Hepatitis Viruses

Sarkhell Araz
PhD. Public health/Epidemiology
 What is
• Hepatitis hepatitis?
refers to an inflammatory condition of the liver.
It’s commonly caused by a viral infection, but there are
other possible causes of hepatitis.

• These include autoimmune hepatitis and hepatitis that

occurs as a secondary result of medications, drugs, toxins,
and alcohol.

• Autoimmune hepatitis is a disease that occurs when your

body makes antibodies against your liver tissue.

• The World Health Organization (WHO) estimates that

354 millionTrusted Source people currently live with chronic hepatitis B and
C globally.
•
What type of virus is hepatitis?
• The most common causes of viral hepatitis are the five unrelated
hepatotropic viruses hepatitis A, B, C, D, and E.

• Other viruses can also cause liver inflammation, including

cytomegalovirus, Epstein-Barr virus (EBV), and yellow fever.
 Signs and symptoms of hepatitis:
• Signs and symptoms of hepatitis range from mild to severe. They usually appear
about one to four months after you've been infected, although you could see them as
early as two weeks post-infection. Some people, usually young children, may not have
any symptoms.

• Hepatitis signs and symptoms may include:

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)
How Do You Get Hepatitis ?
 How Do You Get Hepatitis ?
• The most common ways to get hepatitis include:

• Sex. You can get it if you have unprotected sex with someone who has it and
your partner’s blood, saliva, semen, or vaginal secretions enter your body.

• Sharing needles. The virus spreads easily via needles and syringes
contaminated with infected blood.

• Accidental needle sticks. Health care workers and anyone else who comes in
contact with human blood can get it this way.

• Mother to child. Pregnant women with hepatitis B can pass it to their babies
during childbirth. But there’s a vaccine to prevent newborns from becoming
infected.
 Type of Hepatitis

A B C D E

Source of feces blood/ blood/ blood/ feces

virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids

Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral

transmission permucosal permucosal permucosal

Chronic no yes yes yes no

infection

Prevention pre/post- pre/post- blood donor pre/post- ensure safe

exposure exposure screening; exposure drinking
immunization immunization risk behavior immunization; water
modification risk behavior
modification
 Complications of hepatitis
• Chronic hepatitis B or C can often lead to more serious health problems.
Because the virus affects the liver, people with chronic hepatitis B or C are
at risk for.

• If you have infectious forms of hepatitis that are chronic, like hepatitis B
and C, you may not have symptoms in the beginning. Symptoms may not
occur until the damage affects liver function:

• chronic liver disease

• cirrhosis
• liver cancer
 Diagnosing
• History and physical exam
• To diagnose hepatitis, first your doctor will take
your history to determine any risk factors you may
have for infectious or noninfectious hepatitis.

• During a physical examination, your doctor may

press down gently on your abdomen to see if
there’s pain or tenderness.
• Liver function tests
Liver function tests use blood samples to determine how
efficiently your liver works.
• Ultrasound
An abdominal ultrasound uses ultrasound waves to create an image of
the organs within your abdomen. This test allows your doctor to take
a close at your liver and nearby organs. It can reveal:

• fluid in your abdomen

• liver damage or enlargement
• liver tumors
• abnormalities of your gallbladder
• Liver biopsy
A liver biopsy is an invasive procedure that involves your
doctor taking a sample of tissue from your liver. It can be
done through your skin with a needle and doesn’t require
surgery. Typically, an ultrasound is used to guide your
doctor when taking the biopsy sample.
Hepatitis A Virus
 Hepatitis A Virus Transmission
• Close personal contact
(e.g., household contact, sex contact, child day care centers)
• Contaminated food, water
(e.g., infected food handlers, raw shellfish)
• Blood exposure (rare)
(e.g., injecting drug use, transfusion)
 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(ELISA).

• (The HAV IgM antibody test detects the first antibody produced by
the body when it is exposed to hepatitis A. This test is used to
detect early or recent infections and to diagnose the disease in
people with symptoms of acute hepatitis. )

• Past Infection i.e. immunity is determined by the detection of HAV-

IgG by EIA.
 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)
Hepatitis B Virus
Global Patterns of Chronic HBV Infection
• High (>8%): 45% of global population
• lifetime risk of infection >60%
• early childhood infections common
• Intermediate (2%-7%): 43% of global population
• lifetime risk of infection 20%-60%
• infections occur in all age groups
• Low (<2%): 12% of global population
• lifetime risk of infection <20%
• most infections occur in adult risk groups
 Concentration of Hepatitis B
Virus in Various Body Fluids
Low/Not
High Moderate Detectable

blood semen urine

serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
 Hepatitis B Virus
Modes of Transmission

