MCN recommends that all primary care and public health clinics include questions about hepatitis risks, and history of liver disease and immunization as part of standard medical assessment (whether asked in written or oral format). MCN recommends that clinics ask these questions of all new clients and update this information at least annually. Specific risk question content is detailed in MCN’s Position Paper on Hepatitis Screening. Many clients who move for work purposes are young men. Because young low-income men tend to present in clinics only with acute illness or injury, MCN recommends that, if the client’s condition permits, young men in particular be screened for hepatitis risk factors at any visit, even if they are presenting with unrelated illness or injury.
Hepatitis A is transmitted via a fecal-oral route. Though not chronic, hepatitis A can cause serious illness and loss of work time as well as being a more serious health risk to people with chronic liver disease and weakened immune systems. Adults are more likely to show symptoms of illness (jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever) than children.
Mobile working poor persons may be at increased risk for hepatitis A due to lack of access to appropriate water and sanitation facilities while traveling, and substandard housing situations. In addition, hepatitis A is endemic to Mexico, Central and South America, and the Caribbean, and history of exposure is much more common in those countries than in the U.S.
Hepatitis B virus is spread through blood or infected body fluids, via unprotected sex, sharing injection equipment, job-related needlesticks, and vertical transmission from an infected mother. In the U.S., hepatitis B is primarily a sexually transmitted infection. Adults are more likely to show symptoms of illness (jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain) than children, and about 30% of those infected show no symptoms. Infection can be acute or chronic and chronic infection is more likely for persons infected in childhood. Chronic infection can lead to cirrhosis, liver cancer, and liver failure.
Parts of Central America and the Caribbean are considered to have intermediate rates of hepatitis B. This includes countries of common origin for migrant workers in the U.S., including Guatemala, Honduras, El Salvador, Dominican Republic and Haiti. Little data has been gathered on hepatitis B rates in these countries. Countries with endemic hepatitis B have high rates of vertical or perinatal transmission and children infected with hepatitis B have a much higher risk of developing chronic hepatitis B (and subsequent problems including liver cancer).
Vaccinating young adults against hepatitis B and testing persons born in countries that may have high rates of perinatal transmission of hepatitis B is best practice for protecting the health of Latin American immigrant clients. Many clinics and clinicians do not have funding for adult immunizations and serologic testing for hepatitis B. MCN will continue to advocate for funding for these clinical resources.
Hepatitis C virus is spread through blood or infected body fluids, via sharing injection equipment, job-related needlesticks, and vertical transmission from an infected mother. In the US, hepatitis C is primarily transmitted through sharing of injection drug needles and equipment. Hepatitis C is the most common chronic bloodborne infection in the US. Hepatitis C often found to be chronic and can lead to liver failure. There is no vaccine against hepatitis C infection.
CDC recommends hepatitis C testing for persons with a history of injection drug use, recipients of clotting factors made before 1987, hemodialysis patients, recipients of blood or solid organs before 1992, and persons with undiagnosed liver problems (e.g., persistently abnormal ALT levels). These recommendations apply to migrant and immigrant populations in the same way as to all other groups.
Because treatment of hepatitis C is currently very expensive, clinicians serving poor clients often question the benefits of testing (which is also expensive). MCN recommends that all persons for whom standard (CDC) recommendations indicate testing be tested if financially feasible. Diagnosis of hepatitis C, even in the absence of treatment, can be useful in helping clients maintain liver health and quality of life, as well as in counseling to prevent transmission.
In addition, MCN will continue its work to advocate for the availability of hepatitis C treatment for indigent clients, including working with primary care physicians to explore possibilities for hepatitis C treatment management in the primary care setting as this burgeoning epidemic leaves fewer specialist-only treatment options available.