HEP EXPRESS
Viral hepatitis news from the Immunization Action Coalition
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Issue Number 30 May 20, 2005

CONTENTS OF THIS ISSUE

1. CDC report recommends health professionals limit use of IgM
anti-HAV testing to specific indications
2. Observe Hepatitis Awareness Month: visit IAC's redesigned
hepatitis prevention programs website
3. Observe Hepatitis Awareness Month: read the Migrant
Clinicians Network's position paper on hepatitis
4. Observe Hepatitis Awareness Month: donate $10 to vaccinate
a child in China against hepatitis B
5. Observe Hepatitis Awareness Month: submit an abstract to
the National Viral Hepatitis Prevention Conference
6. Conference sponsored by the Hepatitis C Harm Reduction
Project to be held in Brooklyn, May 26-27
7. WHO releases a guide for estimating the number of sharps-
related HBV, HCV, and HIV infections in healthcare workers
8. Answer to Cancer races to be run in August and September
9. IAC adds Asian Liver Center video about hepatitis B to its
website
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ABBREVIATIONS: ACIP, Advisory Committee on Immunization
Practices; CDC, Centers for Disease Control and Prevention; DVH,
Division of Viral Hepatitis; HAV, hepatitis A virus; HBV,
hepatitis B virus; HCV, hepatitis C virus; IAC, Immunization
Action Coalition; IDU, injection drug user; MMWR, Morbidity and
Mortality Weekly Report; MSM, men who have sex with men; STD,
sexually transmitted disease; VIS, Vaccine Information
Statement; WHO, World Health Organization.
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(1 of 9)
May 20, 2005
CDC REPORT RECOMMENDS HEALTH PROFESSIONALS LIMIT USE OF IgM
ANTI-HAV TESTING TO SPECIFIC INDICATIONS

[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 05/16/05.]

CDC published "Positive Test Results for Acute Hepatitis A Virus
Infection Among Persons With No Recent History of Acute
Hepatitis--United States, 2002-2004" in the May 13 issue of
MMWR. Portions of the article are reprinted below.

***********************

[From the article text]
Hepatitis A is a nationally reportable condition, and the
surveillance case definition includes both clinical criteria and
serologic confirmation. State health departments and CDC have
investigated persons with positive serologic tests for acute
hepatitis A virus (HAV) infection (i.e., IgM anti-HAV) whose
illness was not consistent with the clinical criteria of the
hepatitis A case definition. Test results indicating acute HAV
infection among persons who do not have clinical or
epidemiologic features consistent with hepatitis A are a concern
for state and local health departments because of the need to
assess whether contacts need postexposure immunoprophylaxis.
This report summarizes results of three such investigations,
which suggested that most of the positive tests did not
represent recent acute HAV infections. To improve the predictive
value of a positive IgM anti-HAV test, clinicians should limit
laboratory testing for acute HAV infection to persons with
clinical findings typical of hepatitis A or to persons who have
been exposed to settings where HAV transmission is suspected. .
.

[From the Editorial Note]
Health departments have previously noted positive IgM anti-HAV
tests among persons who do not have illness meeting the case
definition for hepatitis A (CDC, unpublished data, 2001-2005);
however, this report is the first to describe the clinical and
epidemiologic characteristics of these persons. Findings in this
report indicate that persons who are unlikely to have acute
viral hepatitis should not be tested for IgM anti-HAV and that
the use of IgM anti-HAV as a screening tool or as part of
testing panels used in the workup of nonacute liver function
abnormalities should be discouraged. Health departments should
continue to apply clinical criteria in the case definition when
conducting hepatitis A surveillance and determining whether
postexposure immunoprophylaxis is needed for contacts.
Postexposure immunoprophylaxis for contacts is unlikely to be
indicated for persons whose illness does not meet the case
definition, unless recent exposure to a person with acute HAV
infection has occurred.

A positive IgM anti-HAV test result in a person without typical
symptoms of hepatitis A might indicate asymptomatic acute HAV
infection, previous HAV infection with prolonged presence of IgM
anti-HAV, or a false-positive test result. HAV infection can
manifest a broad clinical spectrum, ranging from asymptomatic
infection to typical hepatitis with fever and jaundice. Although
an estimated 70% of children aged <6 years with HAV infection
are asymptomatic, older children and adults usually have
symptoms, and 70% are jaundiced. Studies conducted during
hepatitis A outbreaks or among family members exposed to HAV
indicate that HAV infection can cause asymptomatic infection
with or without abnormal liver tests, primarily among young
children. . . .

