B3: Hepatitis

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Hepatitis

Finish Hepatitis B & C!

D

Education for those w/ chronic HBV

HBV-HDV Superinfection

Pre/Post-exposure prophylaxis

HBV-HDV Coinfection

HBV vaccine

Permucosal

Sexual contact

Percutaneous

IV drug users

Nothing about lab tests, but here's what was in the diagram:

Superinfection

Infected one after another

High risk severe CLD

CLD = Chronic liver disease

Usu. develop chronic HDV infection

Coinfection

Infected at same time

Low risk of chronic

Severe acute

Worsens HBV symptoms

Leads to..

Cirrhosis

Antigens

delta Ag

Replication

Forms ribozyme intermediate

Requires HBV

Defective

Deltavirus

Circular (-)ssRNA

Unassigned

E

Ig Preps ineffective

Avoid uncooked

veggies

fruits

shellfish

Avoid questionable water sources

Low in U.S.: Usually includes history of travel to HEV-endemic areas

Mexico

India

Africa

2-8 weeks

Short similar to HAV

P2P minimal

Exposure to fecally contaminated water

IgG anti-HEV

IgM anti-HEV

High mortality pregnant women

15-25% for pregnant women

1-3% overall

similar to HAV

Enteric

C

Ribavirin + interferon alpha for 24 weeks

Low risk of death

Pareneteral

20% cirrhosis

80% chronic

Aplasic anemia

Porphyria cutanea tarda

Cryoglobulinemia

Mild

Characteristics

Patchy lobar steatosis

Cholestasis

Total or partial suppression of the flow of bile.

Kupffer cell hyperplasia

Hepadna

B

No specifics

Place

US

1.2 mil

75-90%

Mid East

Pacific Islands

Asia

Time

6 wk - 6 mo

Person

Vertical transmission

What percentage of infants born to infected mothers will be infected?

80%

Mortality Rate

0.8% in acute illness

Carriers

How many?

300 million

Refer to lecture notes and syllabus and study the "window"

HBV viral DNA

Chronic disease activity

HBeAg

Highly infectious

HBV e antigen (DNA polymerase): indicates that infection is active (virus is replicating)

Anti-HBc IgM

Recent Infection

Think Immunology (IgM)

Anti-HBc

Anti-HBs

Immunity

HBsAg

Carrier

Infected

Hepatocellular carcinoma

Chronic hepatitis

> 5 y.o.

5%

< 5 y.o.

Rate?

60%

Picorna

A

Treatment

Prevention

Vaccine

Recommendations

Who should get the vaccine?

Travelers to high HAV countries

Children in high HAV areas

w/ Chronic liver disease

Drug users

Homosexual / Bisexual men

Lifelong immunity

No carrier state

Mortality rate

0.1%

Very low

Short

2-3 wks

Fecal-oral

Diagnosis

Anti-HAV IgM

Recently vaccinated

Anti-HAV (total)

Vaccinated

Exposed

Clinical

No chronic cases

F

Misnomer

See HBV

Flavi

G

Epidemiology

Prevalence

25% for high risk groups

3-10%

Incubation period

Long

1-4 mo.

Transmission

Parenteral

esp. Tattoos