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U.S. Department of Health and Human Services
Opioid Stewardship in the Indian Health Service

Hepatitis

Hepatitis A virus (HAV) infection

Hepatitis A vaccination is recommended for people who inject drugs illicitly and use drugs illicitly through noninjection routes. Prevaccination testing is not indicated for the vaccination of adolescents who use drugs illicitly but might be warranted depending on the type and duration of illicit drug use. Providers should obtain a thorough history to identify patients who use drugs illicitly or are at risk for using them and who might benefit from hepatitis A vaccination. Implementation strategies to overcome barriers and increase coverage, including use of standing orders (i.e., a note in the medical record) should be considered.

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Hepatitis B virus (HBV) infection

All people seeking protection from HBV infection are recommended to receive hepatitis B vaccination. Hepatitis B vaccination is recommended for all adults in certain settings, including STD clinics, HIV testing and treatment facilities, facilities providing substance abuse treatment and prevention services, health-care settings providing services to people who inject drugs illicitly, and correctional facilities. Standing orders can be used to administer hepatitis B vaccine as part of routine services to all adults who have not completed a hepatitis B vaccination regimen (e.g., in settings in which high proportions of persons have risk factors for HBV infection).

People who inject drugs illicitly, including participants in substance abuse treatment programs, should be offered screening and counseling for chronic HBV infection. Testing should include a serologic assay for hepatitis B surface antigen (HBsAg) offered as a part of routine care, and if the result is positive, be accompanied by appropriate counseling and referral for recommended clinical evaluation and care. Previous and current sex partners and household and needle-sharing contacts of HBsAg-positive persons should be identified. Unvaccinated sex partners and household and needle-sharing contacts should be tested for HBsAg and for antibody to the hepatitis B core antigen (anti-HBc) or antibody to the hepatitis B surface antigen (anti-HBsAg). All susceptible people should receive the first dose of hepatitis B vaccine as soon as the blood sample for serologic testing has been collected, unless an established patient-provider relationship can ensure that the patient will return for serologic test results and that vaccination can be initiated at that time if the patient is susceptible. Susceptible persons (i.e., those who have tested negative for HBsAg and anti-HBc) should complete the vaccine series by use of an age-appropriate vaccine dose and schedule. Those who have not been vaccinated fully should complete the vaccine series. Contacts determined to be HBsAg-positive should be referred for medical care.

Medical providers should advise patients identified as HBsAg-positive about measures they can take to prevent transmission to others and protect their health. Providers also should refer patients for counseling if needed.

Susceptible persons should complete a 3-dose hepatitis B vaccine series to prevent infection from ongoing exposure.

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Hepatitis C virus (HCV) infection

All who use or inject drugs illicitly should routinely be offered screening and counseling for HCV infection. Those with a history of risk, even those who have injected illicitly once or many years ago, should be offered screening and counseling for HCV infection. Facilities that provide counseling and testing should include services or referrals for medical evaluation and management of those identified as infected with HCV.

For more information from IHS, visit our Hepatitis C page.

Rates of reported acute hepatitis C, by race/ethnicity — United States, 2002–2017

fixed image CDC Graph Exit Disclaimer: You Are Leaving www.ihs.gov . Rates of reported acute hepatitis C by race/ethnicity, 2002-2017. Rates for all (American Indian/Alaska Native, Asian/Pacific Islander, Black, non-Hispanic, White, non-Hispanic, and Hispanic) were less than 1 per 100,000 during the first year for all groups; Only two groups surpassed that number: White non-Hispanics rose gradually to more than 1 per 100,000 in 2017; American Indian/Alaska Native rates remained higher than all others for all years, with more than 2 cases per 100,000 in 2012, and more than 3 per 100,000 in 2017.

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