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Screening for Viral Hepatitis
I didn&#;t know anything about [hepatitis C] so didn&#;t know what to think except feeling like my life was over. I was only 27 years old, and thought I would not reach 30.
&#;Kathleen (Hepatitis C Support Project, )
Medical staff members at substance abuse treatment programs might assume the primary role for screening individuals for hepatitis and explaining the screening process and test results. Opioid treatment programs with medical staff members should screen for hepatitis B and C at intake and periodically as indicated. In programs without onsite medical staff, clients may be referred elsewhere for screening with minimal (if any) involvement of the substance abuse treatment program.
Regardless of the type of program, counselors should have a basic understanding of the importance of screening, the screening process, and the meaning of the results. Counselors can encourage clients referred for hepatitis screening to follow through and complete the screening and evaluation process (evaluation is addressed in Chapter 3). Clients might feel anxious about being diagnosed with hepatitis, and they might delay or avoid getting screened.
Hepatitis screening involves testing a small sample of blood for antigens and antibodies to determine whether the individual has been infected with viral hepatitis. Antigens are foreign substances, such as microorganisms (e.g., bacteria, fungi, parasites, viruses) or chemicals, which invade the body. When the body is exposed to antigens, it produces antibodies as a part of its immune response. Antibodies are proteins that bind to the antigens to try to clear them from the body. Hepatitis blood tests look for antigens or antibodies specific to each type of hepatitis virus.
Screening for hepatitis A involves testing the blood for antibodies to the hepatitis A virus (HAV). HAV screens sometimes are referred to as hepatitis A antibody tests or hepatitis A total antibody tests.
A positive antibody test result indicates that a person has or had HAV infection or has been vaccinated against hepatitis A. This person is immune to future HAV infection. A negative test result indicates that antibodies were not detected in a person&#;s blood. A person without antibodies has never been infected with HAV, has never been vaccinated against HAV, and is still susceptible to HAV infection.
Hepatitis B virus (HBV) antigens are proteins that appear in different areas of the virus. HBV has three antigens (surface, core, and e), some of which can be detected in the blood. The body&#;s immune response produces antibodies tailored to each type of antigen (surface antibody, core antibody, and e antibody), which can also be detected from a blood test. The basic blood test for hepatitis B consists of three screening tests: a hepatitis B surface antigen test, which determines whether a person currently has the infection; a hepatitis B core antibody test, which determines whether a person has ever been infected; and a hepatitis B surface antibody test, which determines whether a person has cleared the virus after infection, or has been vaccinated and is now immune to future infections. These are described below.
Is the person currently infected with HBV? The screening test for hepatitis B surface antigens detects the presence of HBV in the blood. The antigens are detectable 4&#;10 weeks after exposure to HBV. A positive test result means the person is currently infected and can pass the infection to others. Most adults who acquire HBV clear the virus within a few months, and their hepatitis B surface antigen test result will be negative after that time. Some people remain infected and continue to test positive for hepatitis B surface antigen. If, after 6 months, the person still tests positive, his or her HBV infection is considered chronic. People diagnosed with chronic hepatitis B should have an evaluation (see Chapter 3).
Has the person ever been infected with HBV? The hepatitis B core antibody screening test detects the presence of antibodies to the HBV core antigen. The antibody appears in the blood within a few weeks of HBV infection. A positive result means the person has been infected with HBV, but it does not specify whether the person has cleared the virus, still has the infection, or is immune to reinfection.
Is the person immune to HBV? The hepatitis B surface antibody screening test detects the presence of antibodies the immune system produces to attack the virus. These antibodies appear in people who have been vaccinated against HBV, or who had been infected and cleared the virus from their bodies. A positive hepatitis B surface antibody screening test means the person has lifetime immunity from hepatitis B (the Centers for Disease Control and Prevention [CDC], ). In some situations, hepatitis B screening may be unavailable, but the hepatitis B vaccine is available. People can be safely vaccinated against hepatitis B if they have been previously infected or vaccinated.
The most common test for hepatitis C virus (HCV) detects antibodies to HCV in the blood, but the results are not clear cut and should be interpreted carefully. A &#;positive&#; HCV antibody test could mean the person is a chronic carrier of HCV (75 percent to 85 percent), has been infected but has resolved infection (15 percent to 25 percent), or is one of the few recently (acutely) infected (CDC, c). Following HCV infection, it usually takes at least 6&#;8 weeks for the body to develop enough antibodies to be measured in a screening test, but it can take longer. For example, people who have suppressed immune systems (e.g., people who have HIV infection) may not test positive for 15 weeks&#;6 months after exposure to the virus. An infection that has been present for less than 6 months may not be detected with an antibody test. However, an infection that has been present for 6 months is almost always detectable with an antibody test.
