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Published: 10 December 2022
Last updated: 28 January 2023

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1

Great Britain. Expert Advisory Group on AIDS. Guidance for clinical health care workers: Protection against infection with HIV and hepatitis viruses. London: H.M.S.O., 1990.

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2

C. L. van der Poel. Hepatitis C virus: Studies on transmission and epidemology. Amsterdam: Babeliowsky, 1991.

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3

Goh, K. T. Epidemiology and control of hepatitis B virus infection in Singapore. Tokyo: Southeast Asian Medical Information Center, 1992.

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4

Health Care-Associated Transmission of Hepatitis B and C Viruses. Elsevier - Health Sciences Division, 2010.

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5

Wilson, Deanna. Hepatitis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0035.

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Hepatitis A (HAV) and E (HEV) viruses are spread via the fecal-oral route. Hepatitis B virus (HBV) exposure is via occupational or recreational activities. Hepatitis D virus (HDV; also spread parentally) can only coinfect or superinfect those with chronic HBV. Hepatitis C (HCV) transmission is predominantly parenteral; the highest risk group is injection drug users. Prodromal-period patients with acute hepatitis present with vague constitutional symptoms when serum transaminases peak, with elevated serum bilirubin and varying levels of hepatic protein synthesis impairment; during the icteric phase, patients develop abdominal pain, hepatomegaly, and jaundice. Acute hepatitis has limited therapy; treatment is predominantly supportive. However, most adults with acute phase HAV, HBV, HDV, and HEV spontaneously clear the virus. Most individuals with HCV develop chronic hepatitis. Patients with known HAV, HBV, or HEV exposures may be eligible for post-exposure prophylaxis to reduce their risk of infection.
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6

Krain, Lisa J., and Kenrad E. Nelson. Hepatitis E Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0006.

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Hepatitis E virus (HEV) poses serious risks to pregnant women and their developing fetuses, including increased risk of pregnancy loss, stillbirth, preterm delivery, and early infant death. Supportive care is currently the standard treatment for pregnant women with HEV infection, but in some cases, ribavirin treatment or early delivery may be indicated. Infants born with acute HEV infection face increased risk of complications and death. Intensive monitoring and support may be required in the neonatal period, particularly for preterm infants. Infants who survive the early neonatal period are likely to recover fully and clear the virus. Immunoassays and molecular methods for diagnosis of HEV have improved markedly over the past decade. New HEV vaccines may provide an opportunity to prevent both maternal illness and mother-to-child transmission (vertical transmission) (MTCT).
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7

Beattie, R. Mark, Anil Dhawan, and John W.L. Puntis. Hepatitis C. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0058.

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Epidemiology 424Risk of transmission 424Clinical features 424Specific viral tests 425Diagnosis of HCV infection in infants born to HCV +ve mother 425Management 425• Hepatitis C virus (HCV) is an RNA virus of the flaviviride family.• More than 150 million people are infected with HCV worldwide....
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8

Kourtis, Athena P., Shruti Chandramouli, Gonzague Jourdain, and Marc Bulterys. Hepatitis B Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0004.

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Hepatitis B virus (HBV) is the most common cause of chronic viral hepatitis and hepatocellular carcinoma in the world. Worldwide, more than 250 million people are chronically infected with HBV, causing nearly 780,000 deaths each year, and mother-to-child transmission (MTCT) accounts for more than one-third of chronic HBV infections. Universal vaccination in neonates is the most effective strategy for eliminating infections worldwide. Maternal antiviral treatment during the antepartum/postpartum period for mothers with high HBV viral loads is effective in preventing HBV MTCT. Full immunization coverage is currently the only way to reach the goal of eradicating HBV infection. Operational research and, in some resource-limited settings, international funding may be essential to bring the vaccine where neonates and infants need it, including remote locations where home births are common. Continued improvements in the coverage and timeliness of HBV vaccination and education of clinicians about its importance are needed.
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9

Honegger, Jonathan R. Hepatitis C Virus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0005.

