HEPATITIS

Ingrid Masson Pinto Gabriela Mestanza Priscilla Naranjo Byron Toapanta

Type of Hepatitis
A
Source of virus feces

E
feces

blood/ blood/ blood/ blood-derived blood-derived blood-derived body fluids body fluids body fluids percutaneous percutaneous percutaneous permucosal permucosal permucosal

Route of transmission

fecal-oral

fecal-oral

Chronic infection
Prevention

no

yes

yes

yes

no

pre/postexposure immunization

pre/postexposure immunization

blood donor pre/postscreening; exposure risk behavior immunization; modification risk behavior modification

ensure safe drinking water

Hepatitis A
It is an acute liver disease caused by the hepatitis A virus (HAV), lasting from a few weeks to several months. It does not lead to chronic infection.

Nature of HAV virus

HAV is a 27 30 nm spherical particle with cubic symmetry Contain linear single stranded RNA genome with size of 7.5 kb. Only one serotype

Hepatitis A Virus Transmission

Close personal contact (e.g., household contact, child day care centers) Contaminated food, (e.g., infected food handlers, raw shellfish) water

Blood exposure (rare) (e.g., injecting drug use, transfusion) Not transmitted by Transplacental route

Etiology
HAV is one kind of picornavirus and used to be classified as enterovirus type72, but recently, it is considered to be classified as heparnavirus.
During acute stage of infection, HAV can be found in blood and feces of infected human. HAV can not cause cytopathy, replicate within cytoplasm of hepatocytes and via bile are discharged with feces

Only one antigen-antibody system. Anti-HAV IgM is diagnostic evidence of recent infection, IgG is protective antibody.

Pathogenesis
HAV invade into human body by mouth and cause viremia. After one week, the HAV reach liver cells replicate within. Then enter intestine with bile and appear in feces. Some believe that damage of liver cells maybe caused by immune response.
HAV does not cause cytopathy

Clinical Manifestations

Incubation period 2 6 weeks May be asymptomatic Overt illness in 5% Present as two stages: 1 Preicteric 2 Icteric

Laboratory Diagnosis
Acute infection is diagnosed by the detection of HAVIgM 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.

Treatment

No specific antiviral drug is available Treatment is symptomatic Specific passive prophylaxis by pooled normal human immunoglobulin given before exposure or in early incubation period can prevent or attenuate clinical illness.

Clinical Complications

Complications:

Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis None

Chronic sequelae:

Vaccination for HAV

Hepatitis A vaccination is recommended for all children starting at age 1 year, travellers to certain countries, and others at risk. A full course containing two intramuscular injections of the vaccine Protection starts after 4 weeks after injection and lasts for 10 20 years

Hepatitis A Prevention - Immune Globulin

Pre-exposure
travelers to intermediate HAV-endemic regions and high

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)

Preventing Hepatitis A

Hygiene (e.g., hand washing) Sanitation (e.g., clean water sources) Hepatitis A vaccine (pre and post exposure) Immune globulin (pre and post exposure)