A positive HCV antibody test means the person was infected with the virus; it does not always mean the person is still infected. Up to 25 percent of people infected with HCV successfully clear the virus from their systems within 6 months after being infected, but the antibody remains present in the screening test.
Most antibody testing requires a blood sample that is sent to a laboratory for processing. However, in , the U.S. Food and Drug Administration (FDA) approved a rapid antibody blood test for HCV (the first in the United States) that is available in some medical offices. The rapid test is for individuals 15 years and older who are at risk for HCV infection or who have hepatitis symptoms. The test still requires a blood sample, but it involves the use of a &#;test strip&#; that provides results in approximately 20 minutes. However, the rapid test is not sufficient to make a final diagnosis of HCV infection. If the rapid test is positive, more traditional and sophisticated tests will be necessary to confirm the diagnosis (FDA, b).
People who have a positive result on an HCV antibody screening test should receive additional tests to get more information ( ). The most common followup test is a qualitative HCV RNA (ribonucleic acid) test. RNA is the genetic material of the virus, and the qualitative test determines whether the virus is present. A quantitative RNA test&#;or quantitative viral load test&#;measures how much of the virus is present (see Chapter 3). Because of the difficulty in interpreting an HCV antibody screening test, some medical care providers ask for a followup test before reporting the results of the antibody test to their patients. If HCV RNA is present for at least 6 months, the HCV infection is considered chronic.
HCV Screening Process.
Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps.
In people who are at risk of HCV infection, false positive antibody test results are rare. Therefore, a positive result in a person with a history of drug use, particularly injection drug use (IDU), is a true positive more than 99 percent of the time&#;meaning that the person has been infected with HCV.
The accuracy of a negative HCV antibody test result is very high. However, to account for the 6-month window period, people who inject drugs or engage in other high-risk behaviors should be retested every year (Backmund, Reimer, Meyer, Gerlach, & Zachoval, ).
Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps. Even when services offered through the substance abuse treatment program are limited, discussing hepatitis testing with clients presents an opportunity for counselors to motivate clients for change by confronting substance use and by making choices that improve their overall health. However, this may also be true when services are offered on-site through substance abuse treatment programs. A study at one methadone clinic that offered hepatitis screening and vaccination revealed that although the majority of clients completed screening (for hepatitis A, B, and C), only 54.7 percent of clients who lacked immunity for hepatitis A received vaccinations and only 2.9 percent of clients who lacked immunity for hepatitis B received vaccinations (Felsen et al., ).
The Consensus Panel makes the following general recommendations while recognizing that, in some programs, the counselor&#;s role may be limited:
Consider screening to be more than just a blood test. It is an opportunity to educate the client about hepatitis, its effects on health, and prevention strategies. It is an opportunity for clients to identify their risk factors and learn how they can reduce the risk of contracting or transmitting viruses.
Be aware that many clients may not know whether they have been screened for hepatitis in the past or they might not know the results. They might confuse HIV screening or any blood test with hepatitis screening, and they might erroneously believe that they are&#;or are not&#;infected.
Clearly explain that the hepatitis test is optional. Clients may not understand what disease the test will detect or that they have the option not to give consent ( Munoz-Plaza et al., ).
Follow up with clients regardless of the results. Failure to follow up is a missed opportunity to deliver or reinforce prevention messages ( Munoz-Plaza et al., ).
Many clients entering substance abuse treatment do not know their hepatitis status. In two urban studies, as many as 68 percent of clients who did not know whether they had been infected with HCV tested positive (Kwiatkowski, Fortuin, Corsi, & Booth, ; Felsen et al., ). In a five-city sample, 72 percent of those who tested positive for HCV were unaware of their infection (Hagan et al., ).
