Hepatitis Risk Assessment
Check your risk of hepatitis A
| Yes | No | ||
|---|---|---|---|
| 1. | Do you believe you have been exposed to hepatitis A in the past 2 weeks? | ||
| 2. | Do you live with someone currently ill with hepatitis A? | ||
| 3. | Have you had sex with someone currently ill with hepatitis A? | ||
| 4. | Do you currently live in a region of the United States where hepatitis A rates are very high? | ||
| 5. | Do you travel or work in an area outside of the United States where hepatitis A is a problem? (This includes everywhere EXCEPT Australia, New Zealand, Western Europe, Japan, and Canada) | ||
| 6. | If you are a man, do you have sex with other men? | ||
| 7. | Are you an injecting or a non-injecting (snort cocaine) drug user? | ||
If you check yes to any of the questions you are at risk and should see your doctor.
Check your risk of hepatitis B
| Yes | No | ||
|---|---|---|---|
| 1. | Is someone in your household infected with hepatitis B? | ||
| 2. | Have you ever been diagnosed with a sexually transmitted disease? | ||
| 3. | Have you had sex with more than one partner in a 6-month period? | ||
| 4. | If you are a man, do you have sex with other men? | ||
| 5. | Have you or any of your sex partner(s) ever injected illegal drugs? | ||
| 6. | Have you ever shared equipment (needles, syringes, cotton, water, etc) when injecting drugs with someone else? | ||
| 7. | Have you ever received hemodialysis? | ||
| 8. | Did your mother have hepatitis B when you were born? | ||
| 9. | Have you worked in a health care or other occupation where you had a needlestick injury or other sharps exposures on the job? | ||
| 10. | Have you shared a toothbrush, razor, or any other item that might have blood on it (visible or not) with a person who has hepatitis B? | ||
If you check yes to any of the questions you are at risk and should see your doctor.
Check your risk for hepatitis C
| Yes | No | ||
|---|---|---|---|
| 1. | Did you receive a blood transfusion or solid organ transplant (heart, lung, liver, pancreas, kidney) before July 1992? | ||
| 2. | Did you receive clotting factor concentrates produced before 1987? | ||
| 3. | Have you ever received hemodialysis? | ||
| 4. | Have you had blood tests that showed a liver problem? | ||
| 5. | Have you had a needlestick injury working in a health care setting? | ||
| 6. | Did your mother have hepatitis C when you were born? | ||
| 7. | Have you shared a toothbrush, razor, or any other item that might have blood on it (visible or not) with a person who has hepatitis C? | ||
| 8. | Have you or any of your sex partner(s) injected illegal drugs, even if it was only one time many years ago? | ||
If you check yes to any of the questions you are at risk and should see your doctor.
Adapted from the Immunization Action Coalition (IAC)