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An estimated 185 million individuals have been infected with hepatitis C virus (HCV) worldwide. Although often clinically silent for decades, chronic HCV infection predisposes to late-onset complications, including liver cirrhosis and hepatocellular carcinoma. Mother-to-child transmission (MTCT) of HCV affects approximately 5% of children born to viremic mothers and is the primary route of HCV infection in young children. While some vertically acquired HCV infections are resolved during the first years of life, many persist indefinitely. Chronically infected children tend to be asymptomatic and have mild liver disease, but they face a risk of progression to advanced liver disease in adulthood. Current diagnostic and management strategies leave most infected children undiagnosed and untreated. Widespread use of newly-available direct-acting antiviral therapies has the potential to substantially reduce the global burden of HCV, including vertically acquired HCV, but an effective vaccine likely will be required to achieve this ultimate goal.
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10

Hepatitis C. Virus: Studies on Transmission and Epidemiology. C.L. Van Der Poel, 1991.

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11

Meng, X. J. Hepatitis E virus. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0048.

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Hepatitis E virus (HEV) is a small, non-enveloped, single-strand, positive-sense RNA virus of approximately 7.2 kb in size. HEV is classified in the family Hepeviridae consisting of four recognized major genotypes that infect humans and other animals. Genotypes 1 and 2 HEV are restricted to humans and often associated with large outbreaks and epidemics in developing countries with poor sanitation conditions, whereas genotypes 3 and 4 HEV infect humans, pigs and other animal species and are responsible for sporadic cases of hepatitis E in both developing and industrialized countries. The avian HEV associated with Hepatitis-Splenomegaly syndrome in chickens is genetically and antigenically related to mammalian HEV, and likely represents a new genus in the family. There exist three open reading frames in HEV genome: ORF1 encodes non-structural proteins, ORF2 encodes the capsid protein, and the ORF3 encodes a small phosphoprotein. ORF2 and ORF3 are translated from a single bicistronic mRNA, and overlap each other but neither overlaps ORF1. Due to the lack of an efficient cell culture system and a practical animal model for HEV, the mechanisms of HEV replication and pathogenesis are poorly understood. The recent identification and characterization of animal strains of HEV from pigs and chickens and the demonstrated ability of cross-species infection by these animal strains raise potential public health concerns for zoonotic HEV transmission. It has been shown that the genotypes 3 and 4 HEV strains from pigs can infect humans, and vice versa. Accumulating evidence indicated that hepatitis E is a zoonotic disease, and swine and perhaps other animal species are reservoirs for HEV. A vaccine against HEV is not yet available.
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12

Barnett, Ben J., and Margaret Hoffman-Terry. HIV/Hepatitis Co-infection. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190493097.003.0039.

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Hepatitis B virus (HBV) infection is common in people living with HIV, and all patients with HIV should be screened for HBV infection. The most common route of transmission worldwide is through perinatal or early childhood exposure, but adult transmission of HBV is often by routes similar to those for HIV, including sexual contact and injection drug use. Although it varies by exposure route, approximately 10% of HIV-positive patients also have chronic HBV infection, and up to 90% have serologic evidence of past exposure to HBV. Long-term complications of HBV infection can include cirrhosis, end-stage liver disease, and hepatocellular carcinoma.
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13

Wilson, John W., and Lynn L. Estes. Occupational Postexposure Prophylaxis and Management. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199797783.003.0151.

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• Human immunodeficiency virus (HIV) transmission risk is about 0.3% (about 1 in 300)• About 0.1% after mucous membrane exposure• <0.1% after exposure to abraded skin• Hepatitis B virus (HBV) for nonvaccinated persons when blood from source is:• HBsAg (hepatitis B surface antigen) positive ...
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14

Guidelines for Prevention of Transmission Human Immunodeficiency Virus and Hepatitis B. United States Government Printing, 1989.

