Editing Hepatitis (section)

== Prevention ==

=== Vaccines ===
==== Hepatitis A ====

{{Main|Hepatitis A vaccine}}
[[File:Havrix-rokote.jpg|thumb|Havrix vaccine]]
The CDC recommends the [[hepatitis A vaccine]] for all children beginning at age one, as well as for those who have not been previously immunized and are at high risk for contracting the disease.<ref name="WHO Hep A Fact Sheet July 2015">{{cite web|title=Hepatitis A Fact sheet N°328|url=https://www.who.int/mediacentre/factsheets/fs328/en/|website=WHO Media Centre|access-date=March 7, 2016|url-status=live|archive-url=https://web.archive.org/web/20140221042107/http://www.who.int/mediacentre/factsheets/fs328/en/|archive-date=February 21, 2014}}</ref><ref name="Voise 2011">{{cite journal|last1=Voise|first1=Nathan|title=Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention. A shot at hepatitis prevention.|journal=J Am Osteopath Assoc|date=Oct 2011|volume=111|issue=10 Suppl 6|pages=S13–6|pmid=22086888}}<!--|access-date=March 7, 2016--></ref>

For children 12 months of age or older, the vaccination is given as a shot into the muscle in two doses 6–18 months apart and should be started before the age 24 months.<ref name="CDC Birth-18Y Immunizations">{{cite web|title=Birth-18 Years and Catchup Immunization Schedules for Providers.|url=https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html|website=www.CDC.gov|access-date=March 7, 2016|url-status=live|archive-url=https://web.archive.org/web/20160306220930/http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html|archive-date=March 6, 2016}}</ref> &nbsp;The dosing is slightly different for adults depending on the type of the vaccine. &nbsp;If the vaccine is for hepatitis A only, two doses are given 6–18 months apart depending on the manufacturer.<ref name="CDC Adult Vaccine"/> &nbsp;If the vaccine is [[Hepatitis A vaccine|combined hepatitis A and hepatitis B]], up to 4 doses may be required.<ref name="CDC Adult Vaccine"/>

==== Hepatitis B ====
{{Main|Hepatitis B vaccine|l1=Hepatitis B vaccine}}
[[File:WHO-UNICEF estimates of hepatitis B vaccine (HepB-BD) coverage in countries from the European WHO region in the years 2000-2015.png|thumb|WHO-UNICEF estimates of hepatitis B vaccine (HepB-BD) coverage in countries from the European WHO region in the years 2000–2015]]
The CDC recommends the routine vaccination of all children under the age of 19 with the [[hepatitis B vaccine]].<ref name="CDC Update 1999">{{cite web|last1=Centers for Disease Control|title=Update: recommendations to prevent hepatitis B virus transmission—United States. MMWR 1999|date=1999|volume=48|pages=33–4|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00056293.htm|access-date=March 7, 2016|url-status=live|archive-url=https://web.archive.org/web/20160514225848/http://www.cdc.gov/mmwr/preview/mmwrhtml/00056293.htm|archive-date=May 14, 2016}}</ref> They also recommend it for those who desire it or are at high risk.<ref name="Voise 2011"/>

Routine vaccination for hepatitis B starts with the first dose administered as &nbsp;a shot into the muscle before the newborn is discharged from the hospital.  An additional two doses should be administered before the child is 18 months.<ref name="CDC Birth-18Y Immunizations"/>

For babies born to a mother with hepatitis B surface antigen positivity, the first dose is unique – in addition to the vaccine, the hepatitis immune globulin should also be administered, both within 12 hours of birth. &nbsp;These newborns should also be regularly tested for infection for at least the first year of life.<ref name="CDC Birth-18Y Immunizations"/>

There is also a combination formulation that includes [[Hepatitis A vaccine|both hepatitis A and B vaccines]].<ref>{{Cite web|url=https://www.mayoclinic.org/drugs-supplements/hepatitis-a-and-hepatitis-b-vaccine-intramuscular-route/description/drg-20061965|title=Hepatitis A And Hepatitis B Vaccine (Intramuscular Route)|website=Mayo Clinic|access-date=25 January 2018}}</ref>

