(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.

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[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positive IgM anti-HAV tests among persons who do not have illness meeting the case definition for hepatitis A (CDC, unpublished data, 2001-2005); however, this report is the first to describe the clinical and epidemiologic characteristics of these persons.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.

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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@hepprograms.org.
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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@gmail.com.

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@harmreduction.org.
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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@hotmail.com.
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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.