Viral Hepatitis Flashcards by Georgia Leggett

What is Hepatitis A?
Family
Genus
Genome

Family: Picornaviridae
Genus: hepatovirus

Single-stranded, +ve sense RNA

Quasi-enveloped virions

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How is Hepatitis A transmitted? What is the incubation period? What is the treatment?

Faeco-oral
Incubation period of 2-6w
Usually 28-30d

Supportive
No chronicity

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What is the epidemiology of Hepatitis A?

Developing countries with poor socio-economic conditions

300-500 cases annually in the UK

Mostly among age 15-34+ non-travellers

Outbreaks among MSM + IVDU

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What are 6 signs and symptoms of Hepatitis A?

Fever
Malaise
Anorexia
Abdominal pain
Diarrhoea
Signs + Sx of high BR

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List 4 signs and symptoms due to elevated bilirubin in hepatitis

Jaundice
Dark urine
Pale, grey, white stool
Pruritis

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What is the infectious period of Hepatitis A?

2w pre-Sx onset + 1w post-jaundice onset

Isolate for 7d from onset of Sx

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What test can be used to confirm acute cases of Hepatitis A infection?

Stool HVA RNA PCR

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How is Hepatitis A diagnosed?

1st week: Anti-HAV IgM -ve if ALT <500
Acute infection: Anti-HAV IgM +ve
Past infection/ immunisation: Anti-HAV IgG

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What are the public health implications of Hepatitis A?

Notifiable disease- report to UKHSA

Pre-exposure immunisation among population at risk

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Which populations are considered “at risk” for hepatitis A?

Travel to endemic country
Chronic liver disease
Chronic Hep B/C
Haemophilia
IVDU
MSM
Occupational risk

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How does age effect outcome of hepatitis A?

Mortality increases with age
Kids: usually asymptomatic/ mild disease/ jaundice
Elderly: higher change of fulminant hepatitis, necrosis + complications

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What is Hepatitis B?
Family
Genome

Family: Hepadnaviridae

ds-DNA with reverse transcriptase

Enveloped virions

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How is Hepatitis B transmitted? What is the incubation period?

Blood-borne transmission: horizontal + vertical

Incubation period of 40-160 days

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What is the typical presentation of acute Hepatitis B?

Age related presentation + prognosis in acute hepatitis B.

Neonates & children: Mostly asymptomatic or anicteric; 90% HBV-infected neonates develop CHB, + 30% among children age <5y.

Adult: 30-50% icteric hepatitis; 10% become CHB.

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What are risks associated with acute Hepatitis B infection?

0.1-0.05% risk of fulminant hepatitis; related to co-infection with HCV/HDV.

Maternal HBeAg/Ab status + HBV viral load.

HBeAg as the most important risk predictor for vertical transmission.

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What is the definition of chronic Hepatitis B infection?

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Persistence of HBsAg for 6 months or more after acute HBV infection.

What are risks associated with chronic Hepatitis B infection?

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Cirrhosis: 8-20% untreated CHB in 5y;

Hepatocellular carcinoma: The annual risk of 2-5% among CHB cirrhotic patients; affected by host (e.g. alcohol abuse) + viral factors (e.g. high HBV viral load + qHBsAg).

What is the epidemiology of Hepatitis B?

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Approximately 296 million people are living with CHB worldwide; CHB-related mortality at roughly 820,000 people per year.

What are the public health implications of Hepatitis B infection?

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Acute hepatitis B: A notifiable disease

Pre-exposure prophylaxis:

Routine childhood immunisation in the UK since 2017
High risk population

Post-exposure prophylaxis:

Neonate born to mother living with hepatitis B.
Sexual partner: HBV vaccine +/- HBIG (within one week from the contact).
Needle stick injury.

What is Hepatitis D?

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Single-stranded, circular RNA genome.

A defective virus that relies on HBV for propagation.

How is Hepatitis D transmitted?

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Blood-borne transmission

Incubation period: 3-6 weeks

What is the association between Hepatitis B and Hepatitis D?

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HBV/HDV simultaneous co-infection: Similar to classic acute hepatitis B; mostly self-limited. <5% chronic infection.

HDV super-infection in CHB: 80% chronic infection. Increased risk of cirrhosis and HCC than CHB alone.

How is Hepatitis D diagnosed and treated?

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Anti-HDV serology; other HDV investigations rarely used.

PEG-interferon alpha licensed for HDV superinfection in CHB.

Pre-exposure HBV immunisation.

WHat are the public health implications for Hepatitis D infection?

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Notifiable disease

What is Hepatitis C?

The family Flaviviridae, genus Hepacivirus. Single-stranded, positive sense RNA genome.

How is Hepatitis C transmitted?

Blood borne transmission. Incubation period: 2-6 weeks.

What is the epidemiology of Hepatitis C?

58 million people living with chronic hepatitis C worldwide. 1.5 million new cases every year.

What is the presentation of Hepatitis C infection?

Acute infection: * 30% spontaneous clearance * 70% become chronic hepatitis C (CHC) Hepatic versus extra-hepatic manifestation. Cirrhosis (15-30% in 20 years) & HCC as complication of CHC.

How is Hepatitis C treated?

Revolutionised the treatment for acute/chronic HCV infection. Any HCV cases should be considered: * 8 or 12 weeks * Sustained virological response (SVR) at week 12 * Pan-genotypic regimen * Single-tablet regimen * Drug-drug interaction

What are the public health implications of Hepatitis C infection?

Notifiable disease in the UK. Nil vaccine available. Nil post-prophylaxis available. Active HCV screening. Risk reduction (e.g. safe handling and disposal of sharps, protected sex).

What is Hepatitis E?

The family Hepeviridae, genus Orthohepevirus; species A strains (8 genotypoes) infect humans. Single-stranded, positive sense RNA genome. Quasi-enveloped HEV.

How is Hepatitis E transmitted?

Faeco-oral versus blood-borne transmission Incubation period: 15-60 days

What are the natural reservoirs for the different strains of Hepatitis E?

**G1 & G2:** Obligate human pathogens **G3 & G4:** Zoonotic; pigs & wild boar are natural hosts

What is the epidemiology of Hepatitis E?

Approximately 20 million new HEV cases worldwide annually 3.3m symptomatic hepatitis E 44,000 mortality annually UK is a HEV G3 endemic country

What is the clinical manifestation of Hepatitis E?

Mostly self-limited; advised against alcohol during the course Hepatic and systemic symptoms

Which groups are particularly at risk of developing Hepatitis E infection?

**Pregnant women:** G1; fulminant hepatic failure and obstetric complications (e.g. eclampsia and haemorrhage); 25% maternal mortality & high perinatal infant mortality. **Chronic liver disease patients.** **Immunocompromised patients:** May develop chronic hepatitis E (G3 & G4)/

How is Hepatitis E diagnosed?

**Immunocompetent:** HEV serology **Immunocompromised:** HEV PCR

What are the public health implications of Hepatitis E infection?

Notifiable disease HEV patient should avoid prepping food during the first 2 weeks. Immunocompromised and chronic liver disease patients should avoid consumption of undercooked meat (pork, wild boar and venison) and shellfish. **HEV vaccination:** Only licensed in China.

What is the treatment of Hepatitis E?

Only indicated in chronic hepatitis E as most acute HEV infection are self-limited.

Viral Hepatitis Flashcards

(39 cards)