Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.
Risk
international travelers, particularly those traveling to developing countries
Prevention
The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.
Treatment
Hepatitis A usually resolves on its own over several weeks.
Hepatitis B
Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.
Risk
People most likely to get hepatitis B are
Prevention
The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.
Treatment
Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.
People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.
Hepatitis C
Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.
Risk
People most likely to be exposed to the hepatitis C virus are
injection drug users
people who have sex with an infected person
people who have multiple sex partners
health care workers
infants born to infected women
hemodialysis patients
people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced
people who received clotting factors made before 1987, when methods to manufacture these products were improved
Prevention
There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.
Treatment
Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.
If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.
Hepatitis D
Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.
Risk
Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk. Others at risk include
people who live with or have sex with a person infected with hepatitis D
people who received a transfusion of blood or blood products before 1987
Prevention
People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.
Treatment
Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.
Hepatitis E
Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States
Risk
People most likely to be exposed to the hepatitis E virus are
international travelers, particularly those traveling to developing countries
people living in areas where hepatitis E outbreaks are common
people who live with or have sex with an infected person
Prevention
There is no (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.
Treatment
Hepatitis E usually resolves on its own over several weeks to months.
Points to Remember
- Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.
- Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.
- Vaccines offer protection from hepatitis A and hepatitis B.
- No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.
- Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.
Nursing Priorities
1. Reduce demands on liver while promoting physical well-being.
2. Prevent complications.
3. Enhance self-concept, acceptance of situation.
4. Provide information about disease process, prognosis, and treatment needs.
Discharge Goals
1. Meeting basic self-care needs.
2. Complications prevented/minimized.
3. Dealing with reality of current situation.
4. Disease process, prognosis, transmission, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
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