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We are pleased to provide you with information on the following topics related to hepatitis:

HCV Introduction
What is Hepatitis C?
What Do I Need to Know About Hepatitis C?
Getting Tested for Hepatitis C
Treatment of Hepatitis C
Prevention of Hepatitis C

HCV INTRODUCTION

The hepatitis C virus (HCV) is one of the most important causes of chronic (long term) liver disease in the United States. It accounts for about 20 percent of acute (short term) viral hepatitis, 60 to 70 percent of chronic hepatitis, and 30 percent of cirrhosis, end-stage liver disease, and liver cancer.
Over 4 million Americans, or nearly 2 percent of the U.S. population, have the antibody to HCV (anti-HCV), which indicates an ongoing or previous infection with the HCV virus. Hepatitis C causes an estimated 8,000 to 10,000 deaths annually in the United States.
A distinct and major characteristic of hepatitis C is its tendency to cause chronic liver disease. At least 75 percent of patients with acute hepatitis C ultimately develop chronic infection, and most of these patients have accompanying chronic liver disease.
Chronic hepatitis C varies greatly in its course and outcome. At one end of the spectrum are patients who have no signs or symptoms of liver disease and have completely normal levels of serum liver enzymes. A liver biopsy usually shows some degree of chronic hepatitis, but the degree of injury is usually mild, and the overall prognosis may be good.
In the middle of the spectrum are many patients who have few or no symptoms, mild to moderate elevations in liver enzymes, and an uncertain prognosis.
At the other end of the spectrum are patients with severe hepatitis C who have symptoms, HCV RNA in serum, and elevated serum liver enzymes, and who ultimately develop cirrhosis and end-stage liver disease.
Researchers estimate that at least 20 percent of patients with chronic hepatitis C will develop cirrhosis, a process that takes 10 to 20 years. After 20 to 40 years, a smaller percentage of patients with chronic disease develop liver cancer.
Chronic hepatitis C can cause cirrhosis, liver failure, and liver cancer. About 20 percent of patients develop cirrhosis within 10 to 20 years of the onset of infection. Liver failure from chronic hepatitis C is one of the most common reasons for liver transplants in the United States.
Hepatitis C might be the most common cause of primary liver cancer in the developed world. In Italy, Spain, and Japan, at least half of liver cancers could be related to HCV. Men, alcoholics, patients with cirrhosis, people over age 40, and those infected for 20 to 40 years are more likely to develop HCV-related liver cancer.

WHAT IS HEPATITIS C?

Hepatitis C is an emerging disease of growing concern. This liver disease is caused by infection with the hepatitis C virus (HCV), which was first identified in 1988. HCV infection is a major cause of cirrhosis, and HCV-related end stage liver disease is now the leading reason for liver transplantation in the United States.

* It is estimated that 4 million (1.8%) Americans are infected with HCV. About 3 million are chronically infected. Many people do not know they are infected with HCV. Hepatitis C may cause no symptoms for 20-30 years after infection, yet chronic infection may be slowly damaging the liver during that time.
* Of those infected, about 85 percent develop chronic infection, 70 percent develop chronic liver disease, 15 percent develop cirrhosis, and 5 percent die.
* Chronic hepatitis C causes between 8,000 and 10,000 deaths each year.
* The number of new HCV infections in the United States has declined from an average of 240,000 annually in the 1980s to 36,000 in 1996.
* Hepatitis C is spread primarily by direct contact with blood. In the past, blood transfusions were responsible for about 20 percent of cases, although injecting drug use has been the most common risk factor - now accounting for 60 percent of all cases.
* Following the introduction of more sensitive and effective blood tests for the detection of HCV, the risk for transfusion-related hepatitis C is now less than 1 in 100,000 units transfused, compared to 1 in 200 before screening tests were available.
* It is possible to become infected with the HCV virus through unprotected sex with an infected partner.

