What precautions are necessary when caring for a patient with hepatitis A to protect family from infected?

Viral hepatitis isn’t quite the scourge it used to be. Thanks in large part to widespread immunization of adolescents and young children in the U.S. for hepatitis A and B, the incidence of the liver-destroying disease has fallen 90% in the past 20 years. Yet many people who could be vaccinated against hepatitis haven’t been -- and so remain at higher risk.

Scientists have identified several types of viral hepatitis. In the U.S., the main threats are hepatitis A, hepatitis B, and hepatitis C. They cause similar symptoms, including fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, joint pain, clay-colored bowel movements, and jaundice (yellow skin or eyes).

Almost all people with hepatitis A recover fully in weeks or months. In contrast, hepatitis B and C can become chronic infections that lead to cirrhosis of the liver, liver cancer, and even death. What’s more, the three types differ in the way they spread from person to person:

• Hepatitis A. The hepatitis A virus (HAV) is present in the feces of people who have hepatitis A and spreads by fecal-oral contact. Infection can occur if even a microscopic amount of virus-laden feces reaches the mouth. This can happen by consuming contaminated food or beverages, as well as through close personal contact or sex with an infected person.
• Hepatitis B. The hepatitis B virus (HBV) is found in the blood, semen, vaginal secretions, and other body fluids of people who have hepatitis B. Infection occurs when there is contact with these fluids -- for example, during sex with an infected person or exposure to contaminated needles or personal items. Up to 25% of people with chronic HBV infection die from liver disease.
• Hepatitis C. The hepatitis C virus (HCV) is found in the blood of people who have hepatitis C. It can be spread by sexual contact, although it’s usually spread from mother to child during childbirth or by sharing hypodermic needles or other drug paraphernalia. Up to 85% of people infected with HCV develop chronic hepatitis C infection.

What’s the best way to protect your family against hepatitis? Follow these eight tips:

1. Ask your doctor about vaccination.

The vaccines for hepatitis A and hepatitis B are highly effective. They can be given in separate injections, or in a combined vaccine. No vaccine is available for hepatitis C.

2. Make hand-washing a priority.

Insist that family members wash their hands thoroughly after using the bathroom (or changing a diaper) and before handling food or eating. Washing with soap and water is fine, although alcohol-based hand sanitizers seem to be even more effective.

3. Watch out for other people’s blood.

There’s no way to tell that a particular person has hepatitis. “Many people with hepatitis have absolutely no symptoms whatsoever,” says Melissa Palmer, MD, clinical professor of medicine at New York University School of Medicine in New York City.

Consequently, it makes sense to follow the lead of health-care workers and assume that all blood is infectious. “Any blood exposure can transmit hepatitis B and C,” says John W. Ward, MD, director of the division of viral hepatitis at the CDC.

“Of course, if someone needs first aid, you don’t want to avoid helping them. If blood contact does occur, wash the blood off as soon as possible.”

4. Beware of needles.

It’s possible to get hepatitis from hypodermic needles and the tools used to create tattoos and piercings. So be wary of them -- and encourage family members to do likewise. If a family member is determined to get a piercing or tattoo, he should get it only from a licensed professional working in a well-maintained facility.

Don’t be shy about sharing your concerns about infection control -- whether the person wielding the needle is a tattoo artist or your own physician.

“It’s good to express your concern to the people in your doctor’s office,” Ward says. “Let them know that you are concerned about the level of infection control in the practice.”

5. Know when to share -- and when not to.

Sharing works well with toys, tools, and brownies but is a terrible idea when it comes to toothbrushes, razor blades, nail files, and other personal items. This includes medical equipment and needles.

These items can harbor traces of the owner’s blood. If the owner has hepatitis, using them can transmit the disease.

“We’ve even seen a rash of outbreaks of hepatitis B related to diabetics sharing their blood glucose-monitoring equipment, mainly in elder-care facilities,” Ward says. Also, if you’ve had hepatitis B or C, don’t donate blood, organs, or tissue.

6. Keep sex safe.

All three main forms of hepatitis can be spread by sexual contact. So it’s important to know something about your partner’s personal history -- and to use a latex condom unless you’re sure you are both monogamous and uninfected. Be aware that certain sex acts are particularly risky.

“Any sexual practice with an increased likelihood of trauma, including anal sex and rough sex, is associated with an increased risk of transmission of both HCV and HBV,” Palmer says. What’s more, she says, “The likelihood of becoming infected with HBV grows with the number of sexual partners a person has.”

7. Watch what you eat and drink.

Even if you and your family members are careful about hand washing before eating and after using the bathroom, it’s possible to get hepatitis from food that’s been prepared by people who aren’t quite so fastidious.

In general, fresh fruits, vegetables, sandwiches, salads, and other uncooked foods are more likely than cooked foods to transmit hepatitis. And because shellfish is sometimes harvested from contaminated water, think twice before eating raw mussels, clams, oysters, and shrimp. Traveling in a country with poor sanitation? Avoid tap water and uncooked foods. Consume ice cubes only if you’re sure they were made from bottled water.

8. Know your family history.

Viral hepatitis is especially common in certain parts of the world, including Sub-Saharan Africa, Eastern Europe, the Middle East, the Amazon basin, and Asia.

It’s important to know whether a family member (including an adopted child) was born in one of these regions, so that they can get a simple blood test to check for hepatitis.

“We recommend that people be screened for hepatitis if they were born in a country where hepatitis B rates are high,” says Ward. “Anytime one member of the household is found to be infected, all family members should be screened.”