Nina Ian John “G” Rachel Mark Jocelle Edo Gienah Jho Kath Aynz Je Glad Nickie Ricobear

Teacher Dadang Niňa Arlene Vivs Paul F. Rico F. Ren Mai Revs Mavis Jepay Yana Mayi Serge Hung Tope Ag Bien

S3 L17: Hepatitis A-E Viruses by Dra. Madrid
TYPES OF HEPATITIS Hepatitis Virus Family Genome Antigens Antibodies Source of Virus Spread Route of Transmission Chronic Infection Prevention A HAV Picornavirus ssRNA HAV-Ag Anti-HAV Feces Fecal-Oral Fecal-Oral No Pre/Post exposure immunization B HBV Hepadnavirus dsDNA HBsAg HBeAg HBcAg Anti-HBs Anti-HBc Anti-HBe Blood / Blood-derived body fluids Parenteral Sexual Perinatal Percutaneous Permucosal Yes Pre/Post exposure immunization HCV Flavivirus ssRNA HCV-Ag Anti-HCV Blood / Blood-derived body fluids Parenteral ?Sexual Percutaneous Permucosal Yes Blood donor screening; Risk behavior modification C HDV Satellite ssRNA HDV-Ag Anti-HDV D

Decemberr1,,2010 Decembe 1 2010

E HEV Calicivirus ssRNA HEV-Ag Anti-HEV Feces Fecal-Oral Fecal-Oral No Ensure safe drinking water

Blood / Blood-derived body fluids Parenteral ?Sexual Percutaneous Permucosal Yes Pre/Post exposure immunization; Risk behavior modification

HEPATITIS A Clinical Features Incubation Period o Average: 30 days o Range: 15-50 days Jaundice by age group o <6yrs (10%) o 6-14 yrs (40-50%) o >14 yrs (70-80%) Complications o Fulminant Hepatitis o Cholestatic Hepatitis o Relapsing Hepatitis Chronic Sequelae: None CONCENTRATION OF HEPATITIS A VIRUS IN VARIOUS BODY FLUIDS

EVENTS IN HEPATITIS A INFECTION (CDC)

As the immune system responds to the infection, the amount of virus in the blood (viremia) and in the stool (HAV in stool) disappears. The liver enzyme, ALT goes up at the beginning of the infection, but decreases to normal at about 8 weeks. IgM shows acute infection and IgG is positive long – term. Virus Transmission Close personal contact o household contact o sex contact o child day care centers Contaminated food and water o infected food handlers o raw shellfish Blood exposure (rare) o injecting drug use o transfusion

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Laboratory Diagnosis Acute infection: dectection of HAV-IgM in serum by EIA Past Infection: immunity is determined by the detection of HAV-IgG by EIA Vaccination Strategies: Epidemiologic Considerations Many cases occur in community-wide outbreaks o No risk factor identified for most cases o Highest attack rates in 5-14 years old o Children serve as reservoir of infection Persons at increased risk of infection o Travelers o Homosexual men o Injecting drug users Hepatitis A Prevention-Immune Globulin Pre-exposure o Travelers to intermediate and high HAV-endemic regions Post-exposure (w/in 14 days) o Routine  Household and other intimate contacts o Selected situations  Institutions: day care centers  Common source exposure: food prepared by infected food handler HEPATITIS B Clinical Features Incubation Period o Average: 60-90 days o Range: 45-180 days Clinical Illness (jaundice): o <5yrs (<10%) o 5 yrs (30-50%) o >5 yrs (70-80%) Acute Case-fatality rate: 0.5-1% Chronic Infection o <5yrs (30-90%) o 5yrs (2-10%) Premature mortality from chronic liver disease: 15-25% PREVALENCE

GLOBAL PATTERNS OF HEPATITIS A VIRUS TRANSMISSION Endemicity Disease Peak Age of Transmnsission Patterns Rate Infection High Low to Early Childhood Person to person; High Outbreaks uncommon Moderate High Late Childhood/ Person to person; Food Young Adults and waterborne outbreaks Low Low Young Adults Person to person; Food and waterborne outbreaks Very Low Very Low Adults Travelers; Outbreaks uncommon

DISEASE PROGRESSION

Global Patterns of Chronic HBV Infection High (>8%): 45% of global population o Lifetime risk of infection >60% o Early childhood infections common Intermediate (2-7%): 43% of global population o Lifetime risk of infection 20-60% o Infections occur in all age groups Low (<2%): 12% of global population o Lifetime risk of infection <20% o Most infections occur in adult risk groups
CONCENTRATION OF HEPATITIS B VIRUS IN VARIOUS BODY FLUIDS High Moderate Low/Not Detectable Blood Semen Urine Serum Vaginal fluid Feces Wound exudates Saliva Sweat Tears Breastmilk

Modes of Transmission Sexual: sex workers and homosexuals are particular at risk Parenteral: IVDA, health workers are at increased risk Perinatal: main means of transmission in high prevalence populations. Mothers who are HBeAg positive are much more likely to transmit to their offspring than those who are not Diagnosis A battery of serological tests are used for the diagnosis of acute and chronic hepatitis B infection HbsAg: used as general marker of infection HbsAb: used to document recovery and/or immunity to HBV infection Anti-HBc IgM: marker of acute infection Anti-HBc IgG: past or chronic infection HbeAg: indicates active replication of virus and therefore infectiveness Anti-Hbe: virus no longer replicating. However, the patient can still be (+) for HBsAg w/c is made by integrated HBV

Spectrum of Chronic Hepatitis B Disease Chronic Persistent Hepatitis: asymptomatic Chronic Active Hepatitis: symptomatic exacerbations of hepatitis Cirrhosis of Liver Hepatocellular carcinoma