* Increased alcohol consumption by persons with hepatitis C has been shown to increase the rate at which severe liver disease develops. Persons with hepatitis C should not drink alcohol.
* Antiviral drugs are approved for the treatment of chronic hepatitis C and can be successful in eliminating the virus and improving the liver disease.
* There is no vaccine currently available to prevent hepatitis C.

WHAT DO I NEED TO KNOW ABOUT HEPATITIS C?

You need to know that Hepatitis C is a liver disease. Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.

WHAT CAUSES HEPATITIS C?

Hepatitis C is caused by a virus. A virus is a germ that causes sickness (for example, a virus causes the flu.) People can pass viruses to each other. The virus that causes hepatitis C is called the hepatitis C virus.

HOW COULD I GET HEPATITIS C?

Though the hepatitis C virus cannot pass through un-punctured skin, it is primarily spread by blood-to-blood contact. It is essential to become knowledgeable about how hepatitis C is spread from person-to-person.
Hepatitis C spreads by contact with an infected person's blood. This is known as "transmission" of HCV.
You CAN "get" hepatitis C by:

* Sharing IV drug needles or drug use paraphernalia
* Getting pricked with a needle that has infected blood on it
* Being born to a mother with hepatitis C
* Getting a tattoo or body piercing with unsterilized, dirty tools.
* Having sex with an infected person, especially if you or your partner has other sexually transmitted diseases.
* Hepatitis C "transmission" can occur by exposure to infected blood from:

- cuts and nosebleeds
- toothbrushes, razors, and manicure instruments
- tattoos and body piercing
- sharing needles (IV drug users especially)
- jobs with exposure to blood (e.g. healthcare workers)
- sharing straws for inhaling cocaine
- unprotected sex with multiple partners (use condoms!)
- sharing personal care items (such as nail files or clippers)
- hemodialysis patients (using a kidney machine)

* Shaking hands with an infected person.
* Hugging an infected person.
* Kissing an infected person.
* Sitting next to an infected person.

- breast feeding, sneezing, coughing, sharing eating utensils or drinking glasses, food or water or casual contact.

COULD I GET HEPATITIS C FROM A BLOOD TRANSFUSION?

If you had a blood transfusion or organ transplant before 1992, you might have hepatitis C. Before 1992 doctors could not check blood for hepatitis C, and some people received infected blood. If you had a blood transfusion or organ transplant before 1992, ask a doctor to test you for hepatitis C.

WHAT ARE THE SYMPTOMS?

Many people with hepatitis C don't have symptoms. However, some people with hepatitis C feel like they have the flu.
You might:

* Feel tired.
* Feel sick to your stomach.
* Have a fever.
* Not want to eat.
* Have stomach pain.
* Have diarrhea.

* Dark yellow urine.
* Light-colored stools.
* Yellowish eyes and skin.

WHAT ARE THE TESTS FOR HEPATITIS C?

To check for hepatitis C, the doctor will test your blood. These tests show if you have hepatitis C and how serious it is. (More information on specific lab tests used in hepatitis and liver disease is below)
The doctor may also do a liver biopsy. Biopsy (BYE-op-see) is a simple test. The doctor removes a tiny piece of your liver through a needle. The doctor checks the piece of liver for signs of hepatitis C and liver damage.

HOW IS HEPATITIS C TREATED?

Hepatitis C is treated with drugs known as interferons, given alone or in combination with the drug ribavirin. (More Details on Treatment below...)
You may need surgery if you have had hepatitis C for many years. Over time, hepatitis C can cause your liver to stop working. If that happens, you will need a new liver. The surgery is called a liver transplant. It involves taking out the old, damaged liver and putting in a new, healthy one from a donor.

HOW CAN I PROTECT MYSELF?

Protect yourself and others from hepatitis C:

* Don't share drug needles with anyone.
* Wear gloves if you have to touch anyone's blood.
* Don't use an infected person's toothbrush, razor, or anything else that could have blood on it.
* If you get a tattoo or body piercing, make sure it is done with clean tools.
* If you have several sex partners, you should use a condom during sex.
* If you have hepatitis C, don't give your blood or plasma. The person who receives it could become infected with the virus.