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15

Centers for Disease Control (U.S.) and National Institute for Occupational Safety and Health., eds. A Curriculum guide for public-safety and emergency-response workers: Prevention of transmission of human immunodeficiency virus and hepatitis B virus. Atlanta, Ga: Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, 1989.

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16

Russi, Mark. Biological Hazards. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190662677.003.0016.

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This chapter describes various biological hazards and their impact on workers and others. A major focus of the chapter is biological hazards in healthcare and laboratory settings, including exposure to bloodborne pathogens and prevention of diseases related to them. Sections deal with sharps injuries, HIV/AIDS, hepatitis B virus, hepatitis C virus, tuberculosis, and other infectious diseases that can be acquired in the work environment via direct contact, droplet or airborne spread, or fecal-oral transmission. In addition, infectious agents spread by animal contact or arthropod vectors in a broad range of settings will be addressed. Newly emerging infectious or re-emerging infections, such as those due to H5N1 and novel H1N1 influenza, Middle Eastern respiratory syndrome (MERS), and Ebola Virus Disease (EVD) as well as agents associated with bioterrorism are discussed.
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17

Van Calsteren, Kristel. Chronic maternal infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0050.

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Pregnant women diagnosed with chronic infections are a worldwide problem. In developed countries, the most frequently encountered are hepatitis B and C, toxoplasmosis, syphilis, herpes simplex, and Cytomegalovirus infections. In developing countries, human immunodeficiency virus and malaria are also seen commonly in pregnant women. Maternal infections are associated with various complications in pregnant women, but also with congenital infections with or without structural anomalies and long-term sequelae, fetal growth restriction, preterm delivery, and perinatal mortality. Moreover, increasing evidence suggests that maternal infection during pregnancy affects the developing immune system of the fetus independently of the vertical transmission of pathogens. This chapter discusses the pathogen characteristics, ways of transmission, clinical presentation, diagnostic options, treatment, and, if relevant, prophylaxis for the most common infections in pregnant women (excluding hepatitis which is discussed elsewhere).
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18

Prowse, C. Hepatitis: A Virus Transmission by Blood Products ((Journal: Vox Sanguinis Ser.; Vol. 67, Supplement1, 1994)). S. Karger AG (Switzerland), 1994.

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19

Bulterys, Marc, Julia Brotherton, and Ding-Shinn Chen. Prevention of Infection-Related Cancers. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190238667.003.0066.

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This chapter discusses primary prevention measures that disrupt transmission of oncogenic infections. It begins by discussing vaccination against hepatitis B virus (HBV) and human papillomavirus (HPV), two major causes of cancer for which safe and effective vaccines are currently available. It briefly discusses the importance of treatment and prophylaxis against human immunodeficiency virus type 1 (HIV-1), which potentiates the virulence of other viral infections as well as directly increasing the incidence of non-Hodgkin lymphoma. It does not discuss the treatment of HBV or hepatitis C virus (HCV) infection, since these are considered in Chapters 25 and 33. Also beyond the scope of this chapter are the randomized clinical trials currently underway to assess the efficacy and feasibility of eradication of Helicobacter pylori (Chapters 24, 31), vaccination against Epstein-Barr virus (EBV) (Chapters 24, 26, 39), or the prevention of schistosomiasis and liver flukes (Chapters 24, 33, and 52).
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20

Curriculum Guide for Public-Safety & Emergency-Response Workers: Prevention of Transmission of HIV & Hepatitis B Virus. Diane Pub., 1989.

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21

National Institute for Occupational Safety and Health. and Centers for Disease Control (U.S.), eds. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers: A response to P.L. 100-607, the Health Omnibus Programs Extension Act of 1988. Atlanta, Ga: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, 1989.

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22

California. Office of Health Care Services., ed. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. [Sacramento, Calif.]: California Dept. of Corrections, Office of Health Care Services, 1991.

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23

McCann, Shaun R. From a dream to a nightmare. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198717607.003.0003.