Testing of persons with no clinical symptoms of acute viral
hepatitis, and among populations with a low prevalence of acute
HAV infection, lowers the predictive value of the IgM anti-HAV
test. Diagnostic tests for viral hepatitis, including licensed
IgM anti-HAV tests, are highly sensitive and specific when used
on specimens from persons with acute hepatitis. However, their
use among persons without symptoms of hepatitis A can lead to
IgM anti-HAV test results that are false positive for acute HAV
infection or of no clinical importance. This might be occurring
with use of laboratory test panels that include routine testing
for IgM anti-HAV without requiring a specific order for the test
(i.e., "reflex testing") among persons who are not being
evaluated for possible acute hepatitis (e.g., persons with liver
function test abnormalities or persons being screened for
hepatitis C). . . .

Providing immune globulin is not recommended for contacts of IgM
anti-HAV positive persons when the date that these persons might
have been infectious is unknown (because no defined symptom
onset is known), even for those patients who repeatedly test IgM
anti-HAV positive. Clinicians and public health officials who
receive reports of persons who are IgM anti-HAV positive in the
absence of symptoms of viral hepatitis or history of recent
contact with a hepatitis A patient should consider seeking
additional information when making decisions about the need for
postexposure immunoprophylaxis among contacts. Acute HAV
infection is unlikely in persons who have received 1 or more
doses of hepatitis A vaccine >=1 month before symptom onset.
Testing the patient for total anti-HAV and retesting for IgM
anti-HAV might be helpful. Persons with acute HAV infection will
test total anti-HAV positive; if the total anti-HAV test is
negative, acute HAV infection is unlikely. Retesting the same or
another serum specimen, preferably by using a different test
format, might indicate that the person is IgM anti-HAV negative.

Published guidelines for the workup of abnormal liver enzyme
tests among asymptomatic patients do not include IgM anti-HAV
testing. Healthcare providers should limit use of IgM anti-HAV
testing to persons with evidence of clinical hepatitis or to
those who have had recent exposure to an HAV-infected person.
Persons who are IgM anti-HAV positive but who do not have
illness consistent with the case definition for hepatitis A
should not be reported to CDC.

***********************

To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5418a1.htm.

To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5418.pdf.

To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html.
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(2 of 9)
May 20, 2005
OBSERVE HEPATITIS AWARENESS MONTH: VISIT IAC'S REDESIGNED
HEPATITIS PREVENTION PROGRAMS WEBSITE

On May 14, IAC released a redesigned version of its hepatitis
prevention programs website. The website was originally launched
in March 2001, as part of a cooperative agreement with CDC's
Division of Viral Hepatitis.

Originally, the site only showcased innovative programs across
the nation that worked to prevent hepatitis A, B, and/or C in
adults and adolescents at risk of infection. As such, the
content was targeted toward public health and social service
managers who might be able to use the information to improve
their own programs.

As time went by, it became clear that more and more of the
website's visitors were members of the public. Many of these
individuals probably found the website via an Internet search
engine while looking for hepatitis information. To meet their
needs, IAC added support group information and links to other
web pages that provide information on such topics of interest as
tattooing and travel vaccines.

The current redesign continues to broaden the information base
of the website, adding pages of hepatitis A and hepatitis B
FAQs, cases histories, photos, and video clips. We hope that
this expanded coverage will be helpful to the approximately 600
visitors who access this website every day.

Please visit the redesigned website at
http://www.hepprograms.org.

As always, we need your input! If you have a model program to
share, go to: http://www.hepprograms.org/tellus.htm.
If you know of additional HBV or HCV support groups, have viral
hepatitis resources to share (including brochures, manuals,
slide sets, photos, or videos), write admin@....
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(3 of 9)
May 20, 2005
OBSERVE HEPATITIS AWARENESS MONTH: READ THE MIGRANT CLINICIANS
NETWORK'S POSITION PAPER ON HEPATITIS

The Migrant Clinicians Network (MCN) is the nation's oldest and
one of the largest clinical networks dedicated to the mobile
underserved. To address the problem of viral hepatitis
infection, MCN launched HepTalk, a project funded by CDC's
Division of Viral Hepatitis. HepTalk's goal is to help health
centers and local health departments improve their prevention
communication with migrant and immigrant patients.

As part of this project, MCN has released a position paper
clarifying standard hepatitis screening and vaccination
recommendations for these populations. "Hepatitis Screening,
Immunization, and Testing for Mobile Populations and Immigrants
from Mexico, Central and South America, and the Caribbean"
can be accessed at
http://www.migrantclinician.org/_resources/Hep_MCN_Position_Paper.pdf.

To learn more about MCN and their resources, visit
http://www.migrantclinician.org.
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(4 of 9)
May 20, 2005
OBSERVE HEPATITIS AWARENESS MONTH: DONATE $10 TO VACCINATE A
CHILD IN CHINA AGAINST HEPATITIS B

The Asian Liver Center at Stanford University (ALC) is selling a
silicone jade-colored bracelet to benefit children in China,
where HBV infection is a major problem. The bracelets are
thicker than the typical wrist band offered as a fund raiser,
and shaped like a real jade bracelet. The text reads
"LIVERight."

