HEPATITIS VIRAL A-E

dr. Azzaki Abubakar, SpPD

Subbagian Gastroenterohepatologi
Bagian/SMF Ilmu Penyakit Dalam FK Unsyiah/RSUZA Banda Aceh
Definisi

Radang sistemik difus di hati, pembengkakan

hati, nekroinflamasi, peningkatan enzim
transaminase dengan atau tanpa peningkatan
kadar bilirubin (jaundice) yang disebabkan oleh
virus
 Hepatitis Viral - Historical Perspectives

“Infectious” A E
Penularan
secara
fekal oral
Viral hepatitis NANB

Penularan
“Serum” B D C secara
Parenteral
F, G, TTV
? Lain-lain
 Tipe Hepatitis

A B C D E

Sumber feses darah/ darah/ darah/ feces

virus Darah berasal Darah berasal Darah berasal
Cairan tubuh Cairan tubuh Cairan tubuh

Jalur fekal-oral Perkutan Perkutan Perkutan fekal-oral

Penularan permukosa permukosa permukosa

Infeksi tidak ya ya ya tidak

kronik

Pencegahan immunisasi immunisasi skrining immunisasi Minum air

pra/pasca- pra/pasca- Donor darah paparan yang
paparan modifikasi modifikasi bersih dan
paparan
Hidup berisiko Hidup berisiko aman
Hepatitis A Virus
Hepatitis A Virus

 Naked RNA virus

 Related to enteroviruses, formerly known as enterovirus 72,
now put in its own family: heptovirus
 One stable serotype only
 Difficult to grow in cell culture: primary marmoset cell
culture and also in vivo in chimpanzees and marmosets
 4 genotypes exist, but in practice most of them are group 1
 Hepatitis A – Gambaran Klinis

 Masa inkubasi Rata-rata 30 hari

( Kisaran 15-50 hari)
 Ikterik pada <6 th : <10%
kelompok umur : 6-14 th : 40%-50%
>14 yrs : 70%-80%
 Komplikasi: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
 Sequelae kronis : None
 SELF LIMITING DISEASE
 Penularan Virus Hepatitis A

 Kontak pribadi yang dekat

(spt : anggota keluarga, hubungan kelamin,
pusat perawatan anak)
 Makanan/minuman terkontaminasi
(spt : pejamu makanan yang terinfeksi)
 Paparan terhadap darah (jarang)
(spt : penggunaan obat suntik, transfusi)
 Global Patterns of
Hepatitis A Virus Transmission

Disease Peak Age

Endemicity Rate of Infection Transmission Patterns

High Low to Early Person to person;

High childhood outbreaks uncommon
Moderate High Late Person to person;
childhood/ food and waterborne
young adults outbreaks
Low Low Young adults Person to person;
food and waterborne
outbreaks
Very low Very low Adults Travelers; outbreaks
uncommon
Laboratory Diagnosis

 Acute infection is diagnosed by the detection of HAV-IgM

in serum by EIA.
 Past Infection i.e. immunity is determined by the detection
of HAV-IgG by EIA.
 Cell culture – difficult and take up to 4 weeks, not
routinely performed
 Direct Detection – EM, RT-PCR of faeces. Can
detect illness earlier than serology but rarely
performed.
 Hepatitis A Vaccination Strategies
Epidemiologic Considerations

 Many cases occur in community-wide outbreaks

 no risk factor identified for most cases
 highest attack rates in 5-14 year olds

 children serve as reservoir of infection

 Persons at increased risk of infection

 travelers

 homosexual men
 injecting drug users
Hepatitis A Prevention - Immune Globulin

 Pre-exposure
 travelers to intermediate and high
HAV-endemic regions
 Post-exposure (within 14 days)
Routine
 household and other intimate contacts
Selected situations
 institutions (e.g., day care centers)
 common source exposure (e.g., food prepared by
infected food handler)