May Is Hepatitis Awareness Month

May is Hepatitis Awareness Month in the United States, and May 19 is Hepatitis Testing Day. According to the CDC, Hepatitis Awareness Month is designed to raise awareness of viral hepatitis and promote testing and vaccination while decreasing the stigma against the virus.¹

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Each week has a theme, with May 6 through 10 being about increasing vaccination, testing, and treatment to key populations to prevent the spread; May 13 through 17 about screening for pregnant individuals; and May 20 through 24 about point-of-care testing for hepatitis C and life-saving treatment.¹

Hepatitis A virus (HAV) is considered infectious hepatitis, whereas hepatitis B virus (HBV) has a longer incubation period. Before the development of vaccines, infections were primarily managed via prevention methods, including washing of hands before and after meals and ensuring food is sterilized. Immune globulin was also used to prevent hepatitis; however, the antibodies would not stay in the body for a long period of time. In 1995, the first vaccines were licensed in the United States.²

After widespread vaccination, the cases of HAV decreased by more than 95% through 2011, according to the article, but re-emerged in 2016 due to increases in rates of homelessness and drug use. The HAV vaccines have been shown to be effective and elicit long-term protection, with 2 currently licensed in the United States.²

As for HBV, vaccination during early life has been given to minimize the active infection rates. When HBV infection is transmitted from mother to infant, treatment with hepatitis B immunoglobulin and HBV vaccine within 24 hours after birth has shown effectiveness. Another treatment for active infection is interferon alfa (IFN-a), which inactivates viral DNA. Further, tenofovir alafenamide (Vemlidy; Gilead Sciences Inc) is another treatment for chronic HBV, with an expanded indication approved in March 2024 to include pediatric patients aged 6 years or older who weigh at least 25 kg and have compensated liver disease. It was previously approved for chronic HBV in adults in 2016, and for pediatric individuals aged 12 and older in 2022.^2,3

Hepatitis C virus (HCV) may go unnoticed until the liver shows signs of damage, which could be when patients first show symptoms. Because of this, screening for HCV is important. Symptoms in the acute phase can include jaundice, fatigue, nausea, and leave, but may not necessarily lead to a chronic phase. The US Preventive Services Task Force recommends that all adults aged 18 to 79 should be screened for HCV, regardless of symptoms. When symptoms are present, liver biopsy, imaging studies, blood tests, and physical exams could also be used for screening. It is curable when treated using antiviral medications. First-line treatments include elbasvir/grazoprevir (Zepatier; Merck), glecaprevir/pibrentasvir (Mavyret; AbbVie), sofosbuvir/ledipasvir (Harvoni; Gilead Sciences), and sofosbuvir/velpatasvir (Epclusa; Gilead Sciences).⁴

References

1. CDC. Hepatitis Awareness Month. April 23, 2024. May 15, 2024. https://www.cdc.gov/hepatitis/awareness/hepatitisawarenessmonth.htm

2. Yousry N. Molecular Biology, Treatment, and Ongoing Global Management of Hepatitis. Pharmacy Times. February 9, 2023. Accessed May 15, 2024. https://www.pharmacytimes.com/view/molecular-biology-treatment-and-ongoing-global-management-of-hepatitis

3. Gallagher A. FDA Approves Expanded Indication for Tenofovir Alafenamide as Hepatitis B Treatment. Pharmacy Times. March 28, 2024. Accessed May 15, 2024. https://www.pharmacytimes.com/view/fda-approves-expanded-indication-for-tenofovir-alafenamide-as-hepatitis-b-treatment

4. Arakelians S. Infectious Disease Focus: Hepatitis C Treatment Options. Pharmacy Times. July 11, 2023. Accessed May 15, 2024. https://www.pharmacytimes.com/view/infectious-disease-focus-hepatitis-c-treatment-options