Summary
Hepatitis B virus (HBV) is transmitted via blood or sexual contact.
Persons with chronic HBV infection are at increased risk for cirrhosis and
liver cancer and require medical care. This report updates and summarizes
previously published recommendations from the Advisory Committee on
Immunization Practices (ACIP) and CDC regarding the prevention of HBV
infection in the United States. ACIP recommends testing all pregnant women
for hepatitis B surface antigen (HBsAg), and testing HBsAg-positive pregnant
women for hepatitis B virus deoxyribonucleic acid (HBV DNA); administration
of HepB vaccine and hepatitis B immune globulin (HBIG) for infants born to
HBV-infected women within 12 hours of birth, followed by completion of the
vaccine series and postvaccination serologic testing; universal hepatitis B
vaccination within 24 hours of birth, followed by completion of the vaccine
series; and vaccination of children and adolescents aged <19 years who
have not been vaccinated previously. ACIP recommends vaccination of adults
at risk for HBV infection, including universal vaccination of adults in
settings in which a high proportion have risk factors for HBV infection and
vaccination of adults requesting protection from HBV without acknowledgment
of a specific risk factor. These recommendations also provide CDC guidance
for postexposure prophylaxis following occupational and other exposures.
This report also briefly summarizes previously published American
Association for the Study of Liver Diseasest guidelines for maternal
antiviral therapy to reduce perinatal HBV transmission
BACKGROUND
In January 2008, the Centers for Disease Control and Prevention began a nationwide investigation of severe adverse reactions that were first detected in a single hemodialysis facility. Preliminary findings suggested that heparin was a possible cause of the reactions.
METHODS
Information on clinical manifestations and on exposure was collected for patients who had signs and symptoms that were consistent with an allergic-type reaction after November 1, 2007. Twenty-one dialysis facilities that reported reactions and 23 facilities that reported no reactions were included in a case–control study to identify facility-level risk factors. Unopened heparin vials from facilities that reported reactions were tested for contaminants.
RESULTS
A total of 152 adverse reactions associated with heparin were identified in 113 patients from 13 states from November 19, 2007, through January 31, 2008. The use of heparin manufactured by Baxter Healthcare was the factor most strongly associated with reactions (present in 100.0% of case facilities vs. 4.3% of control facilities, P<0.001). Vials of heparin manufactured by Baxter from facilities that reported reactions contained a contaminant identified as oversulfated chondroitin sulfate (OSCS). Adverse reactions to the OSCS-contaminated heparin were often characterized by hypotension, nausea, and shortness of breath occurring within 30 minutes after administration. Of 130 reactions for which information on the heparin lot was available, 128 (98.5%) occurred in a facility that had OSCS-contaminated heparin on the premises. Of 54 reactions for which the lot number of administered heparin was known, 52 (96.3%) occurred after the administration of OSCS-contaminated heparin.
CONCLUSIONS
Heparin contaminated with OSCS was epidemiologically linked to adverse reactions in this nationwide outbreak. The reported clinical features of many of the cases further support the conclusion that contamination of heparin with OSCS was the cause of the outbreak.
Summary
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by
the hepatitis A virus (HAV). The infection is transmitted via the fecal-oral route,
usually from direct person-to-person contact or consumption of contaminated food or
water. Hepatitis A is an acute, self-limited disease that does not result in chronic
infection. HAV antibodies (immunoglobulin G [IgG] anti-HAV) produced in response to HAV
infection persist for life and protect against reinfection; IgG anti-HAV produced after
vaccination confer long-term immunity. This report supplants and summarizes previously
published recommendations from the Advisory Committee on Immunization Practices (ACIP)
regarding the prevention of HAV infection in the United States. ACIP recommends routine
vaccination of children aged 12–23 months and catch-up vaccination for children
and adolescents aged 2–18 years who have not previously received hepatitis A
(HepA) vaccine at any age. ACIP recommends HepA vaccination for adults at risk for HAV
infection or severe disease from HAV infection and for adults requesting protection
against HAV without acknowledgment of a risk factor. These recommendations also provide
guidance for vaccination before travel, for postexposure prophylaxis, in settings
providing services to adults, and during outbreaks
BACKGROUND AND OBJECTIVES: Perinatal exposure is an important mode of hepatitis B virus (HBV) transmission, resulting in chronic disease in ∼90% of infected infants. Immunoprophylaxis recommended for infants born to hepatitis B surface antigen-positive mothers reduces up to 95% of perinatal HBV infections. We sought to identify factors associated with perinatal HBV transmission.
Introduction: Hepatitis C is a leading cause of death from liver disease in the United States. Acute hepatitis C infection is often asymptomatic, and >50% of cases will progress to chronic infection, which can be life-threatening. Hepatitis C can be diagnosed with a blood test and is curable, yet new cases of this preventable disease are increasing.Methods: National Notifiable Diseases Surveillance System data were analyzed to determine the rate of acute hepatitis C cases reported to CDC by age group and year during 2009-2018 and the number and rate of newly reported chronic cases in 2018 by sex and age. The proportion of adults aged ≥20 years with hepatitis C who reported having ever been told that they had hepatitis C was estimated with 2015-2018 National Health and Nutrition Examination Survey data.Results: During 2018, a total of 3,621 cases of acute hepatitis C were reported, representing an estimated 50,300 cases (95% confidence interval [CI] = 39,800-171,600). The annual rate of reported acute hepatitis C cases per 100,000 population increased threefold, from 0.3 in 2009 to 1.2 in 2018, and was highest among persons aged 20-29 (3.1) and 30-39 years (2.6) in 2018. A bimodal distribution of newly reported chronic hepatitis C cases in 2018 was observed, with the highest proportions among persons aged 20-39 years and 50-69 years. Only 60.6% (95% CI = 46.1%-73.9%) of adults with hepatitis C reported having been told that they were infected.
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