GETTING TESTED FOR HEPATITIS C

Tests for Hepatitis C
There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each:

* Anti-HCV (antibody to HCV) Test Purpose: To verify a positive EIA with RIBA. Indicates a past or present infection. Anti-HCV does not tell whether the infection is acute (new), chronic (long-term) or is no longer present.
* EIA (enzyme immunoassay) This test is usually done first. If positive, it should be confirmed by a RIBA test.
* RIBA (recombinant immunoblot assay) a supplemental test used to confirm a positive EIA test.
* Qualitative tests to detect presence or absence of virus (HCV RNA) Purpose: Detects presence or absence of virus as early as 1-3 weeks after exposure. Detection of HCV RNA during course of infection may be intermittent. Also used to monitor patients on antiviral therapy.

- Generic polymerase chain reaction (PCR)
- Amplicor HCV(tm)

� Quantitative tests to detect the amount (titer) of virus (HCV RNA).
� Purpose: Determines titer of HCV. Less sensitive than qualitative PCR. Should not be used to confirm or exclude the diagnosis of HCV or to monitor treatment end point.
� - Amplicor HCV Monitor(tm)
� - Quantiplex HCV RNA [bDNA (branched chain DNA assay)]

NOTE: A single positive PCR test indicates infection with HCV.
About PCR tests: AMPLICOR(R) and COBAS AMPLICOR(TM).
On July 9, 2001 the U.S. Food and Drug Administration (FDA) granted marketing approval for two hepatitis C tests designed to directly detect the presence of the hepatitis C virus (HCV) in patients who have evidence of liver disease and antibody evidence of HCV and who are suspected to be actively infected with HCV.
The AMPLICOR(R) HCV Test, version 2.0, and the COBAS AMPLICOR(TM) HCV Test, version 2.0 are the first qualitative RNA tests to be approved for marketing by the FDA. The AMPLICOR HCV Tests use PCR technology to directly detect the hepatitis C viral RNA. In addition, the AMPLICOR HCV Tests are the first HCV RNA assays to report the analytical sensitivity in International Units (IU/mL), as defined by the WHO International Standard for HCV RNA for Nucleic Acid Amplification Technology (NAT) Assays.
NOTE: A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated.

"False positive" test results:
A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.

"False negative" test results:
Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, tests such as a PCR may be considered.

Positive Anti-HCV test results after exposure to HCV:
Anti-HCV (positive anti-HCV test) can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that the majority of persons who have hepatitis C have no symptoms until years later.

Positive PCR test results after exposure to HCV:
It is possible to find HCV (positive PCR test) within 1 to 2 weeks after being infected with the virus.

Who should get tested for hepatitis C?
It is recommended that the following people be tested:

* Persons who ever injected illegal drugs, including those who injected once or a few times many years ago
* Persons who were treated for clotting problems with a blood product made before 1987, when more advanced methods for manufacturing the products were developed.
* Persons who were notified that they received blood from a donor who later tested positive for hepatitis C
* Persons who received a blood transfusion or solid organ transplant before July 1992, when better testing of blood donors became available
* Long-term hemodialysis patients
* Persons who have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
* Healthcare workers after exposures (e.g., needle sticks or splashes to the eye) to HCV-positive blood on the job
* Children born to HCV-positive women

What is the next step if a person has a confirmed positive anti-HCV test?
The next step would be to measure the level of ALT (alanine aminotransferase, a liver enzyme) in the blood. An elevated ALT indicates inflammation of the liver and should be checked further for chronic (long-term) liver disease and possible treatment. A healthcare professional familiar with chronic hepatitis C should do the evaluation.

