Editing Hepatitis (section)

== Virus screening ==
The purpose of screening for viral hepatitis is to identify people infected with the disease as early as possible, even before symptoms and transaminase elevations may be present. This allows for early treatment, which can both prevent disease progression and  decrease the likelihood of transmission to others.<ref>{{Cite web |date=2021-08-13 |title=Hepatitis Testing |url=https://www.testing.com/hepatitis-testing/ |access-date=2023-05-12 |website=Testing.com |language=en-US}}</ref>

=== Hepatitis A ===
Hepatitis A causes an acute illness that does not progress to chronic liver disease. Therefore, the role of screening is to assess immune status in people who are at high risk of contracting the virus, as well as in people with known liver disease for whom hepatitis A infection could lead to liver failure.<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/statistics/surveillanceguidelines.htm|title=Guidelines For Viral Hepatitis Surveillance And Case Management|website=www.cdc.gov|access-date=2016-03-12|url-status=live|archive-url=https://web.archive.org/web/20160310094046/http://www.cdc.gov/hepatitis/statistics/surveillanceguidelines.htm|archive-date=2016-03-10}}</ref><ref>{{Cite book|title=Harrison's Manual of Medicine|edition=18|chapter=Chapter 164: Chronic Hepatitis|last1=Harrison|first1=Tindsley Randolph|editor-last1=Longo|editor-first1=Dan L.|editor-last2=Fauci|editor-first2=Anthony S.|editor-link2=Anthony Fauci|editor-last3=Kasper|editor-first3=Dennis L.|editor-last4=Hauser|editor-first4=Stephen L.|editor-last5=Jameson|editor-first5=L. Jerry|editor-last6=Loscalzo|editor-first6=Jerry|publisher=McGraw-Hill|date=2013|location=New York, NY}}</ref> People in these groups who are not already immune can receive the [[hepatitis A vaccine]].{{cn|date=March 2023}}

Those at high risk and in need of screening include:<ref name="WHO Hep A Fact Sheet July 2015" /><ref name="Voise 2011" /><ref name="CDC Adult Vaccine">{{cite web|title=Adult Immunization Schedule by Vaccine and Age Group|url=https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html|website=www.CDC.gov|access-date=March 7, 2016|url-status=live|archive-url=https://web.archive.org/web/20160305212647/http://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html|archive-date=March 5, 2016}}</ref>
* People in close contact (either living with or having sexual contact) with someone who has hepatitis A
* People traveling to an area with endemic hepatitis A
* People who do not have access to clean water
* People who use illicit drugs
* People with liver disease
* People with poor sanitary habits such as not washing hands after using the restroom or changing diapers

The presence of anti-hepatitis A [[Immunoglobulin G|IgG]] in the blood indicates past infection with the virus or prior vaccination.<ref>{{Cite book|title=Chapter 163: "Acute Hepatitis." Harrison's Manual of Medicine, 18e.|last=Longo, Dan L.|publisher=McGraw-Hill|year=2013|location=New York, NY|display-authors=etal}}</ref>

=== Hepatitis B ===
[[File:Hepatitis B virus v2.png|thumb|Hepatitis B virus v2]]
The [[Centers for Disease Control and Prevention|CDC]], [[World Health Organization|WHO]], [[United States Preventive Services Task Force|USPSTF]], and [[American Congress of Obstetricians and Gynecologists|ACOG]] recommend routine hepatitis B screening for certain high-risk populations.<ref name="CDC recommendations for Hepatitis B">{{Cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm#fig3|title=Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection|website=www.cdc.gov|access-date=2016-03-11|url-status=live|archive-url=https://web.archive.org/web/20160306035320/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm#fig3|archive-date=2016-03-06}}</ref><ref name="Screening for Hepatitis B">{{Cite book|url=https://www.ncbi.nlm.nih.gov/books/NBK208504/|title=Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation|last1=Chou|first1=Roger|last2=Dana|first2=Tracy|last3=Bougatsos|first3=Christina|last4=Blazina|first4=Ian|last5=Zakher|first5=Bernadette|last6=Khangura|first6=Jessi|date=2014-01-01|publisher=Agency for Healthcare Research and Quality (US)|series=U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews|location=Rockville (MD)|pmid=24921112}}</ref><ref name="WHO guidelines for chronic Hepatitis B">{{Cite web|url=https://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/|title=Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection|website=World Health Organization|language=en-GB|access-date=2016-03-11|url-status=dead|archive-url=https://web.archive.org/web/20160220104219/http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/|archive-date=2016-02-20}}</ref><ref name="ACOG Practice Bulletin">{{Cite web|url=http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Viral-Hepatitis-in-Pregnancy|title=ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists: Viral Hepatitis in Pregnancy|website=www.acog.org|access-date=2016-03-12|archive-date=2020-08-07|archive-url=https://web.archive.org/web/20200807231110/https://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Obstetrics/Viral-Hepatitis-in-Pregnancy|url-status=dead}}</ref> Specifically, these populations include people who are:
* Beginning [[Immunosuppressive drug|immunosuppressive]] or [[Chemotherapy|cytotoxic therapy]]<ref name="CDC recommendations for Hepatitis B" />
* Blood, organ, or tissue donors<ref name="WHO guidelines for chronic Hepatitis B" />
* Born in countries where the prevalence of hepatitis B is high (defined as ≥2% of the population), whether or not they have been vaccinated<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" />
* Born in the United States whose parents are from countries where the prevalence of hepatitis B is very high (defined as ≥8% of the population), and who were not vaccinated<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" />
* Found to have elevated [[Liver function tests|liver enzymes]] without a known cause<ref name="CDC recommendations for Hepatitis B" />
* [[HIV/AIDS|HIV]] positive<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" />
* In close contact with (i.e. live or have sex with) people known to have hepatitis B<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" />
* Incarcerated<ref name="WHO guidelines for chronic Hepatitis B" />
* [[Intravenous drug users]]<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" />
* [[Men who have sex with men]]<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" />
* On [[hemodialysis]]<ref name="CDC recommendations for Hepatitis B" />
* Pregnant<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="ACOG Practice Bulletin" />
Screening consists of a blood test that detects hepatitis B surface antigen ([[HBsAg]]). If HBsAg is present, a second test – usually done on the same blood sample – that detects the antibody for the hepatitis B core antigen (anti-[[HBcAg]]) can differentiate between acute and chronic infection.<ref name="CDC recommendations for Hepatitis B" /><ref>{{Cite book|title=CURRENT Practice Guidelines in Primary Care 2015|author1=Esherick JS |author2=Clark DS |author3=Slater ED |publisher=McGraw-Hill|year=2015|location=New York, NY|display-authors=etal}}</ref> People who are high-risk whose blood tests negative for HBsAg can receive the [[hepatitis B vaccine]] to prevent future infection.<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" /><ref name="ACOG Practice Bulletin" />

