at http://www.aasld.org/patients/pages/viralhepatitisprevention.aspx Accessed March 2014.

16.

Health Protection Agency. Eye of the needle: United Kingdom Surveillance of significant occupation exposure to bloodborne viruses in healthcare workers. November 2008. Available at http://www.hpa.org.uk/webc/HPAwebfile/HPAweb_C/1227688128096 Accessed March 2014.

17.

Prüss-Ustün

Rapiti

Hutin

. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005;48: 482–90.

18.

NHS employers. Needlestick injury. Available at http://www.nhsemployers.org/Aboutus/Publications/Documents/Needlestick%20injury.pdf Accessed March 2014.

19.

World Health Organization. Blood safety and clinical technology. Hepatitis B surface antigen assays: operational characteristics (phase 1). May 2001. Available at http://www.who.int/diagnostics_laboratory/evaluations/en/hep_B_rep1.pdf Accessed March 2014.

20.

El-Sharief

MMO

Salam

Mea Abdel

Hassan

Possible roles for nucleic acids amplification-based techniques (NAT) in blood donor screening in Sudan. Khartoum Med J 2010;3: 440–43.

21.

National Institute of Health and Care Excellence. CG 165: Hepatitis B (chronic): diagnosis and management of chronic hepatitis B in children, young people and adults. NICE; London: June 2013.

22.

Desbois

Vaghefi

Savary

Sensitivity of a rapid immunochromatographic test for hepatitis C antibodies detection. J Clin Virol 2008;41: 129–33.

23.

Alter

Kuhnert

Finelli

. Recommendations and report: Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. MMWR 2003;52: 1–16.

24.

Curry

Afhdal

. Tests used for the noninvasive assessment of hepatic fibrosis. UptoDate. July 2013. Available at: http://www.uptodate.com/contents/tests-used-for-the-noninvasive-assessment-of-hepatic-fibrosis. Accessed March 2014.

25.

Huwart

Sempoux

Vicaut

Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterol 2008;135: 32–40.

26.

Lai

Yuen

. The natural history and treatment of chronic hepatitis B: A critical evaluation of standard treatment criteria and end points (HBV-DNA, ALT). Ann Int Med 2007;147: 58–61.

27.

Woo

Tomlinson

Nishikawa

Tenofovir and Entecavir are the most effective antiviral agents for chronic hepatitis B: A systematic review and Bayesian meta-analyses. Gastroenterology 2010;139: 1218–29.

28.

Lok

ASF

McMahon

. AASLD practice guideline update. Chronic Hepatitis B: Update 2009. Available at: http://www.aasld.org/practiceguidelines/documents/bookmarked%20practice%20guidelines/chronic_hep_b_update_2009%208_24_2009.pdf Accessed March 2014.

29.

Ghany

Strader

Thomas

Seeff

. AASLD PRACTICE GUIDELINES. Diagnosis, Management, and Treatment of Hepatitis C: An Update. Hepatol 2009;49: 1335–74.

30.

Wiegand

Buggisch

Boecher

Early monotherapy with pegylated interferon alpha-2b for acute hepatitis C infection: the HEP-NET acute-HCV-II study. J Hepatol 2006;43: 250–56.

31.

NHS NICE Guidelines. 2006. Hepatitis C – peginterferon alfa and ribavirin (TA106). Available at http://www.nice.org.uk/TA106. Accessed on 20/02/2013.

32.

Fried

Schiffman

Reddy

Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection. N Engl J Med 2002;347: 975–82.

33.

Kwo

Lawitz

Schiff

Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naive patients with genotype 1 hepatitis C infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial. Lancet 2010;376: 705–16.

34.

Stedman

CAM

. Current Prospects for Interferon-free Treatment of Hepatitis C in 2012. J Gastroenterol Hepatol 2013;28: 38–45.