Can a person have a normal ALT level and still have chronic hepatitis C?
It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year, but they still have chronic liver disease.
If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

GENOTYPE

The term genotype refers to the genetic make-up of an organism or a virus. There are at least 6 distinct HCV genotypes identified. Genotype 1 is the most common genotype seen in the United States.
As there are 6 known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding treatment. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin. Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype.
For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. For these reasons, testing for HCV genotype is often clinically helpful. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.
Source: Centers for Disease Control and Prevention (CDC), Hepatitis Branch. [On-line]. Available: www.cdc.gov

WHERE CAN I GET TESTED FOR HEPATITIS C?

Testing for hepatitis C can be done in your doctor's office, a laboratory, an accredited "Testing Center" that offers health awareness screening tests, or your local health department.
Another option now available is at home testing. The US FDA has approved a test for hepatitis C for home use called the "Hepatitis C Check", manufactured by Home Access Health Corporation. This test can be purchased at your local pharmacy or ordered on-line directly from Home Access Health

TREATMENT FOR HEPATITIS C

Chronic Hepatitis C:
Current Disease Management Treatment:
In the United States, four regimens have been approved as therapy for hepatitis C:

* Monotherapy with pegylated alpha (alfa) interferon
* Monotherapy with alpha (alfa) interferon
* Combination therapy with alpha interferon and ribavirin.
* Combination therapy with pegylated (alfa) interferon and ribavirin.

About pegylated alpha-Interferons:
On January 22, 2001 the first pegylated alpha interferon was approved for marketing in United States by the U.S. Food and Drug Administration (FDA). Pegylated interferon is a long acting interferon created by adding long chains of a small molecule substance called Polyethylene Glycol (PEG) using a specialized chemical process.
PEG helps the interferon evade the body's immune system and can therefore remain in an active form for a longer period of time.
Pegylated alpha interferon has a longer half-life than regular alpha interferons.
Half-life means the amount of time it takes for half of the drug to leave the body. The longer the half-life, the longer the drug can stay around to work in the body.
In the case of pegylated interferon, this extended half-life has led to once a week dosing of medication rather than the three times weekly shots (injections) needed for regular alfa interferon in the treatment of chronic HCV.
There are currently two pegylated interferons that have been tested in clinical trials for treating chronic HCV. They are the newly FDA approved PEG-Intron (peginterferon alfa-2b), manufactured by Schering-Plough, and PEGASYS (peginterferon alfa-2a) made by Roche, which is expected to also be FDA approved soon.
PEG-Intron is currently FDA approved for use in people who have never been treated with alfa interferon (treatment na�ve), those who have stable liver disease (compensated), and people who are at least 18 years of age. However, PEG-Intron offers the potential to be prescribed by a physician for previously treated HCV patients through "Off-Label" use.

Combination Therapy:
Combination therapy consistently yields higher rates of sustained response than monotherapy with alpha interferon. Combination treatment is more expensive and is associated with more side effects than monotherapy, but, in most situations, it is preferable. At present, interferon alpha monotherapy should be reserved for patients who have contraindications to the use of ribavirin.
On August 8, 2001 the U.S. Food and Drug Administration (FDA) approved PEG-INTRON (peg interferon alfa-2b) Powder for Injection for use in combination therapy with REBETOL (ribavirin, USP) Capsules for the treatment of chronic hepatitis C in patients with compensated liver disease who have not been previously treated with interferon alpha and who are at least 18 years of age.
The PEG-INTRON and REBETOL treatment regimen is the first and only pegylated interferon-based combination therapy approved in the United States. REBETOL capsules are expected to be available nationwide sometime in the fall of 2001.

Monotherapy:
Several forms of alpha interferon are available (alfa-2a, alfa-2b, and consensus interferon). These interferons are given subcutaneously three times weekly in doses of 3 million units (MU) or, in the case of consensus interferon, 9 �g per injection.
Ribavirin, in contrast, is an oral antiviral agent that is given twice a day in 200-mg capsules for a total daily dose of 1,000 mg for patients who weigh less than 75 kilograms (165 pounds) or 1,200 mg for those who weigh more than 75 kilograms.

