Reporting viral hepatitis
To leave a voicemail, call the reporting line: 360-778-6150.
Send copies of clinical notes, case report forms, or labs to 360-778-6103.
For hepatitis C, fill out the reporting form:
HCV Reporting Form
To leave a voicemail, call the reporting line: 360-778-6150.
Send copies of clinical notes, case report forms, or labs to 360-778-6103.
For hepatitis C, fill out the reporting form:
HCV Reporting Form
Within 24 hours—acute hepatitis A, B or E.
Within 3 days—hepatitis C (acute), hepatitis D (acute or chronic) and pregnant women who test positive for hepatitis B surface antigen.
Monthly—newly diagnosed chronic hepatitis B or C.
Hepatitis A can lead to large-scale outbreaks. Its fecal-oral or contaminated water/food transmission route, extended incubation period, and robust ability to withstand degradation in the environment contribute to its ability to trigger large and long-lasting outbreaks. It is critical to promptly investigate suspected hepatitis A infections to aide in public health interventions.
School-aged children with hepatitis A should not return to school until their diarrhea has ceased.
Food handlers, healthcare workers, and childcare workers or attendees should not return to that setting until they are no longer considered infectious. The infectious period ends when diarrhea has resolved and at least 7 days have passed since the onset of jaundice.
The prevalence of people experiencing HAV infections has decreased over time in the United States due to regular scheduled HAV vaccinations for children. However, there are many other populations who would benefit from HAV vaccination. These include:
It is important to consider all potential causes of acute hepatitis when evaluating someone with symptoms that could be hepatitis A. The most common confirmatory lab is a positive HAV IgM indicative of an antibody response to an acute infection. This should be paired with a congruent clinical presentation, including observed jaundice, elevated bilirubin, or elevated ALT >200 IU/L.
False positive HAV IgM can occur, especially with older individuals who are asymptomatic.
There is no treatment specific to HAV infection. Treatment should be supportive based on the individual’s medical needs.
Hepatitis B virus (HBV) is a blood-borne pathogen. It can be spread through contact with blood, especially shared drug paraphernalia, sexual fluids, and birth. It is completely unrelated to the viruses that cause other forms of hepatitis including hepatitis A, C, D, and E. Someone experiencing an acute hepatitis B infection can be infectious before symptom onset and until the infection is resolved. Unfortunately, many people never experience symptoms of acute hepatitis and the original infection may go unnoticed. Approximately 5-10% of these individuals will go on to develop a lifelong, chronic HBV infection.
Perinatal HBV transmission is also a significant risk, and as many as 90% of acute perinatal HBV infections go on to become lifelong, chronic infections. This is why perinatal interventions are so important.
Infants should get their first dose of HBV vaccine at birth, aiming to complete the series at 6-18 months of age. The birth dose of HBV vaccine is an important part of preventing long-term illness in infants and stopping the spread of HBV in the United States.
All children and adolescents younger than 19 years of age who have not yet gotten the vaccine should be vaccinated.
Hepatitis B vaccine is now recommended for all adults aged 19-59 years regardless of risk factors, and anyone 60 years or older with risk factors. Hepatitis B vaccine may also be offered to all adults 60 years and older who wish to be vaccinated.
See the updated CDC Recommended Adult Immunization Schedule for ages 19 and older.
This information was retrieved from the CDC Vaccine Information Statements page on Hepatitis B
The most important serological marker to differentiate between an acute and chronic HBV infection is Hepatitis B core IgM antibody (anti-HBc IgM). If this lab is positive and other serological markers or viral markers are positive, especially paired with acute symptoms of hepatitis, the person is likely experiencing an acute HBV infection.
In order to have the most thorough understanding of the stage of infection when chronic infection is suspected, consider all of the following labs:
If you need help interpreting hepatitis B labs to determine the infection stage of your patient, please call 360-778-6100 or email CommunicableDisease@whatcomcounty.us. Our hepatitis team works Mon-Fri and would be happy to assist you.
Hepatitis C is a blood-borne pathogen and can be transmitted through blood- most commonly through shared drug equipment, sexual fluids contaminated with blood, and birth. It is less likely to be transmitted through sex than hepatitis B but precautions with intimate partners should still be taken. People who received blood products or transplants prior to 1992 should be screened for hepatitis C as the United States did not routinely screen blood products or transplant donors prior to 1992.
Most people who have a hepatitis C infection never develop symptoms. Only about 20-30% of people who are infected with hepatitis C will have acute symptoms of hepatitis. People can go many years without knowing they have this infection, which is why routine screening based on risk factors is highly encouraged and harm reduction skills are critical.
There is no vaccine currently available to prevent infection with hepatitis C, which is why harm reduction and addressing individual risk factors is so important. Some harm reduction topics include:
Treatment for hepatitis C is now much more effective and accessible with multiple antiviral pills available to prescribe. If you are a primary care provider, consider expanding your practice to treat people infected with hepatitis C. One of the main barriers to treatment now is accessing a provider who is willing to treat hepatitis C. Often, people are referred to a specialist and it may take several months and several appointments before treatment is initiated. The more we can incorporate hepatitis C treatment into the primary care model, the more people will be able to access treatment easily.
If you have a client who is interested in hepatitis C treatment but does not have a primary care provider and/or health insurance, you can reach out to us at CommunicableDisease@whatcomcounty.us for assistance.
Resources for providers:
HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C (American Association for the Study of Liver Diseases and Infectious Diseases Society of America)
UW Viral Hepatitis Project ECHO (2021-2022 flyer; a weekly video conference call providing mentorship for clinicians in treatment of hepatitis B and hepatitis C)
While antibody testing is fast and convenient for hepatitis C, there should be a plan in place for further testing if the antibody test is positive. Most importantly, clinicians and public health need to know whether or not the hepatitis C RNA viral load is positive or negative before recommending treatment. Most labs offer an automatic “reflex to RNA” option when antibody testing is positive. If your facility is unable to do viral load testing, then you should refer anyone with a positive hepatitis C antibody to another provider who can do viral load testing.
Hepatitis C