A $10 donation per bracelet will provide a complete three-shot
hepatitis B vaccination series, using disposable needles and
syringes, as well as a course of education materials, to one
child in China. Any person who wants to receive a postcard from
a child benefiting from their donation, can send their name and
mailing address to i.liveright@....

To order, send $10 for each bracelet to

Asian Liver Center at Stanford University
ATTN: LIVERight Bracelets
300 Pasteur Drive, H3680
Stanford, CA 94305

Checks should be made to Asian Liver Center.

Editor's note: To access a photograph of the LIVERight bracelet,
go to: http://www.hepprograms.org/hepexpress/liveright.jpg.

For more information about the Asian Liver Center, go to
http://liver.stanford.edu.
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(5 of 9)
May 20, 2005
OBSERVE HEPATITIS AWARENESS MONTH: SUBMIT AN ABSTRACT TO THE
NATIONAL VIRAL HEPATITIS PREVENTION CONFERENCE

Time is running out! Abstracts for the National Viral Hepatitis
Prevention Conference are due Friday, May 27, 2005, midnight
Pacific Time. The conference will be held December 5-9, 2005, in
Washington, D.C.

For more information, visit the conference website at
http://www.nvhpc.com.
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(6 of 9)
May 20, 2005
CONFERENCE SPONSORED BY THE HEPATITIS C HARM REDUCTION PROJECT
TO BE HELD IN BROOKLYN, MAY 26-27

The Hepatitis C Harm Reduction Project is sponsoring a
conference on May 26-27, in Brooklyn, New York. Titled "Drug
Using Communities & Hepatitis C: Practice, Research & Policy,"
the conference will cover many topics including the promises and
pitfalls of peer education, HCV treatment with drug users,
prison advocacy, working with elected officials, and more.

For more information call (212) 213-6376, extension 46; or email
Ramirez@....
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(7 of 9)
May 20, 2005
WHO RELEASES A GUIDE FOR ESTIMATING THE NUMBER OF SHARPS-RELATED
HBV, HCV, AND HIV INFECTIONS IN HEALTHCARE WORKERS

WHO has released a guide for assisting countries or settings to
estimate the number of HBV, HCV, and HIV infections in
healthcare workers that may have been caused by contaminated
sharps injuries.

A global assessment estimated that in the year 2000, there were
16,000 HCV infections, 66,000 HBV infections, and about 1,000
HIV infections caused by healthcare worker exposure to
contaminated sharps.

The guide is available as Volume #3 on the following WHO web
page: http://www.who.int/quantifying_ehimpacts/national/en.
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(8 of 9)
May 20, 2005
ANSWER TO CANCER RACES TO BE RUN IN AUGUST AND SEPTEMBER

The third annual Answer to Cancer walk/race will be held on
August 6, 2005, in Oregon, and on September 18, 2005, in New
Jersey. The Answer to Cancer race was founded by Adrian Elkins,
a 20-year-old student who was diagnosed with liver cancer in
October 2002. Adrian died only eight days after the first Answer
to Cancer race, which raised $24,000 for liver cancer research
and education.

To read more about the Answer to Cancer Foundation, including
how to support this year's race effort, go to:
http://www.answertocancer.org.

For more information about the races, email
answertocancer@....
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(9 of 9)
May 20, 2005
IAC ADDS ASIAN LIVER CENTER VIDEO ABOUT HEPATITIS B TO ITS
WEBSITE

The Asian Liver Center at Stanford University (ALC) sponsors
numerous projects, including a Jade Ribbon Youth Council,
composed of twelve high school students chosen to serve the
Asian American community. As part of its outreach, the Council
produced a public service announcement about HBV infection and
liver cancer in Asian communities. The spot addresses the high
incidence of hepatitis B and liver cancer in Asians and Asian
Americans, and includes Chinese subtitles.

ALC was kind enough to grant IAC permission to add this video to
its public website at
http:///vaccineinformation.org/video/hepb.asp.

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We hope you will forward this e-newsletter to others.

Managing editor: Teresa A. Anderson, DDS, MPH
Copy editor: Dale Thompson
Editorial assistant: Janelle Tangonan Anderson
ISSN: 1547-6375

To subscribe or change your HEP EXPRESS email address, or to view
past issues, please visit http://www.hepprograms.org/hepexpress

This publication is supported by Grant No. U50/CCU523259 from
the Division of Viral Hepatitis at the Centers for Disease Control
and Prevention. Its contents are solely the responsibility of IAC
and do not necessarily represent the official views of CDC.
Circulation: 2,326

DISCLAIMER: http://www.immunize.org/admin/discl-ex.htm

PLEASE CONTACT US AT:
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Email: hepxadmin@...
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