Disease Prognosis:
Treatment with interferon alpha alone or combination therapy with interferon alpha and ribavirin leads to rapid improvements in serum ALT levels in 50 to 75 percent of patients and the disappearance of detectable HCV RNA from the serum in 30 to 50 percent.
Research indicates that the liver benefits from undergoing therapy even if the individual is not able to completely eliminate the hepatitis virus.
Long-term improvement in liver disease usually occurs only if HCV RNA disappears during therapy and stays undetectable when therapy is stopped.

Therapy Response:
A response to treatment is considered to be "sustained" if HCV RNA remains undetectable for 6 months or more after therapy stops. With interferon monotherapy, 30 to 35 percent of patients become HCV RNA negative with treatment, but almost half of these relapse when treatment stops: The sustained response rate, therefore, averages only 15 to 20% with monotherapy.
Combination therapy with interferon and ribavirin, however, leads to loss of HCV RNA on treatment in 50 to 55 percent of patients and a sustained loss in 35 to 45 percent. Thus, combination treatment results in both a higher rate of loss of HCV RNA on treatment and a lower rate of relapse when treatment is stopped.
The optimal duration of treatment varies depending on whether interferon monotherapy or combination therapy is used, as well as by HCV genotype. For patients treated with interferon alpha monotherapy, a 48-week course is recommended, regardless of genotype. For patients treated with combination therapy, the optimal duration of treatment depends on viral genotype.
Patients with genotypes 2 and 3 have a high rate of response to combination treatment (60 to 70 percent), and a 24-week course of combination therapy yields results equivalent to those of a 48-week course.
In contrast, patients with genotype 1 have a lower rate of response to combination therapy (25 to 35 percent), and a 48-week course yields a significantly better sustained response rate. Again, because of the variable responses to treatment, testing for HCV genotype is clinically useful when using combination therapy.

Who Should Be Treated?
Patients with HCV RNA, anti-HCV, elevated serum aminotransferase levels, and evidence of chronic hepatitis on liver biopsy, and with no contraindications, should be offered therapy with the combination of alpha interferon and ribavirin. The National Institutes of Health Consensus Development Conference Panel recommended therapy for hepatitis C be limited to those patients who have histological evidence of progressive disease.
Thus, the panel recommended that all patients with fibrosis or moderate to severe degrees of inflammation and necrosis on liver biopsy should be treated and that patients with less severe histological disease be managed on an individual basis. Patient selection should not be based on the presence or absence of symptoms, the mode of acquisition, the genotype of HCV RNA, or serum HCV RNA levels.
Patients with cirrhosis found through liver biopsy can be offered therapy if they do not have signs of decompensation, such as ascites, persistent jaundice, wasting, variceal hemorrhage, or hepatic encephalopathy.
However, interferon and combination therapy have not been shown to improve survival or the ultimate outcome in patients with preexisting cirrhosis.
Patients older than 60 years also should be managed on an individual basis, since the benefit of treatment in these patients has not been well documented and side effects appear to be worse in older patients.
The role of interferon therapy in children with hepatitis C remains uncertain. Ribavirin has yet to be evaluated adequately in children, and pediatric doses and safety have not been established. Thus, if children with hepatitis C are treated, monotherapy is recommended, and ribavirin should not be used outside of controlled clinical trials.
In many of these indefinite situations, the indications for therapy should be reassessed at regular intervals. In view of the rapid developments in hepatitis C today, better therapies may become available within the next few years, at which point expanded indications for therapy would be appropriate.
In patients with clinically significant extrahepatic manifestations, such as cryoglobulinemia and glomerulonephritis, therapy with alpha interferon can result in remission of the clinical symptoms and signs.
However, relapse after stopping therapy is common. In some patients, continual, long-term alpha interferon therapy can be used despite persistence of HCV RNA in serum if clinical symptoms and signs resolve on therapy.

Who Should Not Be Treated?
Therapy is inadvisable outside of controlled trials for patients who have:

- Clinically decompensated cirrhosis because of hepatitis C.
- Normal aminotransferase levels.
- A kidney, liver, heart, or other solid-organ transplant.
- Specific contraindications to either monotherapy or combination therapy.