Clinical Scenario
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Counselor:&#;Hi, Jim. I&#;m glad you came in today. We&#;ve focused a lot on your drug use and you&#;ve described a lot of consequences in terms of your relationships, job, and finances. Today, I wondered if it would be okay to talk about how your use has generally affected your health.&#;Jim:&#;Sure, I guess so.&#;Counselor:&#;Great! First I&#;d like to know how much you know about your risks of getting hepatitis due to your injection drug use.&#;Jim:&#;Well, I know some folks who have gotten sick and died from it, but I also know some who got treated and seem to be okay. I&#;m worried that I may have this infection and will end up like the ones who died&#;I&#;m not very lucky.&#;Counselor:&#;It is true that hepatitis can lead to death in some people, but there have been some important improvements in hepatitis treatment over the past few years. But before we talk about hepatitis treatment, I&#;d like to talk a bit about how the virus is spread, tests for hepatitis, and some factors, such as alcohol use, that can affect how the virus damages the liver. Is that okay?&#;Jim:&#;It&#;s something that I&#;d rather not think about, but I know I should. I&#;ve avoided getting tested because I&#;m worried that I&#;ll test positive. I don&#;t have any health insurance and can&#;t afford treatment.&#;Counselor:&#;That&#;s a lot to worry about, so I do understand why you&#;re unsure about the next steps, if any, to take. So let&#;s talk a bit more about what you think your next step should be. I can tell you that we&#;ll do everything we can to help you. And please remember that not everyone who tests positive for hepatitis needs treatment. So, what do you think?&#;For many clients, a discussion with the counselor might be the first conversation they have about hepatitis. Clients might be uninformed about hepatitis or reluctant to discuss the disease. By using motivational strategies, counselors can improve clients&#; chances for engagement in a discussion about hepatitis.
It is crucial that a treatment counselor or health professional use a non-judgmental and compassionate tone.
It is crucial that a treatment counselor or health professional use a nonjudgmental and compassionate tone. Clients need to feel comfortable disclosing information about their health and risky behaviors. The following strategies can help initiate the conversation:
Display posters, literature, or other hepatitis-related items that could help prompt the client to ask questions about hepatitis. (See Appendix C for hepatitis resources).
Assess clients&#; ability to discuss hepatitis, based on their degree of openness in the counseling session, the amount of detail they provide in their responses, and the length of the therapeutic relationship.
Raise the subject in a way that avoids making clients feel defensive or afraid. Consider introducing the subject by making parallels with other conditions that have been discussed. Say, for example, &#;You said you were tested for HIV several times. Were you ever tested for viral hepatitis?&#; or &#;You mentioned that your friend is sick with HIV. Have you been tested for HCV or HIV? Tell me about those tests.&#;
Be patient and allow time for multiple, short conversations about the subject. This might ease feelings of fear, anxiety, or shame.
Clients may believe they know about viral hepatitis, but their understanding of the disease may not be accurate. It is easy to confuse the three main types of viral hepatitis A, B, and C. Clients may have formed impressions based on limited or incorrect information. Counselors should briefly describe hepatitis A, B, and C, including their prevalence, transmission, and relationship to drug use, as well as to other infections, such as HIV and sexually transmitted diseases. (Chapter 1 provides an overview of hepatitis. Resources for online materials are in Appendix C.) Specific strategies for speaking with clients include:
Speak clearly and keep the message simple, focused, and brief.
Use language, examples, and concepts that the client understands.
Use appropriate visual aids.
Frame numerical statements in terms that are easy to visualize. Say &#;5 out of 100 people&#; rather than &#;5 percent of the population&#;; say &#;more than half&#; instead of &#;the majority.&#;
Repeat the information at different times in different ways. The average client retains only approximately one-third of what he or she is told. Summarize essential points.
Pay attention to a client&#;s response to the information. For example, if a client stiffens his or her posture, consider saying, &#;I notice that this topic seems to make you uncomfortable. It does for a lot of people. Please tell me what you&#;re feeling right now. I&#;d really like to help you with this.&#;
Use the opportunity to describe the potential detrimental effects of alcohol and other substance use on the liver of a person who is infected with HCV.
Screening is an opportunity to draw attention to the client&#;s behaviors that put him or her at risk for contracting hepatitis:
Ask for the client&#;s perception of his or her risk for having contracted hepatitis: &#;How likely do you think it is that the test will be positive?&#;
Listen for and identify behaviors that put the client at risk for contracting hepatitis A, B, and C and HIV, especially unprotected sex and sharing injection drug paraphernalia.
Assess the client&#;s alcohol consumption.
Once clients are comfortable talking about viral hepatitis, they might be more willing to undergo screening. However, clients might be anxious about the test itself; a reassurance that testing is a simple procedure can help allay these concerns. Many substance use treatment facilities do not offer screening, and clients might need to be referred elsewhere. The following strategies can enhance the discussion of the hepatitis screening process and hepatitis prevention:
Ask the client whether he or she has ever had a hepatitis test: &#;Have you ever been tested before?&#; or &#;What did you do when you found out that you were positive [or negative] for hepatitis?&#;
Remember that information about screening might need to be repeated, depending on the rapport between client and counselor, the client&#;s cognitive abilities and interest, and other issues that come up during a session.
