HEPATITIS 1


HEPATITIS

Hepatitis is a disease which causes inflammation of the liver, and sometimes death. There are 4 forms of hepatitis (A, B, C and D), only the sexually transmitted ones (Hepatitis A and B) will be discussed here.

Hepatitis A is caused by the Hepatitis A Virus and is highly contagious.

It is transmitted by:

  • fecal-oral contact

Hepatitis B is caused by the Hepatitis B Virus [HBV].

It is found in:

  • blood
  • fecal matter
  • saliva
  • urine

There are up to 200,000 infections reported per year and up to 33% of Americans have evidence of some past infection (immunity).

 


Hepatitis A


Hepatitis A is the most common type of Hepatitis reported in the United States with at least 1.4 million people worldwide

Hepatitis A is a viral infection of the liver and is spread by:

  • fecal-oral route through close person-to-person contact
  • ingestion of contaminated food or water

Hepatitis A Symptoms

Hepatitis A symptoms include:

  • aches and pains
  • a general feeling of not being well
  • dark urine
  • diarrhea
  • fatigue
  • fever
  • intermittent nausea and possibly vomiting
  • jaundice, which can make the sclera (whites) of the eyes a yellowish color
  • loss of appetite
  • pale feces

Adults usually experience more symptoms than children

Incubation Period

  • Average time 28 days for Hepatitis A virus
  • From 2 weeks to 6 months after being infected

Transmission of Hepatitis A

Hepatitis A is transmitted through:

  • contact with a household member or sex partner with Hepatitis A
  • contaminated food/water
  • diaper changing tables (if not cleaned properly)
  • eating raw or partially cooked contaminated shellfish
  • feces
  • infected food handlers by not washing hands with soap and water
  • oral-fecal contact by touching contaminated items, food etc.

Hepatitis A Diagnosis

Blood Test

In order to diagnose Hepatitis A the appropriate blood test is required

  • IgM antHAV

 


Treatment of Hepatitis A

Hepatitis A usually heals spontaneously with no complications

Hepatitis A vaccine is highly effective combined with immune globulin for maximum protection (antibodies given within 2 weeks after exposure)

Immune globulin can be given during pregnancy and breast-feeding

Vaccination

There is no live virus in hepatitis A vaccines, but it is inactivated during production. No serious adverse side effects have been attributed to the vaccine

Note

  • Safety of the vaccine has not been determined.
  • The vaccination cannot be used after exposure to the virus

Hepatitis A endemic regions include:

  • Africa
  • Asia (except Japan)
  • Central America
  • Eastern Europe
  • Mexico
  • Parts of the Caribbean
  • South America
  • The Mediterranean basin
  • The Middle East

When Traveling

Hepatitis A is the most common vaccine-preventable disease in travelers to endemic regions.

Travelers to endemic areas can contract Hepatitis A even in the best hotels, resorts and restaurants.

Up to 30-35 million travelers from industrialized nations annually visit regions where the risk of contracting hepatitis A is 3 to 6 per 1,000 per month of stay. Under poor hygienic conditions, this risk may be increased up to six times. In unprotected travelers, Hepatitis A occurs 100 times more often than typhoid fever and 1,000 times more often than cholera

Risk Groups

HEPATITIS A VACCINE IS RECOMMENDED FOR:

Persons traveling to or working in countries with a high incidence of Hepatitis A including:

  • Military personnel
  • Missionaries
  • People working or studying abroad in countries with high or intermediate levels of Hepatitis A
  • Tourists where risk exists even if staying in luxury accommodation

Children in communities with high rates of Hepatitis A outbreaks including:

  • Alaska Native
  • American Indian

Vaccination of children before starting school should receive highest priority. Children should be routinely vaccinated from 2 years old both in rural and urban areas.

Men who have sex with men:

  • Sexually active men (both adolescents and adults) who have sex with men should be vaccinated as there have been frequent outbreaks in urban areas in United States, Canada and Australia

Illegal-drug users

  • Illegal drug users (injecting and non-injecting) should be vaccinated if local outbreaks of Hepatitis A occur as outbreaks have been reported in United States and Europe

Occupational risk

  • Persons working with virus-infected primates or with hepatitis A virus in a research laboratory setting should be vaccinated. There have been outbreaks reported from primates born in the wild not in captivity.

