Hep B Blog

SHEA Updated Guidelines: Health Care Personnel Living Hepatitis B, Hepatitis C, and HIV

SHEA Updated Guidelines on Health Care Workers Living With Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus

 Many health care students and professionals in the U.S. are living with hepatitis B, hepatitis C or HIV. Living with these conditions should not interfere with a person’s health care education or professional career. It is important that health care students and professionals are aware of their rights and responsibilities – and equally important that health care schools and institutions are aware of their responsibilities, as well. There are now new guidelines to help institutions understand how to manage health care professionals living with hepatitis B, hepatitis C or HIV.

The Society of Healthcare Epidemiology of America (SHEA) recently updated their guidelines on health care workers who are living with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). These updates reflect the advances in medical technologies and the low transmission risk health care workers living with HBV, HCV, and HIV pose. It is important to note, there have been very few cases of health care personnel (HCP) transmitting HBV,  HCV, or HIV to patients. These new guidelines, which align with the CDC’s Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students, can help reduce discrimination of health care students and personnel.

Some of the important updated recommendations for health care workers living with hepatitis B include:

  • Pre-vaccination testing does not need to be done unless the individual has an increased risk of infection
  • Health care workers should have a complete vaccination series for hepatitis B. Learn more about the vaccination series
  • Health care professionals living with HBV who do not perform exposure-prone procedures should not be prohibited from participating in patient-care activities solely on the basis of their HBV infection
  • Health care personnel living with HBV should seek optimal medical management, including, when appropriate, treatment with effective antiviral agents
  • Consistent with CDC guidelines, there is no justification for, nor benefit gained from, notifying patients with regard to health care professionals living with HBV who are being managed through an institution’s oversight panel

Some of the important updated recommendations for health care workers living with hepatitis C includes:

  • Because of the opioid epidemic in the United States, consideration should always be given to the possibility of substance use disorder when health care professional-to-patient transmission of a bloodborne pathogen is detected
  • Health care professionals living with HCV should seek optimal medical management, including treatment with effective antiviral agents to achieve cure of the infection
  • Health care professionals living with HCV who received treatment resulting in ‘undetectable’ circulating HCV-RNA levels can perform exposure-prone procedures with some stipulations:
    • Has not been previously identified as having transmitted infection to patients following definitive therapy resulting in a sustained virologic response (SVR)
    • Provides the oversight panel with records and laboratory results (or permits the HCP’s personal physician to provide records and laboratory results) confirming receipt of treatment and SVR
    • Has achieved SVR by remaining HCV RNA negative for 12 weeks following the completion of therapy

Some of the important updated recommendations for health care workers living with HIV:

  • Health care professionals living with HIV and who, despite appropriate antiretroviral treatment, have a confirmed viral load >200 copies/mL should not perform exposure-prone procedures until they have achieved virologic suppression
  • Scientists acknowledge that when the viral load is undetectable = untransmittable
  • Health care professionals living with HIV whose confirmed viral load is below 200 copies/mL can perform exposure-prone procedures with some stipulations:
    • Has not been previously identified as having transmitted infection to patients while receiving appropriate suppressive therapy
    • Obtains advice from an oversight panel about recommended practices to minimize the risk of exposure events
    • Is followed by a physician who has expertise in the management of HIV infection and who is allowed by the individual to participate in or communicate with the oversight panel about the individual’s clinical status
    • Is monitored on a periodic basis (eg, every 6 months) to assure that the HIV RNA remains below the level of detection, with results provided to the oversight panel.
    • Is followed closely by their physician and the oversight panel instances in which fluctuations in HIV viremia occur, including appropriate retesting as discussed above to reevaluate the HCP’s viral load
    • Agrees, in writing, to follow the recommendations of the oversight panel

Read more about the guidance and information on how hospitals, professional schools, and institutions should proceed for healthcare workers living with HBV, HCV, and HIV. You can also read more about the rights and protections for health care students and professionals living with hepatitis B in the U.S.

 

Reference

Henderson, D., Dembry, L., Sifri, C., Palmore, T., Dellinger, E., Yokoe, D., . . . Babcock, H. (2020). Management of healthcare personnel living with hepatitis B, hepatitis C, or human immunodeficiency virus in US healthcare institutions. Infection Control & Hospital Epidemiology, 1-9. doi:10.1017/ice.2020.458

Author: Evangeline Wang, Program Coordinator, Hepatitis B Foundation

Contact Information: info@hepb.org

Hepatitis B and Discrimination of Health Care Students

Hepatitis B and Discrimination of Health Care Students

Hepatitis B virus (HBV) infection affects more than 290 million persons globally and up to 2.2 million persons in the United States. Living with hepatitis B can mean living with stigma and facing discrimination. Stigma related to hepatitis B is often caused by low awareness​ from the general public and health care providers. Low awareness can lead to fear and misconceptions about the disease. Discriminatory practices that affect health care students with hepatitis B infection may include unjustified denial of school admission or enrollment, restriction of clinical training, or dismissal from an academic program. Given substantial progress in hepatitis B research and treatment in recent decades, it is important to address discriminatory policies that affect health care students.