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Historically, one of the contentious issues in the understanding of blood was the clotting process. Ancient observers posited that a cooling process led to clotting, while William Harvey, writing in the seventeenth century, postulated that fibrous mucous in the blood contributed to clotting. It was through the study of haemophilia patients in the eighteenth and nineteenth centuries that the underlying factors in the clotting mechanism were first understood, and not until the 1930s that the clotting factor involved, Factor VIII, was identified. Subsequent attempts to treat patients with Factor VIII concentrates led to an understanding of the transmission process of hepatitis B. The link between haemophilia and hepatitis B was subsequently central to the early understanding of the AIDS virus.
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24

United States. Dept. of Health and Human Services. and Centers for Disease Control (U.S.), eds. A Curriculum guide for public-safety and emergency-response workers: Prevention of transmission of human immunodeficiency virus and hepatitis B virus. Atlanta, Ga: Department of Health and Human Services, Public Health Service, Centers for Disease Control, 1989.

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25

Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. [Atlanta, Ga.?: Centers for Disease Control, 1988.

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26

Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public Safety Workers Response to p. United States Government Printing, 1989.

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27

Center for Infectious Diseases (U.S.) and National Institute for Occupational Safety and Health., eds. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers: A response to P.L. 100-607, The Health Omnibus Programs Extension Act of 1988. Atlanta, Ga: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, 1989.

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28

Nuevas generaciones sin la infección por el VIH, la sífilis, la hepatitis B y la enfermedad de Chagas en las Américas 2018. ETMI Plus. Organización Panamericana de la Salud, 2019. http://dx.doi.org/10.37774/9789275120675.

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En el presente documento se comunica el progreso logrado en la Región hacia la eliminación de la transmisión maternoinfantil del VIH y la sífilis entre los años 2010 y 2017. Se trata también del primer informe regional sobre la eliminación de la transmisión maternoinfantil y durante la primera infancia de la hepatitis B y la enfermedad de Chagas congénita. Los resultados principales son los siguientes: El acceso de las embarazadas a la atención prenatal y del parto es alto en la Región de las Américas. El tamizaje de la infección por el VIH y la sífilis en las embarazadas sigue siendo alto, pero se han logrado pocos avances para salvar las brechas; por otra parte, el tamizaje de la enfermedad de Chagas en las embarazadas es muy variable, dado que oscila entre 7% y 55% en los pocos países que presentan informes al respecto. El tratamiento de la infección por el VIH y la sífilis en las embarazadas seropositivas sigue en aumento. La vacunación contra la hepatitis B se ha estabilizado en 87% de los menores de 1 año que completan su tercera dosis, aunque continúa en aumento la adopción de políticas de administración de una dosis al nacer de la vacuna contra el virus de la hepatitis B a todos los recién nacidos. Durante mucho tiempo se ha observado una disminución continua de la transmisión maternoinfantil del VIH, pero comienza a estabilizarse. Los casos de sífilis congénita están en aumento. Se considera que la transmisión maternoinfantil causa más de 20% de los casos nuevos de enfermedad de Chagas. This document reports the progress made in the Americas towards the EMTCT of HIV and syphilis between 2010 and 2017. It is the first Regional report regarding elimination of mother-to-child and early childhood transmission of hepatitis B and congenital Chagas disease. The main findings are as follows: Access to prenatal and delivery care for pregnant women is high in the Americas. Screening of pregnant women for HIV and syphilis remains high but little progress has been made in closing the gaps; meanwhile, screening of pregnant women for Chagas disease varies widely, ranging from 7% to 55% among the few reporting countries. HIV and syphilis treatment of seropositive pregnant women continues to increase. Vaccination for hepatitis B has stabilized at 87% of children under one year old who completed their third dose, and policies for universal timely hepatitis B vaccine birth dose are increasingly being adopted. MTCT of HIV experienced longstanding reductions but has begun to stabilize. Congenital syphilis cases are on the rise. Mother-to-child transmission is estimated to cause over 20% of new cases of Chagas disease.
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