Chronic liver disease patients

  • Persons with chronic liver disease or who are recipients of liver transplants are at a higher risk of developing fulminant (rapid onset of liver failure often leading to death) and should be vaccinated for Hepatitis A

Clotting-factor disorders

  • Persons who have never had hepatitis A using clotting-factor concentrates, especially solvent detergent-treated concentrates, should be vaccinated

Hemophiliacs

  • Hemophiliacs (Factor VIII, Factor IX) receiving replacement therapy should be vaccinated as there is an increased risk of transmission from clotting-factor concentrates that are not heat inactivated

People with AIDS

  • AIDS sufferers are more prone to contracting Hepatitis and STDs

HEPATITIS A VACCINE IS NOT RECOMMENDED FOR:

Food service workers

  • Food borne hepatitis outbreaks are relatively uncommon in the United States, but consideration may be given to vaccination when community outbreaks occur

Sewerage workers

  • Among workers exposed to sewage no work related outbreaks have been reported

Health-care workers

  • Not at increased risk for hepatitis A

Children under 2 years of age

  • Not currently licensed for this age-group

Children attending Day-care

  • Outbreaks of hepatitis A not frequent enough to warrant vaccination

Pregnant Women

  • The vaccine is not recommended during pregnancy

Prevention of Hepatitis A

Hepatitis A affects anyone and ranges from isolated cases to widespread epidemics with outbreaks about every 10 years nationwide

Preventing the spread of Hepatitis A:

  • Good personal hygiene
  • Practicing safe sex using latex condoms
  • Proper sanitation
  • Relevant community information

Risk Factors

  • All sores and rashes should be covered and not touched
  • Clean up any blood spills with a 10% solution of household bleach
  • Infected persons should not pre-chew food for babies

Do not share anything that could have an infected person’s blood on it including:

  • Body piercing instruments
  • Cocaine straws
  • Drug needles and other drug paraphernalia
  • Nail clippers
  • Razors
  • Toothbrushes

 


Hepatitis B


History

Dr. Blumberg, when studying hemophilia in 1965, found an antibody in two patients which reacted against an antigen from an Australian Aborigine. Subsequent study found the Australian Antigen to be the Hepatitis B surface antigen. Dr. Blumberg was awarded the Nobel Prize for his discovery.

Hepatitis B Virus is a complex structure which consists of a surface and a core.


Hepatitis B Symptoms

Incubation period

  • From 2 weeks to 6 months after viral entry to the liver, during which time a person is extremely contagious
  • Symptoms disappear over 6-12 months until complete recovery

Hepatitis B symptoms are similar to Hepatitis A but can also include:

  • Muscle/joint aches
  • Pain in the abdomen

However, the virus may continue its silent attack on the liver which over a period of years can lead to:

Cirrhosis

  • scarring of the liver which slows the blood flow through the liver, causing increased pressure in the vein that transports blood from the stomach and the intestines to the liver

Lifelong infection

Varicose veins

  • esophageal varicies can develop in the stomach and esophagus and these large veins can break without warning, causing a person to vomit blood or have black, tarry stools

Over 5,000 persons die from chronic liver disease caused by the Hepatitis B Virus infection each year including:

  • Liver cancer
  • Liver cell damage
  • Liver failure
  • Scarring of the liver

Transmission of Hepatitis B

Hepatitis B is transmitted through:

  • Blood
  • Blood sucking arthropods (mainly in the tropics).
  • Blood transfusions
  • Contaminated drinking water or ice
  • Feces
  • Raw or uncooked shellfish (oysters, clams or mussels)
  • Saliva
  • Seminal fluid
  • Uncooked fruits or vegetables grown with or washed in contaminated water
  • Urine
  • Vaginal secretions

Risk Factors

  • After breakdowns in sanitary conditions
  • After floods and other natural disasters
  • Any sexual and intimate contact
  • Infected mother to newborn
  • Infected workers toilet training children in day-care centers
  • Kissing
  • Needle sharing
  • Sexual practices involving the use of feces or urine
  • Sharing a toothbrush
  • Tattoo/body piercing instruments

Hepatitis B Diagnosis

Because of the complexity and the antigenic differences of the virus, there are a number of tests available for Hepatitis B.

