Transmission

• Hep A: Oral-Anal contact, poor sanitation, contaminated food or water
• Hep B: exchange of bodily fluids through sexual intercourse or needle sharing
• Hep C: exchange of blood through needle sharing. Low transmission by exchange of bodily fluids through sexual intercourse.

Symptoms

• Ranges from asymptomatic with increased transaminases on blood work to fulminant liver failure with nausea, fatigue and jaundice.

Testing

• Blood test using an Ontario Public Health Laboratory requisition.
• Hep A:
  • positive HAV IgM antibodies indicate acute infection
  • positive HAV IgG antibodies indicate immunity
• Hep B:
  • Positive surface antigen indicates chronic active Hep B infection
  • Positive surface antibody and core antibody indicate resolved Hep B infection
  • Positive surface antibody and negative core antibody indicate immunized with Hep B vaccine.
• Hep C: positive HCV antibodies, then Hep C nucleic acid amplification to confirm active infection.

Treatment

• Hep A: self-limited. No treatment
• Hep B: suppressive therapy with entecavir, tenofovir or lamivudine
• Hep C: curative treatment with direct acting antivirals. Choice depends on genotype.

Prevention

• Hepatitis A:  HAVRIX, 1 mL (1440 ELU) at 0 and 6 months
• Hepatitis B:
  • Engerix-B, 1 mL (20 mcg HBsAg) at 0, 1 and 6 months
  • Recombivax HB, 1 mL (10 mcg HBsAg) at 0, 1 and 6 months
• Hepatitis A and B: Twinrix, 1 mL at 0, 1 and 6 months
• Hepatitis C: no vaccine