Hepatitis | Risks & protection

Being well informed can help

Knowing about the different hepatitis viruses and their modes of transmission is a prerequisite to protect yourself and others against an infection. Therefore, in this chapter we have summarized some important key issues about the risks and prevention of infection. The key words on the right side will lead you to short answers on the following frequently asked questions:

  • What are the modes of transmission and how do the viruses enter the body?
  • What is the mode of infection?
  • Which are high risk situations?
  • Who is particularly at risk for infection?
  • In which countries should travellers be particularly careful?
  • What are the appropriate medical actions and how can I protect myself in everyday life?

Transmission of viral hepatitis

Hepatitis can be transmitted through contact- and smear infection

Situations of transmission

  • Faecal contacts (A, E)
  • Contaminated Food (A, E)
  • Blood contacts (B/D, C, E)
  • Sexual contacts (A,B/D, C, E)
  • Mother-to-child (B/D, C, E)
  • Needlestick injury (C, B, D)

Modes of transmission

  • oral (A)
  • small skin injuries (B/D, C)
  • small mucosal injuries (B/D, C)
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Carrier substances

Substances that can transmit hepatitis viruses are:

HAV HBV HCV HDV HEV HFV
blood x x x
excrements x
body fluids
hemorrhagic saliva x x
seminal fluid x x
vaginal fluid x x
beverages
polluted water x x
juices x
food
undercooked meat (in particular wild boar, pig) x
vegetables exposed to faeces (e.g. salad) x x
seafood (e.g. mussles) x x
blood products (routine screening established in most developed countries)
blood pads x x
objects
tooth brush x x
razor x x
nail scissors x x
syringes x x
contaminated instruments for tattooing, piercing, ear-piercing x x
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Risk factors

The following conditions increase the risk for an infection:

  • travelling to areas with poor hygienic standards or endemic areas
  • intravenous drug use
  • unsafe sexual contacts

Due to contact with infected persons or procedures with a potential risk of transmission, the risk of infection is also higher in the following situations:

  • working in hospitals
  • working in jail, psychiatry or asylum
  • living in household with infected persons
  • birth (for mother-to-child transmission)
  • surgical interventions (in case of poor hygienic standards)
  • dental treatment (in case of poor hygienic standards)
  • needlestick injury
  • poor hygienic conditions
  • tattoos (in case of poor hygienic standards)
  • (ear-)piercings (in case of poor hygienic standards)
  • picking and biting between infected toddlers

Blood bottles and blood products

The current third-generation blood test systems have reduced the risk of transmission to approximately 1:100,000-300,000. Since the introduction of the HCV nucleid acid test in Germany in April 1999, the risk of being infected by HCV-contaminated blood or blood product infusions is estimated to be < 1x1005

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Groups at high risk

Viral hepatitis is not accompanied by specific symptoms; in most cases an acute hepatitis occurs without jaundice. However, an early diagnosis during the acute phase of infection increases the chance of successful therapy. For this reason, persons at high risk should consider regular screening for viral hepatitis.

Persons at high risk are:

  • travellers to developing world countries
  • intravenous drug users
  • persons with multiple sex partners
  • homosexual men
  • healthcare professionals
  • inmates, persons working in jails
  • patients undergoing dialysis
  • hemophiliacs
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Prevention

There are various possibilities to prevent an infection with hepatitis viruses:

Medicinal / technical actions

  • active vaccination (HAV, HBV)
  • passive immunization immediately after risk contact (if no antibodies are present) (HBV)
  • passive immunization prior to a journey (HAV)
  • preventive measures for the embryo/newborn (HBV)
  • testing of blood products (HBV, HCV)

Self-protection in profession and everyday life

  • avoidance of direct blood-to-blood contact (HAV, HBV/HDV, HCV, HEV)
  • avoidance of faecal-oral contacts (HAV, HEV)
  • no needle sharing or sharing of the devices (e.g. spoon and other tools, HBV, HCV)
  • use of one-way materials (HBV/HDV, HCV)
  • use of sterile equipment (HBV/HDV, HCV)
  • cooking of food (HAV, HEV)
  • cooking of water (HAV, HEV)
  • chemical desinfection (HAV, HBV/HDV, HCV, HEV)
  • protective gloves (HAV, HBV/HDV, HCV, HEV)
  • use of face masks and safety goggles HAV, HBV/HDV, HCV, HEV)

Vaccination

Vaccines are available against HAV and against HBV (which is also effective against HDV).
A vaccination against HBV is recommended for all children and adolescents.
Travellers to high-endemic areas are recommended to be vaccinated against both HAV and HBV.

ATTENTION

Hepatitis A

  • strong resistance to high temperatures
  • strong resistance to cleaning agents
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