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Vaccination. Hepatitis A is preventable by vaccination. Two vaccines (Havrix, Vaqta) are available, both very safe and effective. They are given in 2 shots, 6 months apart. A combination Hep A - Hep B vaccine (Twinrix) that contains both Havrix and Engerix-B (a hepatitis B vaccine) is also available for people age 18 years and older. It is given as 3 shots over a 6-month period.
The U.S. Centers for Disease Control and Prevention (CDC) recommend hepatitis A vaccination for:
Others who may benefit include:
Prevention After Exposure to Hepatitis A. Unvaccinated people who have recently been exposed to hepatitis A may be able to prevent hepatitis A by receiving injection with immune globulin (IG) or the hepatitis A vaccine. These shots must be given within 2 weeks after exposure to be effective. In the past, immune globulin was the standard postexposure prophylaxis (preventive treatment after exposure) for hepatitis A. However, recent studies have indicated that the hepatitis A vaccine provides as good protection as immune globulin. The CDCâ ' s Advisory Committee on Immunization Practices now recommends the vaccine for postexposure prophylaxis for healthy individuals between the ages of 1 - 40 years. Others should be given immune globulin if warranted.
Lifestyle Measures for Hepatitis A Prevention. Frequent handwashing after using the bathroom or changing diapers is important for preventing transmission of hepatitis A. International travelers to developing countries should use bottled or boiled water for brushing teeth and drinking, and avoid ice cubes. It is best to eat only well-cooked heated food and to peel raw fruits and vegetables.
Vaccination. Hepatitis B is preventable by vaccination. There are several inactivated virus vaccines, including Recombivax HB and Engerix-B. A combination vaccine (Twinrix) that contains Engerix-B and Havrix, a hepatitis A vaccine, is also available. The hepatitis B vaccine is usually given as a series of 3 - 4 shots over a 6-month period.
The CDC recommends hepatitis B vaccination for:
Prevention After Exposure to Hepatitis B. The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent hepatitis B infection if given within 24 hours of exposure.
Lifestyle Measures for Hepatitis B Prevention. The following are some precautions for preventing the transmission of hepatitis B (and hepatitis C):
Hepatitis B (and hepatitis C) viruses cannot be spread by casual contact such as holding hands, sharing eating utensils or drinking glasses, breast-feeding, kissing, hugging, coughing or sneezing.
There is no vaccine for hepatitis C prevention. Lifestyle precautions are similar to those for hepatitis B. People who are infected with the hepatitis C virus should avoid drinking alcohol as this can accelerate the liver damage associated with hepatitis C. People who are infected with hepatitis C should also receive vaccinations for hepatitis A and B.
Advisory Committee on Immunization Practices (ACIP) Centers for Disease Controland Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2007 Oct 19;56(41):1080-4.
American Academy of Pediatrics Committee on Infectious Diseases. Hepatitis A vaccine recommendations. Pediatrics. 2007 Jul;120(1):189-99.
Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008 Oct 2;359(14):1486-500.
Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008 Jun 3;148(11):ITC6-1-ITC6-16.
Lai CL, Gane E, Liaw YF, Hsu CW, Thongsawat S, Wang Y, et al. Telbivudine versus lamivudine in patients with chronic hepatitis B. N Engl J Med. 2007 Dec 20;357(25):2576-88.
Lok ASF and McMahon BJ. American Association for the Study of Liver Diseases Practice Guidelines: Chronic Hepatitis B. Hepatology. 2007;2:507 -539.
Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet. 2008 Jul 26;372(9635):321-32.
Mukherjee S, Sorrell MF. Controversies in liver transplantation for hepatitis C. Gastroenterology. 2008 May;134(6):1777-88.
National Institutes of Health. Consensus Development Conference Statement: Management of Hepatitis B. October 20 -22, 2008.
Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc. 2007 Aug;82(8):967-75.
Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003620.
Scott JD, Gretch DR. Molecular diagnostics of hepatitis C virus infection: a systematic review. JAMA. 2007 Feb 21;297(7):724-32.
Victor JC, Monto AS, Surdina TY, Suleimenova SZ, Vaughan G, Nainan OV, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007 Oct 25;357(17):1685-94. Epub 2007 Oct 18.
Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
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