Discuss the benefits of screening, such as the possibility for early diagnosis and treatment (e.g., prevention of transmission to others, reduced risk of long-term complications). Clearly state that screening is voluntary.
Describe the screening procedure and explain that blood samples are needed. Be sensitive to potential relapse triggers. For a person who injects drugs, the use of a needle in the blood draw might prompt cravings.
Advise a client with a history of IDU that the blood draw might be difficult if his or her veins are damaged.
Tell the client how long it generally takes to receive results (the timeframe varies by testing venue and the laboratory). A delay does not indicate a positive result.
Make a plan with the client to get to and from the appointment.
Ensure that the client has emotional support or referrals during the waiting period. If a support group is available, encourage the client to attend to learn more about viral hepatitis and about others&#; responses to it.
Clarify the meaning of possible results. Say, for example, &#;A positive HCV antibody test result means that you have been infected with HCV. It does not necessarily mean that you are sick or that you are still infected. A negative result means that you have not been infected with hepatitis C or your infection occurred within the last 6 months.&#;
Make a plan with the client for receiving the screening results; for example, call a member of a mutual support group or schedule an additional appointment with the counselor.
The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.
Anxiety might interfere with some clients&#; ability to comprehend or retain information, which might need to be repeated.
Suggestions for conversations with clients when the test results are negative include the following:
Explain results clearly and simply: &#;So the HCV antibody screening result was negative? This means that, as of 6 months ago, you did not have hepatitis C.&#;
Emphasize that a negative result to an HCV test does not indicate immunity to hepatitis C and that the client should take precautions to avoid infection. If a relapse to drug use occurs, advise clients to avoid sharing any drug paraphernalia or equipment. Specify that this includes cookers, cotton, water, needles, syringes, pipes, and straws.
Emphasize the importance of getting HAV and HBV vaccinations. Provide information about the availability of low- or no-cost vaccinations.
Clients whose screening test results are positive for chronic hepatitis will need additional tests and examinations&#;usually with doctors who specialize in diseases of the liver (i.e., gastroenterologists)&#;to get accurate diagnoses and to determine their health status and the extent of liver damage. These tests are described in Chapter 3.
The following guidelines can help prepare clients for the next steps in evaluating their chronic hepatitis:
Ask clients whether they were referred to a medical care provider for additional tests. Encourage them to make and keep appointments.
Explain that the screening test indicates only that clients have been infected with hepatitis and additional testing is necessary to determine their health status.
Prepare clients to consider getting further evaluation. Say, for example, &#;Depending on the results of the additional medical tests, you might be asked to make some important decisions about whether to undergo antiviral treatment.&#;
Identify barriers to further testing (e.g., transportation to medical appointments, insurance coverage) and ways to overcome them.
Clients will react in a variety of ways to news of a positive result. Anxiety might interfere with some clients&#; ability to comprehend or retain information, which might need to be repeated. Some clients might be worried about spreading the virus to others or about the reaction of family, friends, and others. Impediments to clients&#; coping with a positive screening test for HCV include their concern about any disclosure of the positive test result and fear of inappropriate or disrespectful treatment by medical staff members or other clients (Strauss et al., ). For others, a positive test might be of little concern because they are more concerned with treatment for a substance use disorder (SUD) and stressors in their life other than an asymptomatic viral infection.
To help clients come to terms with their positive test results:
Explain results clearly and simply: &#;Let&#;s look at your test result, and then we&#;ll talk about how best to understand it. The HCV test result is positive, which means you have been infected with the hepatitis C virus.&#;
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Assess reactions to the results: &#;How do you feel about knowing that you have been infected with hepatitis C? What does this result mean to you?&#;
Address immediate fears and concerns before providing further information.
Provide information on liver health in the client&#;s language of choice and at the client&#;s reading and comprehension levels.
Provide reassurance and hope: &#;For some people, hepatitis is very serious, but for most people it never causes life-threatening disease. You can do many things to protect your liver.&#;
Stress the importance of getting vaccinated against hepatitis A and B. &#;If you get hepatitis A or B, it can make your hepatitis C worse. There are vaccinations against hepatitis A and B. We can help arrange for you to get vaccinated.&#;
Reiterate the importance of not drinking alcohol: &#;Alcohol damages the liver faster in people who have hepatitis. It&#;s really important to stick with treatment.&#;
Caution against taking medications without first consulting a medical care provider. &#;Some medications&#;even ones you buy over the counter or those that are available by prescription&#;can harm your liver. Even some vitamins and herbal medications can be dangerous. Check with your medical care provider before you take anything.&#;
Encourage clients to learn their HIV status. HBV and HCV infections cause liver damage more quickly in people who also have HIV infection. Chronic hepatitis can complicate the treatment of HIV. If clients are not HIV positive, urge them to take measures to avoid infection.
Explain hepatitis transmission to promote prevention:
HCV is easily spread through exposure to infected blood by sharing drug use paraphernalia or equipment or any item that can have minute bits of blood on it, including toothbrushes and razors.
HCV is not spread by sneezing, coughing, hugging, or sharing eating utensils or drinking glasses; it is not spread through casual contact.
The risk of spreading HCV by sexual contact is very low, but HBV can be spread by sexual contact (and any close personal contact).
Open sores or wounds should be treated and covered with a bandage. Having hepatitis C does not exclude clients from work, school, or other settings.
Clients who are infected with HCV cannot donate blood, body organs, or semen.
In the event of a relapse, clients should not share any drug paraphernalia or equipment and should return to treatment.
Screening for hepatitis A involves a blood test that detects antibodies produced by a person&#;s immune system to fight the virus.
A positive test result means the person is currently infected, had been infected, or has been vaccinated against infection and is immune to infection.
A negative test result means the person has never been infected or vaccinated. This person should probably be vaccinated against HAV.
Screening for hepatitis B involves blood tests that measure HBV antigens and antibodies.
The test for hepatitis B surface antigen detects the presence of HBV. A positive result means the person is currently infected and can pass the infection to others. If, after 6 months, the person still tests positive, his or her HBV infection is considered chronic.
The test for hepatitis B core antibody detects the presence of the core protein of the virus. A positive result means the person has been infected with HBV, but it does not specify whether the person has cleared the virus, still has the infection, or is immune to reinfection. A negative result means the person has never been infected with HBV. This test does not tell whether a person is immune to infection or reinfection.
The test for hepatitis B surface antibody detects the presence of the surface protein (or the surface antigen) of the virus that appears after the virus has been cleared (or the person has been successfully vaccinated). People who have surface antibodies have lifetime protection from future HBV infection. In people who do not clear the virus but develop chronic infection, these antibodies never appear.
Screening for hepatitis C involves a blood test to detect antibodies, but the results are not clear cut and should be interpreted carefully.
A positive test result means the person has been infected with HCV and might be chronically infected; it does not always mean the person is still infected. Diagnostic tests are needed.
A negative test result means either the person has not been infected or the person was infected recently and antibodies have not yet appeared. Another test might be needed in 6 months.
Counselors can use the screening as an opportunity to:
Educate clients about hepatitis.
Identify patterns of risky behavior.
Urge clients to get vaccinated against HAV and HBV.
Educate clients to prevent hepatitis transmission.
What is hepatitis B?
Hepatitis B is a viral infection that is caused by the hepatitis B virus (HBV) and results in inflammation of the liver and liver disease (e.g. cirrhosis and liver cancer). The World Health Organization (WHO) estimated that 254 million people were living with chronic hepatitis B infection in .
Is hepatitis B a notifiable disease?
Hepatitis B is a notifiable disease under the Infectious Disease Regulations. All cases should be notified to the Medical Officer of Health, including those identified by laboratories, migrant screening programmes and through STI screening programmes and GUM clinics. HPSC reports describing hepatitis B notifications and epidemiology are available here: https://www.hpsc.ie/a-z/hepatitis/hepatitisb/surveillancereports/
Where is hepatitis B a problem?
Countries are classified as having low, intermediate, or high hepatitis B prevalence based on the percentage of the population positive for infection (shown by being positive for hepatitis B surface antigen (HBsAg) on a blood test).
Ireland, most countries in Western Europe, the United States, Canada, and Australia have a low hepatitis B prevalence (<2% HBsAg). Most countries in the Caribbean, South America, Central Europe, North Africa, and the Middle East have intermediate levels of hepatitis B (2-7% HBsAg). Almost all countries in Sub-Saharan Africa, and many countries in East and South-East Asia and Eastern Europe, have high levels of hepatitis B (&#;8% HBsAg).