==== Other ====

There are currently no vaccines available in the United States for hepatitis C or E.<ref name="Final Recommendation Statement: Hepatitis C: Screening" /><ref name="WHO - Hepatitis E" /><ref name="WHO Hepatitis D" /> In 2015, a group in China published an article regarding the development of a [[vaccine for hepatitis E]].<ref>{{Cite journal|last=Zhang|date=March 5, 2015|title=Long-Term Efficacy of a Hepatitis E Vaccine|journal=NEJM|doi=10.1056/NEJMoa1406011|pmid=25738667|display-authors=etal|volume=372|issue=10|pages=914–22|doi-access=free}}</ref> As of March 2016, the United States government was in the process of recruiting participants for the [[Phases of clinical research|phase IV trial]] of the hepatitis E vaccine.<ref>{{Cite web|url=https://clinicaltrials.gov/ct2/show/NCT02189603|title=Phase IV Clinical Trial of Recombinant Hepatitis E Vaccine(Hecolin) - Full Text View - ClinicalTrials.gov|website=clinicaltrials.gov|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160309154410/https://clinicaltrials.gov/ct2/show/NCT02189603|archive-date=2016-03-09}}</ref>

=== Behavioral changes ===

==== Hepatitis A ====
Because hepatitis A is transmitted primarily through the [[Fecal-oral route|oral-fecal route]], the mainstay of prevention aside from vaccination is good hygiene, access to clean water and proper handling of sewage.<ref name="Voise 2011" />

==== Hepatitis B and C ====
As hepatitis B and C are transmitted through blood and multiple [[bodily fluids]], prevention is aimed at screening blood prior to [[Blood transfusion|transfusion]], abstaining from the use of injection drugs, safe needle and sharps practices in healthcare settings, and safe sex practices.<ref name="WHO Hepatitis B" /><ref name="Final Recommendation Statement: Hepatitis C: Screening" />

====Hepatitis D====
[[File:Hep D Epidemiology Figure 1.svg|thumb|350x350px|Worldwide prevalence of HDV among HBV carriers in 2015. Eight genotypes have been identified worldwide by comparative phylogenetic analysis. Genotype 1 is the most frequent and has variable pathogenicity, Genotypes 2 and 4 are found in East Asia causing relatively mild disease. Genotype 3 is found in South America in association with severe hepatitis. Genotypes 5, 6, 7, 8 have been found only in Africa.<ref>{{Cite journal|last=Rizzetto|first=Mario | name-list-style = vanc |date=2020|title=Epidemiology of the Hepatitis D virus|url=https://en.wikiversity.org/wiki/WikiJournal_of_Medicine/Epidemiology_of_the_Hepatitis_D_virus|journal=WikiJournal of Medicine|language=en|volume=7|pages=7|doi=10.15347/wjm/2020.001 |doi-access=free}}</ref>]]
The hepatitis D virus requires that a person first be infected with hepatitis B virus, so prevention efforts should focus on limiting the spread of hepatitis B. In people who have chronic hepatitis B infection and are at risk for [[superinfection]] with the hepatitis D virus, the preventive strategies are the same as for hepatitis B.<ref name="WHO Hepatitis D">{{Cite web|url=https://www.who.int/csr/disease/hepatitis/whocdscsrncs20011/en/index5.html|title=WHO {{!}} Hepatitis D|website=www.who.int|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160308152650/http://www.who.int/csr/disease/hepatitis/whocdscsrncs20011/en/index5.html|archive-date=2016-03-08}}</ref>

====Hepatitis E====

Hepatitis E is spread primarily through the oral-fecal route but may also be spread by blood and from mother to fetus.  The mainstay of hepatitis E prevention is similar to that for hepatitis A (namely, good hygiene and clean water practices).<ref name="WHO - Hepatitis E">{{Cite web|url=https://www.who.int/mediacentre/factsheets/fs280/en/|title=Hepatitis E|website=World Health Organization|language=en-GB|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160306175719/http://www.who.int/mediacentre/factsheets/fs280/en/|archive-date=2016-03-06}}</ref>

====Alcoholic and metabolic hepatitis====

As excessive alcohol consumption can lead to hepatitis and cirrhosis, the following are maximal recommendations for alcohol consumption:<ref>{{Cite web|url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking|title=Drinking Levels Defined {{!}} National Institute on Alcohol Abuse and Alcoholism (NIAAA)|website=www.niaaa.nih.gov|date=14 September 2011|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160323085131/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking|archive-date=2016-03-23}}</ref>
* Men – ≤ 4 drinks on any given day and ≤ 14 drinks per week
* Women – ≤ 3 drinks on any given day and ≤ 7 drinks per week
To prevent MAFLD it is recommended to maintain a normal weight, eat a healthy diet, avoid [[added sugar]], and exercise regularly.<ref>{{cite web |title=Preventing fatty liver disease before it's too late |url=https://wexnermedical.osu.edu/blog/fatty-liver-disease |website=wexnermedical.osu.edu |access-date=4 September 2023 |language=en |date=17 June 2020}}</ref><ref>{{cite web |title=Nonalcoholic Fatty Liver Disease (NAFLD) |url=https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/ |website=liverfoundation.org |access-date=4 September 2023 |date=23 May 2022}}</ref>

