Both feces and blood from patients with hepatitis A con-tain virus during the prodromal and early icteric phases of the disease. Raw shellfish concentrate the virus from sewage pollu-tion and may serve as vectors of the disease. General hygienic measures should include handwashing by contacts and careful handling, disposal, and sterilization of excreta and contaminat-ed clothing and utensils. Close contacts of patients with hep-atitis A should receive immune serum globulin (ISG) as soon as possible but no later than 6 weeks after exposure. Travelers to endemic areas where sanitation facilities are poor may be protected by prior administration of ISG or by using hepatitis

1. Note: Generally, a decoction should be taken in two separate doses a day, one ,n the morning and the other in the evening. The whole course of treatment covers 3¡«6 successive days, or depends on the pa-tient's condition. This principle is applicable to all the recipes that are mentioned in this book. A vaccines. The use of such vaccines in other high-risk groups is currently under study.

Hepatitis B is rarely transmitted by body finds other than blood, but nonetheless one should avoid contact with the excreta of patients. Far more important is the meticulous disposal of contami-nated needles and other blood-contaminated utensils.

Efforts at preventing hepatitis B have involved the use of ISG enriched in anti-HBs [ hepatitis B immune globulin (HBIG)]and the recombinant hepatitis B vaccine. Postexpo-sure prophylaxis with HBIG after blood or mucosal exposure(e.g., needlestick, eye splash, sexual contacts of acute hep-atitis B patients, neonates born to mothers with acute or chronic infection) should be given within 7 days and subse-quently with hepatitis B vaccine. Preventive vaccination is cur-rently recommended for high-risk groups and individuals (health care professionals, patients undergoing dialysis, pa-tients with hemophilia, residents and staff of custodial care in-stitutions, sexually active homosexual men) and is advocated universally for children.

No accepted prevention strategies are available for HCV. Because ISG does not contain HCV-neutralizing antibodies, it is of no use for postexposure prophylaxis. However, evidence indicates that early treatment of acute hepatitis C with agents such as interferon-a may significantly reduce the development of chronic infection. The advent of widespread blood product screening for anti-HCV has significantly reduced the incidence of post-transfusion hepatitis.

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