According to researchers at the Center for Disease Control, Hepatitis A virus (HAV) infection is associated with poor sanitation and hygiene and is transmitted by ingesting contaminated food or water or direct contact with a patient with HAV. The "congregate living conditions" of people experiencing homelessness can increase the risk for disease transmission and result in outbreaks. Recent outbreaks with direct HAV transmission among persons reporting homelessness signal a shift in HAV infection epidemiology in the United States.
The Global Burden of Disease (GBD) study assesses cause-specific mortality in 195 countries. The study showed that in 2016, 1.34 million deaths were related to viral hepatitis, including liver cancer, acute cases, cirrhosis, hepatitis A, E, B, C and D, according to the World Hepatitis Alliance. This exceeded the number of deaths from TB (1.2 million), HIV/AIDS (1 million) and malaria (719,000). Viral hepatitis remains one of the top 10 leading causes of death worldwide.
HIV and Viral Hepatitis fact sheet
HIV Risk Factors Among Clients with Mental Health Disorders
Acquired Immunodeficiency Syndrome (AIDS) in Older Adults
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Is the Availability of Direct-Acting Antivirals Associated with Increased Access to Hepatitis C Treatment for Homeless and Unstably Housed Veterans? McInnes DK, Troszak LK, Fincke BG, Shwartz M, Midboe AM, Gifford AL, Dunlap S, Byrne T. J Gen Intern Med. 2021 Jun 25. doi: 10.1007/s11606-021-06933-z
Homelessness, Unstable Housing, and Risk of HIV and Hepatitis C Virus Acquisition among People Who Inject Drugs: A Systematic Review and Meta-Analysis. Arum C, et al. Lancet Public Health. 2021 Mar 26:S2468-2667(21)00013-X. doi: 10.1016/S2468-2667(21)00013-X
Treating Opioid Use Disorder and Related Infectious Diseases in the Criminal Justice System. Winetsky D, Fox A, Nijhawan A, Rich JD. Infect Dis Clin North Am. 2020 Sep;34(3):585-603. doi: 10.1016/j.idc.2020.06.012.
Prevalence of Hepatitis B Virus Exposure in the Veterans Health Administration and Association With Military-Related Risk Factors. Beste LA, Ioannou GN, Chang MF, Forsberg CW, Korpak AM, Boyko EJ, Sporleder JL, Smith NL, Maynard C, Chartier M, Dominitz JA. Clin Gastroenterol Hepatol. 2020 Apr;18(4):954-962.e6. doi: 10.1016/j.cgh.2019.07.056
Community Screening, Identification, and Referral to Primary Care, for Hepatitis C, B, and HIV Among Homeless Persons in Los Angeles. Fuster D, Gelberg L. J Community Health. 2019 Dec;44(6):1044-1054. doi: 10.1007/s10900-019-00679-w.
Treating Hepatitis C in Homeless Veterans at the Greater Los Angeles Veterans' Affairs Medical Center. Bakr O, Gelberg L, Seragaki S, Youn S, Kawamoto J, Hoppe M, Altman L, Kopelson K, May FP, Cowan B, Bhattacharya D.Bakr O, et al. Hepatology. 2019 Sep;70(3):1071-1073. doi: 10.1002/hep.30643. Epub 2019 May 28.
Life projects: the transformative potential of direct-acting antiviral treatment for hepatitis C among people who inject drugs. E Williams B, Nelons D, Seaman A, Witkowska M, Ronan W, Wheelock H, Zaman A, Garcia J.
Int J Drug Policy. 2019 Oct;72:138-145. doi: 10.1016/j.drugpo.2019.03.015. Epub 2019 Apr 15.
Evaluation of a Multifaceted Intervention to Reduce Health Disparities in Hepatitis C Screening: A Pre-Post Analysis. Jain MK, Rich NE, Ahn C, Turner BJ, Sanders JM, Adamson B, Quirk L, Perryman P, Santini NO, Singal AG.
Hepatology. 2019 Jul;70(1):40-50. doi: 10.1002/hep.30638. Epub 2019 May 31.
Hepatitis C treatment outcomes among homeless-experienced individuals at a community health center in Boston. Beiser ME, Smith K, Ingemi M, Mulligan E, Baggett TP. Int J Drug Policy. 2019 Oct;72:129-137. doi: 10.1016/j.drugpo.2019.03.017. Epub 2019 Apr 6.
Homelessness and Hepatitis A - San Diego County, 2016-2018. Peak CM, Stous SS, Healy JM, Hofmeister MG, Lin Y, Ramachandran S, Foster M, Kao A, McDonald EC.
Clin Infect Dis. 2019 Aug 15. pii: ciz788. doi: 10.1093/cid/ciz788. [Epub ahead of print]
Notes from the Field: Hepatitis A Outbreak Associated with Drug Use and Homelessness - West Virginia, 2018. Wilson E, Hofmeister MG, McBee S, Briscoe J, Thomasson E, Olaisen RH, Augustine R, Duncan E, Bamrah Morris S, Haddy L.
MMWR Morb Mortal Wkly Rep. 2019 Apr 12;68(14):330-331. doi: 10.15585/mmwr.mm6814a4. No abstract available.
A Novel Measure to Assess Variation in Hepatitis C Prevalence Among Homeless and Unstably Housed Veterans, 2011-2016. Byrne T, Troszak L, Midboe AM, Fincke BG, Shwartz M, Gifford AL, McInnes DK. Public Health Rep. 2019 Mar/Apr;134(2):126-131. doi: 10.1177/0033354918821071. Epub 2019 Jan 30.
Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. MMWR Morb Mortal Wkly Rep. 2019 Feb 15;68(6):153-156. doi: 10.15585/mmwr.mm6806a6.
Effect of a Computerized Alert on Emergency Department Hepatitis A Vaccination in Homeless Patients During a Large Regional Outbreak. Castillo EM, Chan TC, Tolia VM, Trumm NA, Powell RA, Brennan JJ, Kreshak AA. J Emerg Med. 2018 Dec;55(6):764-768. doi: 10.1016/j.jemermed.2018.09.004. Epub 2018 Oct 10.
Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness - California, Kentucky, Michigan, and Utah, 2017. Foster M, Ramachandran S, Myatt K, Donovan D, Bohm S, Fiedler J, Barbeau B, Collins J, Thoroughman D, McDonald E, Ballard J, Eason J, Jorgensen C. MMWR Morb Mortal Wkly Rep. 2018 Nov 2;67(43):1208-1210. doi: 10.15585/mmwr.mm6743a3.
Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Friedman EE, Dean HD, Duffus WA.
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CDC website on Viral Hepatitis: CDC is the nation's health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic. CDC increases the health security of our nation.
Guidelines and Recommendations
Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices MMWR 2018; 67 (RR 1);1–31
This report updates and summarizes previously published recommendations from the Advisory Committee on Immunization Practices (ACIP) and CDC regarding the prevention of HBV infection in the United States.
Sexually Transmitted Diseases Treatment Guidelines 2015 MMWR 2015;64(No.3)
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013.
Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection MMWR 2008;57(RR-8)
Identification of infected persons allows for primary prevention of ongoing HBV transmission by enabling persons with chronic infection to adopt behaviors that reduce the risk of transmission to others and by permitting identification of close contacts who require testing and subsequent vaccination (if identified as susceptible) or medical management (if identified as having chronic HBV infection). Appropriate HBsAg testing and counseling also help prevent health-care — associated transmission in dialysis settings by allowing for cohorting of infected patients.
Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease MMWR 1998;47(RR-19)
This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, delivery, and evaluation of prevention and clinical services.
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