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HBV-DNA: indicates active replication of virus, more accurate that HbeAg especially in cases of escape mutants. Used mainly for monitoring response to therapy

Hemodialysis (yrs on treatment) Accidental injuries with needles/sharps Sexual/household exposure to anti-HCV-positive contact Multiple sexual partners Born to HCV- infected mother

Treatment Interferon o for HBeAg +ve carriers wit chronic active hepatitis o response rate is 30-40% Lamivudine o a nucleoside analogue reverse transcriptase inhibitor o Well tolerated,most patiens will respond favorably o Tendency to relapse on cessation of treatment o Rapid emergence of drug resistance *Successful response to treatment will result in the disappearance of HBsAg, HBV-DNA and seroconversion to HbeAg Prevention Vaccination o Highly effective recombinant vaccines are now available o given to those who are at increased risk of HBV infection such as health care workers o given routinely to neonates as universal vaccination in many countries Hepatitis B Immunoglobulin (HBIG) o Protect persons exposed to hepatitis B o efficacious w/in 48 hrs of the incident o given to neonates who are at increased risk for contracting hepatitis B (i.e. whose mother are HBsAg(+) and HBeAg (+)) Other measures o screening of blood donors o blood and body fluid precautions HEPATITIS C Clinical Features Incubation Period o Average: 6-7weeks o Range: 2-26 weeks Clinical Illness (jaundice): 30-40% (20-30%) Chronic Hepatitis: 70% Persistent Infection: 85-100% Immunity: No protective antibody response identified Chronic Hepatitis C Infection The spectrum is essentially the same as chronic hepatitis B infection All the manifestations of chronic hepatitis B infection may be seen, though with a lower frequency i.e. chronic persistent hepatitis, chronic active hepatitis, and hepatocellular carcinoma Risk Factors Associated with Transmission of HCV Transfusion or transplant from infected donor Injecting drug use

DISEASE PROGRESSION

Laboratory Diagnosis HCV antibody o generally used to diagnosis to hepatitis C infection o not useful in acute phase as it takes at least 4 weekson before antibody appears HCV-RNA o techniques include PCR and branched DNA o maybe used to diagnose HCV infection in the acute phase o main use is in monitoring the response to antiviral therapy HCV-antigen o an EIA for HCV antigen is available o used in the same capacity as HCV-RNA tests but is much easier to carry out
Specifications Mode of detection Sensitivity Specificity Detection Post-exposure Use DIAGNOSTIC TESTS Diagnostic Test Type Serologic Virologic Antibodies Virus > 95% > 98% Variable > 98% 2-6 mos 2-6 wks Screening Confirmation

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Treatment Interferon o may be considered for patients with chronic active hepatitis o response rate is 50% but 50% of responders will relapse upon withdrawal of treatment Ribavirin o Less experience with ribavirin than interferon o Recent studies suggest that a combination of interferon and ribavirin is more effective than interferon alone Prevention Screening of blood, organ, tissue donor High-risk behavior modification Blood and body fluid precautions HEPATITIS D (DELTA) VIRUS Clinical Features Coinfection o severe acute disease o low risk of chronic infection Superinfection o usually develop chronic HDV infection o high risk of severe chronic liver disease o may present as an acute hepatitis

o 1-3% overall o 15-25% in pregnant women Illness Severity: increased with age Chronic Sequelae: None Epidemiologic Features Most outbreaks are associated with faecally contaminated drinking water Several other large epidemics have occurred since in the Indian subcontinent and the USSR, China, Africa and Mexico In the US and other nonendemic areas, where outbreaks of hepatitis E have not been documented to occur, a low prevalence of anti-HEV (<2%) has been found in healthy populations. The source of infection for these persons is unknown. Minimal person-to-person transmission Prevention and Control Measures for Travelers to HEV-Endemic Regions Avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler IG prepared from donors in Western countries does not prevent infection Unknown efficacy of IG prepared from donors in endemic areas Vaccine? --------------------------------------END OF TRANS-------------------------------------------FUN CHRISTMAS FACTS The song "White Christmas" holds the credit as the most-selling Christmas single of all time. Santa Claus has nine reindeer counting Rudolph that pull his sleigh. Saturnalia, was the Romans holiday that was celebrated in December. It wasn't until about 200 years after Christ's death that Christians started celebrating his birth. In northern Europe there was a holiday known as Yule. They celebrated this holiday by making great fires. They then would dance around the fires, yelling for the winter to end. Austria was the first country to issue a Christmas postage stamp. Silver and gold are the popular Christmas colors after red and green. Eggnog the popular Christmas food was an American discovery. The Christmas carol "I Saw Momma Kissing Santa Claus" was made famous by Jimmy Boyd when he was just 12 years old. Christmas lights were invented by the American Ralph E. Morris. W. C. T. Dobson invented the Christmas card. Canada is the largest exporter of Christmas trees. King's Canyon National Park, California has the world's largest Christmas tree. Coca-Cola made the concept of Santa Claus popular in America. There are twelve days between Christmas and the Epiphany. And the most important fact: The true reason for this season... the birth of our Savior and King JESUS CHRIST Merry Christmas everyone from Microbioman! Ang trans na ito ay pamaskong handog ng: MICROBIOMAN Ayna. Katuray. Edo. Nickie. Teacher. Niña. Paulfie

Mode of Transmission Percutaneous exposures: injecting drug use Permucosal exposure: sex contact Prevention HBV-HDV Coinfection o pre/postexposure prophylaxis to prevent HBV infection HBV-HDV Superinfection o education to reduce risk behaviors among persons with chronic HBV infection HEPATITIS E Clinical Features Incubation Period

o Average: 40 days o Range: 15-60 days Case-Fatality Rate

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