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There are three standard blood tests:

Antigens

  • HBsAg – presence of the virus
  • HBcAg – not detected in blood
  • HBeAg – correlates with the viral replication and infectivity

Antibodies

Anti-HBs- antibodies to the surface (antibody to HbsAg)

  • Positive means you are immune to Hepatitis B (from either having had the disease or from having been given the vaccine)

Anti-HBc

  • Antibodies to the core can be either IgM (acute) or IgG (chronic)

Anti-HBe

  • Antibodies to ‘e’ indicating low infection rate and probable recovery

Other Markers

HBV DNA

  • Indicates virus presence and activity

DNA polymerase

  • Determines the presence of HBV DNA

HBsAgin liver cells (Orcein stain, Shakata cells)

HBsAg inside hepatocytes

Standard Blood Tests

HBsAG(Hepatitis B surface antigen)

  • Positive means current infection.

Anti-HBc (antibody to Hepatitis B core antigen)

  • Positive means current infection.

Although uncommon, a number of conditions associated with Hepatitis B antigen/antibody complexes have been found.

These include:

Polyarteritis

  • Appears early
  • Usually involves medium and small arteries

Glomerulonephritis

  • Liver disease is usually mild
  • Occurs largely in children

Polymyalgia Rheumatica

  • Usually in older persons

Essential Mixed Cryoglobulinemia

  • Sometimes only a test tube finding

Guillain-Barre Syndrome

Myocarditis


Treatment for Hepatitis B

There is no medical treatment but an effective vaccination is available.

There are two medications to treat chronic Hepatitis B Virus:

  • Interferon (IFN)
  • Lamivudine

Less than 50% of patients with chronic Hepatitis B Virus (HBV) are suitable for Interferon therapy:

  • Initially, 40% of Hepatitis B Virus (HBV) patients who are treated with Interferon (IFN) will respond
  • Some will relapse when the treatment is stopped
  • About 35% of eligible patients will benefit

Side Effects

A number of side effects have been experienced from this treatment including:

  • Depression
  • Diarrhea
  • Fatigue
  • Flu-like symptoms
  • Headache
  • Loss of appetite
  • Nausea
  • Thinning of hair
  • Vomiting

Blood tests are needed to monitor levels of Interferon as it can also lower the production of white blood cells, platelets and liver enzymes by depressing the bone marrow

A person who is infected with Hepatitis B virus can:

Develop immunity

  • 95% of infected adults develop antibodies but usually recover within 6 months with immunity to the disease
  • Blood tests will test positive for Hepatitis B virus (HBV) antibody and Blood Banks will not accept blood donations

Become chronically infected

  • A person is classified as a carrier or chronically infected if the virus has not been cleared from the body within 6 months
  • These people often have no signs or symptoms, however, the virus remains in blood and body fluids and can infect others
  • People who are chronically infected should avoid all alcohol as it may cause additional damage to your liver

Prevention of Hepatitis B

Help Factors

  • All individuals living in the same household with a chronically infected individual should be vaccinated against Hepatitis B
  • If exposed to hepatitis B, get a Hepatitis B immune globulin ( HBIG) injection within 14 days following exposure
  • Individuals with hepatitis C and other chronic liver diseases should receive the Hepatitis B vaccine
  • Practice safety measures as for Hepatitis A
  • Those who are chronically infected with Hepatitis B virus should be vaccinated against Hepatitis A as well

Vaccines

Risk Groups recommended for vaccination

  • All newborns and children up to the age of 19
  • Drug users
  • Those who are are exposed to blood at their workplace
  • Those with multiple sex partners

Vaccination provides protection for more than 15 years and boosters are not recommended