Hepatitis Immunizations: More Important Now Than Ever

A major responsibility of every organization providing emergency medical care is to ensure that their providers are protected. This level of protection is often thought of as gloves, glasses, and N95's. However, ensuring your providers are protected on the inside is just as important.

This article will discuss hepatitis immunizations, how to set up a departmental immunization program, immunization tracking, and value added components to your program.

Overview:

Emergency medical personnel are working in a world that has changed over the last few years. The patients are sicker and the hospital stays are shorter than ever. We are working in a world where disease spread can occur rapidly, even moving from continent to continent in days. We are also deploying personnel anywhere in the country in the event of a disaster.

Because of these issues, EMS leaders must be diligent in keeping their personnel as safe as possible. In addition to physical fitness programs and training sessions, the creation and maintenance of a quality immunization program is critical to your operation.

The Hepatitis Family:

One must understand the disease before determining a prevention strategy. Hepatitis is a family of diseases which can easily infect your personnel. Hepatitis primarily attacks the hepatic (liver) system. This article will only briefly touch on three of the most common types of hepatitis, which are types A, B, and C. For the most part, hepatitis is a disease which is preventable through the use of vaccines. In fact, both Hepatitis A and B are preventable with vaccines.

Hepatitis A is a vaccine preventable hepatitis. It can be transmitted without contact to blood.

Transmission factors include:

• Working in areas with poor sanitation systems, for example disaster areas, flooding, or wildland firefighting operations.
• Working in areas with poor hygiene.
• Ingestion of contaminated water or food.
• Person-to-person contact with someone infected.

Consequences of infection:

• Those infected lose an average of 27 days of work (management needs to think of the overtime and the cost benefit ratio).
• Up to 22% of symptomatic patients may need hospitalization.
• 10%-15% of symptomatic patients have the disease up to six months before symptoms develop.
• Possible liver complications or even liver failure.
• Up to 100 deaths in the U.S. each year.

Hepatitis B is a vaccine preventable hepatitis. It is transmitted through direct contact to infected blood, including dried infected blood for up to several days.

• Exposure to infected blood through open wounds.
• Accidental needle sticks.
• Unsafe sexual practices with infected partners.

Consequences of infection:

• Possible liver failure.
• Cirrhosis (chronic liver damage).
• Hepatitis B causes 80% of liver cancers.
• Chronic Hepatitis B infection is the second leading cause of cancer, behind tobacco.
• Estimated 1.25 million chronic carriers of hepatitis B in the U.S.
• Causes an estimated 5,000 deaths in the U.S. each year.

Hepatitis C is not vaccine preventable. It is transmitted through direct contact to infected blood.

Transmission factors include:

• Exposure to infected blood through open wounds.
• Accidental needle sticks.
• Unsafe sexual practices with infected partners.

• Leads to chronic infection in 75%-80% of people.
• Possible liver failure.
• Cirrhosis (chronic liver damage).
• Estimated 4 million people in the U.S. with hepatitis C.
• Causes an estimated 8,000 -10,000 deaths in the U.S. each year.

An interesting fact is that most people who have either hepatitis A or hepatitis B do not know how they were infected with the virus. According to the Centers for Disease Control, almost 50% of those patients with hepatitis A have no known risk factors. Likewise, almost 30% of hepatitis B patients have no reported risk factors.

Immunization Recommendations: