Hepatitis

Question 1

How is Hep A transmitted?

Answer 1

Faecal-oral spread
Poor hygiene/overcrowding
Some cases imported
Some clusters - gay men and People Who Inject Drugs

Question 2

When is Hep A most prevelant? Can it be acute or chronic?

Answer 2

Peak incidence of symptomatic disease in older children/young adults
Can be acute - not chronic

Question 3

What investigations can be done for Hep A?

Answer 3

Laboratory confirmation of acute infection

• Clotted blood for serology (gold top vacutainer)
• Hepatitis A IgM

Question 4

What control measures can be taken to prevent Hep A?

Answer 4

Hygiene

Vaccine prophylaxis - gay and IV drug users

Question 5

What are the characteristics of Hep E?

Answer 5

More common in tropics (person to person transmission)
Has become more common than Hep A in UK
Faecal-oral transmission like Hep A in tropics
Cases acquired in UK are thought to be zoonoses (genotype 3)
Tropical genotypes associated with severe disease in pregnant women

Question 6

When does chronic Hep E come about?

Answer 6

immunocomprimised

Question 7

What are the characteristics of Hep D?

Answer 7

Only found with Hepatitis B virus
Exacerbates Hepatitis B virus infection
Parasite of a parasite
Co-infection or superinfection

Question 8

How is Hep B transmitted?

Answer 8

Sex - multiple partners
Mother to child
Blood - iv drugs, tattoos, bad transfusions

Question 9

How is Hep B investigated?

Answer 9

Hepatitis B surface antigen (HBsAg) present in blood of all infectious individuals
- present for more than 6 months in chronic infection
- Hepatitis B e antigen (HBeAg) usually also present in highly infectious individuals
- Hep B virus DNA always also present in high titre (amount) in highly infectious individuals
- Hep B DNA tests also used to predict risk of chronic liver disease and monitor therapy
Hep B IgM most likely to be present in recently infected cases
Anti-HBs present in immunity (i.e. have cleared the antigen)

Question 10

How can Hep B be prevented?

Answer 10

Minimise exposure: safe blood, safe sex, needle exchange, prevention of needlesticks, screening of pregnant women
Two pre-exposure vaccination strategies in use
- vaccination of all children born since 1st August 2017
- vaccination of at risk older children and adults
Post-exposure prophylaxis
- vaccine
- plus HBIG (hyperimmune Hep B immunoglobulin)
Screen pregnant women so that infected women can have their babies vaccinated at birth to prevent mother to child transmission

Question 11

How is Hep C transmitted?

Answer 11

Sex
Blood
Mother to baby

Question 12

What defines a chronic infection

Answer 12

6 months

Question 13

What can Hep B and Hep C infection cause?

Answer 13

cirrhosis - 20 years

hepatocellular carcinoma - 30 years

Question 14

There can be a spontaneous cure in Hep B or Hep C?

Answer 14

Hep B

Question 15

What is the management of acue viral hepatitis?

Answer 15

Symptomatic
No antivirals given
Monitor for encephalopathy
Monitor for resolution of Hep B or Hep C, or Hep E if immunocompromised

Question 16

What are the most used drugs for chronic HBV?

Answer 16

adefovir

entecavir

Question 17

What screening may be done for hepatocellular carcinoma?

Answer 17

serum - alpha fetoprotein (AFP) and ultrasonography

Question 18

What is the treatments for chronic Hep B?

Answer 18

Suppressive antiviral drug - suppression not cure
OR
Peginterferon alone - possible cure

Question 19

What is the treatment for chronic Hep C?

Answer 19

Classes of HCV antiviral called NS3-NS4A, NS5A and NS5B inhibitors
Treatment:
all oral, interferon free courses of 2 or 3 antivirals for up to 12 weeks with high Sustained Virological Responses