Contraindications to alpha interferon therapy include severe depression or other neuropsychiatric syndromes, active substance or alcohol abuse, autoimmune disease (such as rheumatoid arthritis, lupus erythematosus, or psoriasis) that is not well controlled, bone marrow compromise, and inability to practice birth control.
Contraindications to ribavirin and thus combination therapy include marked anemia, renal dysfunction, and coronary artery or cerebrovascular disease, and again, the inability to practice birth control.
Alpha interferon has multiple neuropsychiatric effects. Prolonged therapy can cause marked irritability, anxiety, personality changes, depression, and even suicide or acute psychosis. Patients particularly susceptible to these side effects are those with preexisting serious psychiatric conditions and patients with neurological disease.
Interferon therapy is also associated with relapse in people with a previous history of drug or alcohol abuse. Alpha interferon should not be given to a patient who has only recently stopped alcohol or substance abuse. Typically a 2 year abstinence is recommended before starting therapy. Strict abstinence from alcohol is recommended during therapy with interferon.
Alpha interferon therapy can induce auto-antibodies, and a 6- to 12-month course triggers an autoimmune condition in about 2 percent of patients, particularly if they have an underlying susceptibility to autoimmunity (high titers of antinuclear or anti-thyroid antibodies, for instance). Exacerbation of a known autoimmune disease (such as rheumatoid arthritis or psoriasis) occurs commonly during interferon therapy.
Alpha interferon has bone marrow suppressive effects. Therefore, patients with bone marrow compromise or cytopenias, such as low platelet count (< 75,000 cells/mm3) or neutropenia (< 1,000 cells/mm3) should be treated cautiously and with frequent monitoring of cell counts.
Ribavirin causes red cell hemolysis to a variable degree in almost all patients. Therefore, patients with a preexisting hemolysis or anemia (hemoglobin < 11 gm or hematocrit < 33 percent) should not receive ribavirin. Similarly, patients who have significant coronary or cerebral vascular disease should not receive ribavirin, as the anemia caused by treatment can trigger significant ischemia. Fatal myocardial infarctions and strokes have been reported during combination therapy with alpha interferon and ribavirin.
Ribavirin is excreted largely by the kidneys. Patients with renal disease can develop hemolysis that is severe and even life threatening.
Patients who have elevations in serum creatinine above 2.0 mg/dL should not be treated with ribavirin. Finally, ribavirin causes birth defects in animal studies and should not be used in women who are not practicing adequate means of birth control. Alpha interferon also should not be used in pregnant women as it has direct antigrowth and anti-proliferative effects.
Combination therapy should therefore be used with caution. Patients should be fully informed of the potential side effects before starting therapy.

Source: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 99-4230 May 1999 e-text last updated: February 2000. [On-line] Available: http://www.niddk.nih.gov
Information on Pegylated interferon is from http://www.hepatitisneighborhood.com article, "The Word is Out -- PEG is Here!" posted to site January 2001.

IF I NEED TREATMENT FOR HEPATITIS C, WHERE CAN I GET MY MEDICINE?

People who have hepatitis C and decide with their doctor to undergo the above treatment can have their doctor's prescription filled at their local pharmacy. Because treatment for hepatitis C lasts for several months and side effects may occur during treatment, many people decide to obtain their medication from a specialty pharmacy.
Priority Healthcare Corporation, a specialty pharmaceutical company that provides individuals with specialized pharmaceuticals which are dose specific medications, as ordered by a doctor, and is delivered to the patient's home. A very important part of Priority Healthcare's service is the availability of nurses and pharmacists 24 hours a day to answer patient's questions about their disease and their treatment.
For more information about Priority Healthcare's services, you can call 1-800-892-9622. You can also visit the Web site at http://www.priorityhealthcare.com.

HOW CAN I FIND A DOCTOR WHO TREATS PEOPLE WITH HEPATITIS C?