=== Successes ===

====Hepatitis A====

In the United States, universal immunization has led to a two-thirds decrease in hospital admissions and medical expenses due to hepatitis A.<ref>{{Cite journal|last1=Franco|first1=Elisabetta|last2=Meleleo|first2=Cristina|last3=Serino|first3=Laura|last4=Sorbara|first4=Debora|last5=Zaratti|first5=Laura|date=2012-03-27|title=Hepatitis A: Epidemiology and prevention in developing countries|journal=World Journal of Hepatology|volume=4|issue=3|pages=68–73|doi=10.4254/wjh.v4.i3.68|issn=1948-5182|pmc=3321492|pmid=22489258 |doi-access=free }}</ref>

====Hepatitis B====

In the United States new cases of hepatitis B decreased 75% from 1990 to 2004.<ref>{{Cite web|url=https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html|title=Pinkbook {{!}} Hepatitis B {{!}} Epidemiology of Vaccine Preventable Diseases {{!}} CDC|website=www.cdc.gov|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160307091653/http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html|archive-date=2016-03-07}}</ref> &nbsp;The group that saw the greatest decrease was children and adolescents, likely reflecting the implementation of the 1999 guidelines.<ref name="Carroll chapter 35" />

====Hepatitis C====

Hepatitis C infections each year had been declining since the 1980s, but began to increase again in 2006.<ref>{{Cite web|url=https://www.cdc.gov/hepatitis/statistics/2013surveillance/commentary.htm|title=Commentary {{!}} U.S. 2013 Surveillance Data for Viral Hepatitis {{!}} Statistics & Surveillance &nbsp;{{!}} Division of Viral Hepatitis {{!}} CDC|website=www.cdc.gov|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160305151134/http://www.cdc.gov/hepatitis/statistics/2013surveillance/commentary.htm|archive-date=2016-03-05}}</ref>  The data are unclear as to whether the decline can be attributed to [[needle exchange programme]]s.<ref>Wright NMJ, Millson CE, Tompkins CNE (2005). What is the evidence for the effectiveness of interventions to reduce hepatitis C infection and the associated morbidity? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report; {{cite web |url=http://www.euro.who.int/document/E86159.pdf |title=WHO/Europe &#124; Home |access-date=2016-03-09 |url-status=live |archive-url=https://web.archive.org/web/20100501124733/http://www.euro.who.int/document/e86159.pdf |archive-date=2010-05-01 }}, accessed 9 Mar 2016).</ref>

====Alcoholic hepatitis====

[[File:Depiction of a liver failure patient.png|thumb|Depiction of a liver failure patient]]
Because people with alcoholic hepatitis may have no symptoms, it can be difficult to diagnose and the number of people with the disease is probably higher than many estimates.<ref>{{Cite journal|last1=Basra|first1=Sarpreet|last2=Anand|first2=Bhupinderjit S|date=2011-05-27|title=Definition, epidemiology and magnitude of alcoholic hepatitis|journal=World Journal of Hepatology|volume=3|issue=5|pages=108–113|doi=10.4254/wjh.v3.i5.108|issn=1948-5182|pmc=3124876|pmid=21731902 |doi-access=free }}</ref> Programs such as [[Alcoholics Anonymous]] have been successful in decreasing death due to [[cirrhosis]], but it is difficult to evaluate their success in decreasing the incidence of alcoholic hepatitis.<ref>{{Cite web|url=http://pubs.niaaa.nih.gov/publications/arh27-3/209-219.htm|title=The Epidemiology of Alcoholic Liver Disease|website=pubs.niaaa.nih.gov|access-date=2016-03-09|url-status=live|archive-url=https://web.archive.org/web/20160303180417/http://pubs.niaaa.nih.gov/publications/arh27-3/209-219.htm|archive-date=2016-03-03}}</ref>