Kate Moraras, Deputy Director of Public Health at the Hepatitis B Foundation led a research project which found that 36 accredited health care programs in Pennsylvania (43%) had policies which appear to be discriminatory against students living with hepatitis B. These policies included requiring proof of hepatitis B immunity for enrollment or program completion. Failure to produce proof could result in revocation of program admission or not being allowed to enter clinical rotations. This is problematic because the Americans with Disabilities Act (ADA) protects individuals living with hepatitis B. The Department of Justice (DOJ) states that there is no lawful basis for excluding persons living with hepatitis B from health profession schools. Not only does the DOJ protect individuals living with hepatitis B, but the Centers for Disease Control and Prevention (CDC)  states that health care students with hepatitis B pose no risk to patients and should not be limited in their health care education. The CDC recommends that health care students should not be arbitrarily excluded or restricted from activities that could impede practice or studies. They additionally recommend hepatitis B testing only for healthcare providers at increased risk of infection or conducting invasive, exposure-prone procedures and most health care students are not participating in these invasive procedures. If you want to know what to do if you are facing discrimination visit the Know Your Rights section of our website.

 Resources

Please join Hep Free Hawai’i, ACLU Hawai’i, the National Task Force on Hepatitis B: Focus on AAPIs, Hep B United, and Hepatitis B Foundation on October 15th at 6PM ET to address hepatitis B discrimination among health care students. Dr. Chari Cohen, Senior Vice President of the Hepatitis B Foundation and Taylor Mangan, University of California President’s Public Service Law Fellow at ACLU Hawai’i will discuss hepatitis B related institutional discrimination against health care students, current protections and recommendations in place to protect health care students from discrimination. Register here.

The Hepatitis B Foundation’s website has an entire page focused on the rights of individuals living with hepatitis B. Check it out each section:

Reference

 

Moraras, K., Block, J., Shiroma, N., Cannizzo, A., & Cohen, C. (2020). Protecting the Rights of Health Care Students Living With Hepatitis B Under the Americans With Disabilities Act. Public Health Reports, 135(1_suppl), 13S-18S. https://doi.org/10.1177/0033354920921252

Author: Evangeline Wang, Program Coordinator, Hepatitis B Foundation

Contact Information: info@hepb.org

Your Liver and Hepatitis B

 

Your Liver and Hepatitis B

 Happy Liver Cancer Awareness Month! Your liver is an important organ for digesting food and breaking down toxins. Its main functions include: filtering blood from the digestive tract and transporting it back to the rest of the body, removing toxins from the blood, and storing important nutrients that keep the body healthy.

Hepatitis B is a viral infection of your liver that can cause serious damage over time. Chronic infection with the hepatitis B virus (HBV) can ultimately lead to scarring, cirrhosis, liver cancer, and liver failure. Liver cancer is the 3rd deadliest cancer worldwide, with 5-year survival rates of only 19%. There are few effective treatments for liver cancer, and we, therefore, must rely on prevention and early detection in order to save lives. Chronic hepatitis B infection causes approximately 78% of hepatocellular carcinoma (HCC), or primary liver cancer. The key to saving lives is ensuring that individuals infected with HBV are diagnosed and linked with appropriate care, including regular screening for liver cancer.

In the U.S., liver cancer incidence and death rates are increasing at a faster rate than any other cancer and are projected to continue to rise through at least 2030. Up to 2.2 million people are chronically infected by HBV in the U.S. and the majority is unaware of their infection. Identifying, managing and treating those with HBV infection can help prevent liver cancer in many people. Additionally, regularly screening people with chronic hepatitis B  for liver cancer can aid with early detection and treatment of liver cancer. If diagnosed early, liver cancer can be treated and even cured.

Below are some practices you can easily incorporate into your daily life and routine to keep your liver healthy while living with hepatitis B.

Healthy Liver Tips

  1. Reduce alcohol intake: Alcoholic beverages can damage or destroy liver cells and create additional health problems.
  2. Eat a healthy diet: Increase the amount of whole foods in your diet like fruits and vegetables while decreasing the amount of refined carbohydrates (pastas, white rice, white bread), processed sugar, and saturated fats which can create a healthy environment for your liver.
  3. Daily exercise: It is recommended for adults to exercise at least 60 minutes per day. Not only does this have many other health benefits, but it can reduce the fat surrounding your liver which can decrease your risk of liver cancer.
  4. Avoid the use of illicit drugs: Drugs like marijuana, cocaine, heroin, inhalants, or hallucinogens put stress on your liver and reduce its functioning capability.
  5. Wash produce and read labels on household chemicals: Pesticides and other chemicals can contain toxins which are harmful to your liver.

Incorporating these healthy practices does not have to be difficult. Choose one of the five tips that is most convenient with your current lifestyle and use it as a starting point for a healthier routine. By gradually incorporating each healthy liver tip into your lifestyle, you can reduce your risk of a negative liver outcome creating a healthier you!

Resources for Liver Cancer and Hepatitis B

Please join Hepatitis B Foundation, Hep B United and Hep B United Philadelphia’s webinar on October 20th at 3PM ET to learn more about hepatitis B and liver cancer. Dr. Kenneth Rothestein, Director of Regional Outreach and Regional Hepatology from Penn Medicine will be highlighting the importance of liver cancer screening for prevention. Register here!

To promote and ultimately prevent liver cancer this October we are pleased to share the Centers for Disease Control and Prevention’s Know Hepatitis B (KHB) Campaign Product of the Month – the Infographic: “Get Tested for Hepatitis B.”

The CDC’s Know Hepatitis B Campaign’s infographic, “Get Tested for Hepatitis B” encourages Asian Americans and Pacific Islanders to get tested for hepatitis B. This 2-page downloadable document is available in English, Traditional Chinese, Vietnamese and Korean languages and answers commonly asked questions about hepatitis B.

For more information about the Know Hepatitis B Campaign, visit the campaign website.

 

Author: Evangeline Wang, Program Coordinator, Hepatitis B Foundation

Contact Information: info@hepb.org