viral hepatitis overview and prevention

Question 1

HAV: source

Answer 1

oral

Question 2

HBV: source

Answer 2

blood/blood-derived, body fluids

Question 3

HCV: source

Answer 3

blood/blood-derived

Question 4

HAV transmission route

Answer 4

fecal-oral

Question 5

HBV transmission route

Answer 5

percutaneous, permucosal

Question 6

HCV transmission route

Answer 6

percutaneous, permucosal

Question 7

HAV: chronic infxn?

Answer 7

no

Question 8

HBV: chronic infxn?

Answer 8

yes

Question 9

HCV: chronic infxn?

Answer 9

yes

Question 10

HAV: acute liver failure?

Answer 10

yes

Question 11

HBV: acute liver failure?

Answer 11

yes

Question 12

HCV: acute liver failure?

Answer 12

no

Question 13

HAV: general prevention?

Answer 13

pre/post-exposure immunization, immune globulin

Question 14

HBV: general prevention?

Answer 14

pre/post-exposure immunization, immune globulin

Question 15

HCV: general prevention?

Answer 15

donor screening, risk behavior modification

Question 16

signs of acute liver dysfunction

Answer 16

yellow eyes/skin, abdominal pain, pale stools, dark urine

Question 17

hepatitis A risk factors

Answer 17

travel to endemic areas, sexual contact, contaminated food, contact with infected people, handling non-human primates, homelessness. highest risk: injecting or non injecting drug use, unstable housing/homeless, MSM, incarceration, liver disease

Question 18

HBV risk factors

Answer 18

IV drug users, blood transfusions, household contact with infected individuals, healthcare workers, patients undergoing dialysis

Question 19

HCV risk factors

Answer 19

blood transfusions, healthcare workers, multiple sex partners, IV drug users, healthcare workers, piercing/tattooing

Question 20

chronic complications of viral hepatitis if left untreated

Answer 20

hepatocellular carcinoma, end stage liver disease

Question 21

viral hepatitis risk reduction

Answer 21

hygiene, universal precautions, needle exchange

Question 22

adult vaccination for hepatitis A

Answer 22

non-IVDU, homelessness, work-related, contact with international adoptee, settings, HIV, MSM, chronic liver disease, travel, pregnancy, IVDU

Question 23

adult vaccination for hepatitis B

Answer 23

all adults 19-59 should get vaccinated. adults 60+ with risk factors should get vaccinated. adults 60+ may get vaccinated without known risk factors.

Question 24

hepatitis A childhood immunization

Answer 24

> 12 months. 2 dose series, 6 months apart

Question 25

hepatitis B childhood immunization

Answer 25

birth, 1-2 mo, 6-18 mo (0,1,6)

Question 26

HAV pre exposure prophylaxis: when should you get VACCINE for travel

Answer 26

healthy, >6 months of age, any time pre-departure

Question 27

special note for infants 6-12 months in HAV pre exposure prophylaxis

Answer 27

pre-exposure vaccine does not count towards standard childhood immunization.

Question 28

when should you get IMMUNOGLOBULIN for travel HAV pre exposure prophylaxis

Answer 28

infants <6 months

Question 29

when should you get immunoglobin + vaccine for travel HAV exposure pre prophylaxis

Answer 29

>40 years old, CLD, immunocompromised, travel in <2 weeks

Question 30

dose of IG for <1 month of travel

Answer 30

0.1 mL/kg IM

Question 31

dose of IG for 1-2 months of travel

Answer 31

0.2 mL/kg IM

Question 32

dose of IG for >2 months of travel

Answer 32

0.2 mL/kg IM, repeat q2months

Question 33

when to initiate drugs in pregnancy to prevent HBV transmission based on a number

Answer 33

HBV DNA >200,000

Question 34

when to start drugs in pregnancy to prevent HBV transmission based on time

Answer 34

28-32 weeks gestation

Question 35

which drugs for pregnancy to prevent HBV transmission

Answer 35

lamivudine, telbivudine, tenofovir DF

Question 36

how long to continue HBV medications post partum

Answer 36

0-3 months, breastfeeding is not contraindicated. monitor every 3 months post DC for 6 months

Question 37

how soon to give IG or vaccine for HAV post exposure

Answer 37

2 weeks

Question 38

when to give IG for HAV post exposure

Answer 38

<12 months, >40 years, immunocompromisd, CLD, vaccine allergy

Question 39

dose of IG for HAV post exposure

Answer 39

0.1 mL/kg IM

Question 40

when to give vaccine for HAV post exposure

Answer 40

12 months-40 years old, healthy, single dose

Question 41

when to give HBV post exposure prophylaxis

Answer 41

perinatal, sexual, health care worker

Question 42

infants born to HBV infected mothers should receive ____

Answer 42

HBIG and HBV vaccine both within 12 hours of birth. should additionally receive vaccine at 1 and 6 months

Question 43

people exposed to HBV through sexual contact should receive what prophylaxis

Answer 43

HBIG within 14 days, HBV vaccine at 0, 1, 6 months

Question 44

HCW exposed to HBV should receive what prophylaxis

Answer 44

HBIG within 24 hours, HBV vaccine within 7 days, complete series or 2nd dose of HBIG

Question 45

risks for HBV reactivation

Answer 45

chemo, stem cell transplant, immunosuppression, HCV DAA therapy

Question 46

for moderate and high risk groups to HBV reactivation, how long to give prophylactic treatment

Answer 46

6-12 months

Question 47

which agents are preferred for HBV reactivation prophylaxis

Answer 47

tenofovir and entecavir

Question 48

which immunosuppression drugs have a high risk of HBV reactivation

Answer 48

B-cell depleting: rituximab

Question 49

which immunosuppression drugs have a moderate risk of HBV reactivation

Answer 49

TNF alpha inhibitors: adalimumab

Question 50

which immunosuppression drugs have a low risk of HBV reactivation

Answer 50

oral steroids <1 week, prednisone <10 mg for >4 weeks, intra-articular steroids. no prophylaxis indicated.

Question 51

what is a black box warning for all HCV medications

Answer 51

HBV reactivation

Question 52

hepatitis C prevention?

Answer 52

avoidance, monitoring.