=== Hepatitis C ===
[[File:HCV structure.png|thumb|HCV structure]]
[[File:ABHD5CGI-58-the-Chanarin-Dorfman-Syndrome-Protein-Mobilises-Lipid-Stores-for-Hepatitis-C-Virus-ppat.1005568.s014.ogv|thumb|ABHD5CGI-58-the-Chanarin-Dorfman-Syndrome-Protein-Mobilises-Lipid-Stores-for-Hepatitis-C-Virus-ppat.1005568.s014]]
The [[Centers for Disease Control and Prevention|CDC]], [[World Health Organization|WHO]], [[United States Preventive Services Task Force|USPSTF]], [[AASLD]], and [[American Congress of Obstetricians and Gynecologists|ACOG]] recommend screening people at high risk for hepatitis C infection.<ref name="ACOG Practice Bulletin" /><ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force">{{Cite web|url=https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening|title=Final Recommendation Statement: Hepatitis C: Screening – US Preventive Services Task Force|website=www.uspreventiveservicestaskforce.org|access-date=2016-03-21|url-status=live|archive-url=https://web.archive.org/web/20160321180306/http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening|archive-date=2016-03-21}}</ref><ref name="AASLD-IDSA" /> These populations include people who are:
* Adults in the United States born between 1945 and 1965<ref name="Task Force" /><ref name="AASLD-IDSA" />
* Blood or organ donors.<ref name="AASLD-IDSA" />
* Born to HCV-positive mothers<ref name="AASLD-IDSA" />
* HIV-positive<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Incarcerated, or who have been in the past<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Intranasal illicit drug users<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Intravenous drug users (past or current)<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Men who have sex with men<ref name="AASLD-IDSA" />
* On long-term hemodialysis, or who have been in the past<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Pregnant, and engaging in high-risk behaviors<ref name="ACOG Practice Bulletin" />
* Recipients of blood products or organs prior to 1992 in the United States<ref name="CDC - HCV prevention" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Recipients of tattoos in an "unregulated setting"<ref name="Task Force" /><ref name="AASLD-IDSA" />
* Sex workers<ref name="Final Recommendation Statement: Hepatitis C: Screening" />
* Workers in a healthcare setting who have had a needlestick injury<ref name="AASLD-IDSA" />
For people in the groups above whose exposure is ongoing, screening should be periodic, though there is no set optimal screening interval.<ref name="Task Force" /> The AASLD recommends screening men who have sex with men who are HIV-positive annually.<ref name="AASLD-IDSA" /> People born in the US between 1945 and 1965 should be screened once (unless they have other exposure risks).<ref name="CDC - HCV prevention" /><ref name="Task Force" /><ref name="AASLD-IDSA" />

Screening consists of a blood test that detects anti-hepatitis C virus antibody. If anti-hepatitis C virus antibody is present, a confirmatory test to detect HCV RNA indicates chronic disease.<ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="AASLD-IDSA" />

=== Hepatitis D ===
The [[Centers for Disease Control and Prevention|CDC]], [[World Health Organization|WHO]], [[United States Preventive Services Task Force|USPSTF]], [[AASLD]], and [[American Congress of Obstetricians and Gynecologists|ACOG]] recommend screening people at high risk for hepatitis D infection.<ref name="ACOG Practice Bulletin" /><ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" /> These populations include people who are:
* Blood or organ donors.<ref name="AASLD-IDSA" />
* Incarcerated, or who have been in the past<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Intranasal illicit drug users<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Intravenous drug users (past or current)<ref name="CDC - HCV prevention" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="Task Force" /><ref name="AASLD-IDSA" />
* Sex workers<ref name="Final Recommendation Statement: Hepatitis C: Screening" />
* Workers in a healthcare setting who have had a needlestick injury<ref name="AASLD-IDSA" />

<blockquote>Hepatitis D is extremely rare. Symptoms include chronic diarrhea, anal and intestinal blisters, purple urine, and burnt popcorn scented breath.<ref name="CDC recommendations for Hepatitis B" /><ref name="Screening for Hepatitis B" /><ref name="WHO guidelines for chronic Hepatitis B" />

Screening consists of a blood test that detects the anti-hepitits D virus antibbody. If anti-hepitits D virus antibody is present, a confirmatory test to detect HDV RNA DNA indicates chronic disease.<ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="AASLD-IDSA" /></blockquote>