In low prevalence countries like Ireland, most infections are acquired sexually or through drug use. In high prevalence countries, hepatitis B is commonly spread from mother to child at birth or is acquired through exposure to infected blood from another child or family member in early childhood. Transmission in healthcare settings may also be important.
How is hepatitis B spread?
Hepatitis B is spread when blood, semen or other body fluids from an infected person enter the body of a person who is not immune. This occurs in a variety of ways, including sexual contact with an infected person, transmission from an infected mother to her baby around the time of birth, sharing of needles and other drug paraphernalia by people who inject drugs, and sharing items that can break skin or mucous membranes (e.g. razors, toothbrushes, glucose monitoring equipment).
Poor infection control practises in healthcare settings (e.g. dialysis units, diabetes clinics) and needlestick injuries can also spread hepatitis B.
You cannot get hepatitis B from sneezing, coughing, kissing, hugging, sharing cutlery or dishes, food, or water.
Who is most at risk of hepatitis B infection?
Although anyone can get hepatitis B, there are certain groups of people who are more at risk of getting infected. These include:
What is the incubation period for hepatitis B?
The incubation period (time from infection to onset of symptoms) is 6 weeks to 6 months, the average being 2 to 3 months.
What are the symptoms of hepatitis B infection?
Not all those with acute HBV infection have symptoms. In fact, only 30 to 50% of adults and 10% of children develop symptoms when they are first infected. These symptoms include:
In those with acute hepatitis B infection, symptoms last from a few weeks to several months.
What are the complications of chronic hepatitis B?
Persistent (chronic) infection can occur in around 80-90% of infants infected in their first year of life, 30-50% of children infected before the age of 6 years, and <10% of people infected as adults.
Those who develop chronic infection are at increased risk of developing:
This liver damage usually occurs gradually over 20-30 years and people with chronic infection may have mild symptoms or no symptoms for a long time. Premature death from chronic liver disease occurs in 15-25% of chronically infected people.
How is hepatitis B diagnosed?
Hepatitis B is diagnosed by testing the patient's blood for the presence of specific viral antigens or by nucleic acid testing.
Specific tests might also be used to assess for the presence and extent of liver disease. This includes a physical examination, blood tests, and imaging scans.
Can hepatitis B be treated?
There is no specific treatment for the acute hepatitis B infection. Therapy should be supportive and aimed at maintaining adequate nutritional balance.
Chronic hepatitis B infection can be treated with life-long antiviral medications. The aim of this treatment is to slow the occurrence and progression of liver disease, as well as to improve long term survival. However, eradication of the hepatitis B virus is rare. As a result, people with chronic hepatitis B infection should avoid alcohol and should ensure they are immunised against hepatitis A infection.
HIV coinfection creates challenges when it comes to treating hepatitis B. However, antiretroviral therapies (ART) are available that are active against both infections. For more information, visit WHO&#;s Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection
How can hepatitis B infection be prevented?
Hepatitis B infection can be prevented in different ways:
Hepatitis B vaccination
Hepatitis B is preventable with a vaccination. All those at increased risk of hepatitis B should receive the vaccination:
Infants receive 3 doses of the hepatitis B vaccine through the Irish Childhood Immunisation Schedule, which was started in .
Hepatitis B can be passed from mother to child while the mother is pregnant. As a result, pregnant women should be screened for infection, and if a pregnant woman is hepatitis B positive, she might be asked to take antiviral medications during her pregnancy. Regardless of whether she takes this medication, all babies born to mothers with hepatitis B should receive a birth dose of the vaccine within 24 hours of delivery.
More information is detailed in the Immunisation Guidelines for Ireland.
Other information
Ireland
Epidemiology: https://www.hpsc.ie/a-z/hepatitis/hepatitisb/
Hepatitis B information leaflets (available in several languages)
HSE hepatitis information: https://www2.hse.ie/conditions/hepatitis/
Information on drugs and drug services: https://drugs.ie/
Sexual health and wellbeing: https://www.sexualwellbeing.ie/
International
WHO hepatitis B factsheet: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
WHO global hepatitis report
ECDC reports and factsheets: https://www.ecdc.europa.eu/en/hepatitis-b
ECDC &#; Epidemiological assessment of hepatitis B and C among migrants in the EU/EEA (includes global prevalence data): https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/epidemiological-assessment-hepatitis-B-and-C-among-migrants-EU-EEA.pdf
CDC hepatitis B general information and educational materials: https://www.cdc.gov/hepatitis-b/index.html
Last updated: 24 July
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