What are the prevention and treatment options for Hepatitis A (Hep A), Hepatitis B (Hep B), and Hepatitis C (Hep C)?

Prevention and Treatment of Hepatitis A, B, and C

Vaccination is the cornerstone of prevention for hepatitis A and B, while risk reduction strategies are essential for preventing hepatitis C, for which no vaccine currently exists.

Hepatitis A (HAV)

Prevention

• Hepatitis A vaccination is recommended for all children aged ≥12 months in the United States 1
• Additional high-risk groups who should receive HAV vaccination:
  • Men who have sex with men (MSM) 1
  • Users of injection and non-injection drugs 1
  • Persons with chronic liver disease 1, 2
  • Persons with clotting-factor disorders 1
  • Persons experiencing homelessness 3
  • International travelers to endemic areas 1, 4
  • Persons who work with HAV in laboratory settings 1

Treatment

• No specific antiviral treatment exists for acute HAV infection
• Management is primarily supportive care
• Immune globulin (IG) provides post-exposure prophylaxis when administered within 2 weeks of exposure 1
  • Dosage: 0.02 mL/kg IM for post-exposure prophylaxis
  • Efficacy: 80-90% effective when given early in incubation period

Hepatitis B (HBV)

Prevention

• Universal hepatitis B vaccination is recommended for all infants, unvaccinated children, and adults at risk for HBV infection 1, 2
• High-risk groups requiring vaccination:
  • People who inject drugs 1
  • MSM 1
  • People with multiple sexual partners 1
  • Healthcare workers 1
  • Inmates of correctional facilities 1
  • Persons with chronic liver disease 2
  • Household and sexual contacts of HBV-infected persons 1

Treatment

• Antiviral therapy for chronic HBV infection based on:
  • HBV DNA levels
  • ALT levels
  • Presence of liver disease
• FDA-approved treatments include:
  • Nucleos(t)ide analogues (entecavir, tenofovir)
  • Pegylated interferon-alpha 2
• Post-exposure prophylaxis with hepatitis B immune globulin (HBIG) and vaccination for unvaccinated persons exposed to HBV 1

Hepatitis C (HCV)

Prevention

• No vaccine is currently available for HCV prevention 2
• Prevention strategies focus on risk reduction:
  • Screening of blood, organ, and tissue donors 2
  • Improved infection control practices in healthcare settings 1, 2
  • Risk reduction counseling for high-risk individuals 1
  • For people who inject drugs:
    • Never sharing needles, syringes, or drug preparation equipment 1
    • Using sterile equipment for each injection 1
    • Proper disposal of used syringes 1
  • Safe sex practices, particularly for those with multiple partners 1

Testing

• Anti-HCV antibody testing followed by HCV RNA testing to confirm active infection 1, 2
• Birth cohort testing recommended for all persons born 1945-1965 2
• Testing recommended for:
  • Current or former injection drug users 1
  • Recipients of blood products before 1992 2
  • Healthcare workers after needlestick injuries 1
  • Children born to HCV-positive mothers 2

Treatment

• Direct-acting antivirals (DAAs) are the standard of care for HCV treatment, with cure rates >95% for most genotypes 2
• Treatment decisions based on:
  • HCV genotype
  • Prior treatment history
  • Presence of cirrhosis
  • Comorbidities
• Treatment duration typically 8-12 weeks for most patients 2

Special Considerations

Co-infection Management

• Persons with HCV should be vaccinated against HAV and HBV if susceptible 2, 5
• Co-infection with multiple hepatitis viruses leads to more severe disease and higher mortality 5

Lifestyle Modifications

• All patients with viral hepatitis should:
  • Avoid alcohol consumption 1, 2
  • Maintain healthy weight 2
  • Avoid hepatotoxic medications 2
  • Not donate blood, organs, or tissues 2

Post-exposure Management

• For HCV exposure (e.g., needlestick):
  • Test source person for anti-HCV 1
  • If source is positive, test exposed person at baseline and 4-6 weeks later 1
  • No recommended post-exposure prophylaxis for HCV 1

Implementation Challenges

• Barriers to vaccination include cost, access to care, and vaccine hesitancy
• Strategies to improve vaccination rates:
  • Standing orders in clinical settings 1
  • Integration into routine healthcare visits 1
  • Vaccination programs in correctional facilities 1
  • Outreach to high-risk populations 3

The comprehensive approach to viral hepatitis prevention and treatment requires both individual and public health strategies, with vaccination playing a critical role for HAV and HBV, while risk reduction and effective treatment remain the focus for HCV management.