 Sexual - sex workers and homosexuals are

particular at risk.
 Parenteral - IVDA, Health Workers are at
increased risk.
 Perinatal - Mothers who are HBeAg positive are
much more likely to transmit to their offspring
than those who are not. Perinatal transmission is
the main means of transmission in high
prevalence populations.
 Control and Prevention hepatitis B
• Vaccination - highly effective recombinant vaccines are now
available. Vaccine can be given to those who are at increased risk
of HBV infection such as health care workers. It is also given
routinely to neonates as universal vaccination in many countries.

• Hepatitis B Immunoglobulin - HBIG may be used to protect

persons who are exposed to hepatitis B. It is particular efficacious
within 48 hours of the incident. It may also be given to neonates
who are at increased risk of contracting hepatitis B i.e. whose
mothers are HBsAg and HBeAg positive.

• Other measures - screening of blood donors, blood and body fluid

precautions.
 Chronic Hepatitis C Infection

• The spectrum of chronic hepatitis C infection is

essentially the same as chronic hepatitis B
infection.
• All the manifestations of chronic hepatitis B
infection may be seen, albeit with a lower
frequency i.e. chronic persistent hepatitis, chronic
active hepatitis, cirrhosis, and hepatocellular
carcinoma.
 Risk Factors Associated with
Transmission of HCV

 Transfusion or transplant from infected donor

 Injecting drug use
 Hemodialysis (yrs on treatment)
 Accidental injuries with needles/sharps
 Sexual/household exposure to anti-HCV-positive
contact
 Multiple sex partners
 Birth to HCV-infected mother
 Relative Importance of Risk Factors for
Hepatitis C
Remote and Recent Infection

Remote (>20 yrs ago) Recent (<20 yrs ago)

Injection Drug Use Injection Drug Use

Transfusion
Transfusion
Unknown
Other*
Unknown

Other* Sexual
Sexual

* Nosocomial, occupational, perinatal

 Laboratory Diagnosis

• HCV antibody - generally used to diagnose hepatitis C infection. Not

useful in the acute phase as it takes at least 4 weeks after infection
before antibody appears.

• HCV-RNA - various techniques are available e.g. PCR and branched

DNA. May be used to diagnose HCV infection in the acute phase.
However, its main use is in monitoring the response to antiviral
therapy.

• HCV-antigen - an EIA for HCV antigen is available. It is used in the

same capacity as HCV-RNA tests but is much easier to carry out.
 Prevention of Hepatitis C

 Screening of blood, organ, tissue donors

 High-risk behavior modification

 Blood and body fluid precautions

 Hepatitis D (Delta) Virus
 antigen HBsAg

RNA
 Hepatitis D - Clinical Features

 Coinfection
– severe acute disease.
– low risk of chronic infection.
 Superinfection
– usually develop chronic HDV infection.
– high risk of severe chronic liver disease.
– may present as an acute hepatitis.
Hepatitis D Virus Modes of Transmission

 Percutanous exposures
 injecting drug use
 Permucosal exposures
 sex contact
 Hepatitis D - Prevention

 HBV-HDV Coinfection
Pre or postexposure prophylaxis to prevent
HBV infection.
 HBV-HDV Superinfection
Education to reduce risk behaviors among
persons with chronic HBV infection.
Hepatitis E Virus
 Hepatitis E -
Epidemiologic Features
 Most outbreaks associated with faecally contaminated drinking
water.
 Several other large epidemics have occurred since in the Indian
subcontinent and the China, Africa and Mexico.
 In the United States and other non endemic 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.
 Unknown efficacy of IG prepared from donors in
endemic areas.
 Vaccine?
Tips to prevent hepatitis

• Hygiene
• Practicing good hygiene is one key way to avoid
contracting hepatitis A and E. If you’re traveling to
a developing country, you should avoid:
• local water
• ice
• raw or undercooked shellfish and oysters
• raw fruit and vegetables
Hepatitis B, C, and D contracted through contaminated blood can be
prevented by:
• not sharing drug needles
• not sharing razors
• not using someone else’s toothbrush
• not touching spilled blood
• Vaccines
• The use of vaccines is an important key to
preventing hepatitis. Vaccinations are available to
prevent the development of hepatitis A and B.
Experts are currently developing vaccines against
hepatitis C. A vaccination for hepatitis E exists in
China, but it isn’t available in the United States.
GOOD LUCK