You can check with your local Medical Association or you may choose to search the directory of doctors who are hepatitis C aware on the Hepatitis Awareness Center Web site
You may also search the Physician database in the Hepatitis Neighborhood Support Center

PREVENTION OF HEPATITIS C

At present, the only means of preventing new cases of hepatitis C are to screen the blood supply, encourage health professionals to take precautions when handling blood and body fluids, and inform people about high-risk behaviors. Programs to promote needle exchange offer some hope of decreasing the spread of hepatitis C among injection drug users.
Unfortunately vaccines and immunoglobulin products do not exist for the prevention of hepatitis C. Development seems unlikely in the near future because these products would require antibodies to all the genotypes and variants of the hepatitis C virus. Nevertheless, advances in immunology and innovative approaches to immunization make it likely that some form of vaccine for hepatitis C will eventually be developed. However, there is currently no vaccine to prevent hepatitis C.
Source: CDC

WHERE CAN I GO FOR MORE INFORMATION AND SUPPORT FOR HEPATITIS C?

There are many places to get support and information about hepatitis C, such as The Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the American Liver Association, and the Hepatitis Foundation International, are good sources for HCV information. One Web site devoted to information and support for persons with hepatitis is the Hepatitis Neighborhood. The Hepatitis Neighborhood is dedicated to providing up-to-date, comprehensive information about hepatitis.
You can visit the numerous places in the Neighborhood, such as the Clinic, the Pharmacy, and the Library for hepatitis information.
You can find support in the online "Support Center", which includes a directory of hepatitis support groups located through out the United States. You can also find support in the Neighborhood Cafe, where you have the opportunity to chat with others about living with hepatitis.
The Town Hall presents hosted chat rooms each week on various topics related to hepatitis. You can ask your questions and get answers from hepatitis experts by participating in the weekly chats.
You can also post questions about hepatitis on the Ask a Nurse, Ask the Pharmacist, and Ask the Nutritionist message boards.
In the Hepatitis Neighborhood Library, you can search for, read, view and print hepatitis specific articles.
These are only a few of the many benefits of becoming a member of the Hepatitis Neighborhood. New features are continually being added.
Membership is FREE, confidential, and without solicitation.
You can join the Hepatitis Neighborhood

Hepatitis B

The Hepatitis B virus is carried in the blood and body fluids of an infected person. It can pass through tiny breaks in the skin, mouth, vagina, or penis.

A person can get infected in several ways, such as:

- During birth when the infected mother passes the virus to her baby
- By having sex with an infected person
- By being stuck with a used needle
- By sharing personal items, such as a razor or toothbrush

People can spread hepatitis B virus without even knowing they have it.

You cannot get hepatitis B by:

- Shaking hands with an infected person.
- Hugging an infected person.
- Sitting next to an infected person.

There is a vaccine for hepatitis B if you are exposed to/ or at risk for exposure to HBV. The hepatitis B vaccine is given through three shots. You need all of the shots to be protected. If you miss a shot, call your doctor or clinic right away to set up a new appointment.

You can also protect yourself and others from hepatitis B if you:

- Use a condom when you have sex.
- Don't share drug needles with anyone.
- Wear gloves if you have to touch anyone's blood.
- Don't use an infected person's toothbrush, razor, or anything else that could have blood on it.
- Also, if you get a tattoo or body piercing, make sure it is done with clean tools.

Hepatitis A

Hepatitis A is transmitted by oral/fecal contact, by putting your hand or something in the mouth that has been contaminated with infected feces, fecal contamination of food and water. Or by handling something that has been in contact with someone who has the virus on their hands, from not washing after toileting.
It is not a blood borne virus like B or C. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.
Proper HANDWASHING is essential to the Prevention of the spread of Hepatitis A anywhere.
More Information regarding Hep A is located on our website
At the Library, as well as in the Clinic, New in the News section, on the searchable clinical message boards & in the Pharmacy

Thank you,