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Questions and Answers
What is the primary mode of transmission for Hepatitis A?
What is the primary mode of transmission for Hepatitis A?
Which of the following populations is most commonly affected by Hepatitis A in developed countries?
Which of the following populations is most commonly affected by Hepatitis A in developed countries?
What type of food is associated with the transmission of Hepatitis E?
What type of food is associated with the transmission of Hepatitis E?
How long is the incubation period for Hepatitis B?
How long is the incubation period for Hepatitis B?
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Which statement correctly describes Hepatitis C?
Which statement correctly describes Hepatitis C?
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What does a positive Anti Hepatitis B surface antibody (Anti-HBs) usually indicate?
What does a positive Anti Hepatitis B surface antibody (Anti-HBs) usually indicate?
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Which of the following antibodies indicates an acute Hepatitis B infection?
Which of the following antibodies indicates an acute Hepatitis B infection?
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In a serology test, which marker indicates the presence of replicating Hepatitis B virus?
In a serology test, which marker indicates the presence of replicating Hepatitis B virus?
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What does a negative result for Anti Hep B core total (IgG) indicate in a person with positive HBsAg?
What does a negative result for Anti Hep B core total (IgG) indicate in a person with positive HBsAg?
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Which serology results would most likely indicate a person who has cleared Hepatitis B infection?
Which serology results would most likely indicate a person who has cleared Hepatitis B infection?
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Which of the following viruses is responsible for hepatitis A?
Which of the following viruses is responsible for hepatitis A?
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What is the primary function of the hepatitis B virus in hepatocytes?
What is the primary function of the hepatitis B virus in hepatocytes?
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Which hepatitis virus is considered a defective virus that requires the presence of another virus to replicate?
Which hepatitis virus is considered a defective virus that requires the presence of another virus to replicate?
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What type of virus is hepatitis C categorized as?
What type of virus is hepatitis C categorized as?
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Which of the following hepatitis viruses has multiple genotypes and does not offer cross-protection?
Which of the following hepatitis viruses has multiple genotypes and does not offer cross-protection?
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In which type of infections is hepatitis E virus primarily classified?
In which type of infections is hepatitis E virus primarily classified?
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Which structures are part of the hepatitis B virus?
Which structures are part of the hepatitis B virus?
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What is the primary complication associated with viral hepatitis infections?
What is the primary complication associated with viral hepatitis infections?
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What is the appropriate course of treatment for Hepatitis A?
What is the appropriate course of treatment for Hepatitis A?
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Which antibody indicates a past infection with Hepatitis B?
Which antibody indicates a past infection with Hepatitis B?
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What is crucial for effective post-exposure prophylaxis for Hepatitis A?
What is crucial for effective post-exposure prophylaxis for Hepatitis A?
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Which of the following markers would indicate a hepatitis C infection has been cleared?
Which of the following markers would indicate a hepatitis C infection has been cleared?
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Which of the following is a preventive measure for Hepatitis A?
Which of the following is a preventive measure for Hepatitis A?
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In the diagnosis of chronic Hepatitis C, which laboratory result is expected?
In the diagnosis of chronic Hepatitis C, which laboratory result is expected?
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What type of vaccine is used for Hepatitis A?
What type of vaccine is used for Hepatitis A?
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What is the timeframe for Hepatitis C antibodies to become positive after exposure?
What is the timeframe for Hepatitis C antibodies to become positive after exposure?
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Which of the following populations is considered at risk for severe complications from hepatitis?
Which of the following populations is considered at risk for severe complications from hepatitis?
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What is the primary treatment approach for acute hepatitis E infection?
What is the primary treatment approach for acute hepatitis E infection?
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What is a key goal of chronic hepatitis B treatment?
What is a key goal of chronic hepatitis B treatment?
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What immediate action is recommended for individuals experiencing a needle stick incident if they have inadequate vaccine protection?
What immediate action is recommended for individuals experiencing a needle stick incident if they have inadequate vaccine protection?
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What is one of the standard precautions recommended to prevent the spread of hepatitis B?
What is one of the standard precautions recommended to prevent the spread of hepatitis B?
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Which of the following is a part of the management for chronic hepatitis B?
Which of the following is a part of the management for chronic hepatitis B?
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Which of the following groups is primarily recommended for hepatitis B vaccination?
Which of the following groups is primarily recommended for hepatitis B vaccination?
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What is the recommended titre level for hepatitis B vaccination to be considered effective?
What is the recommended titre level for hepatitis B vaccination to be considered effective?
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What transmission method is primarily associated with Hepatitis E in developing countries?
What transmission method is primarily associated with Hepatitis E in developing countries?
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What is the incubation period range for Hepatitis A after infection?
What is the incubation period range for Hepatitis A after infection?
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Among the following, which population is least likely to experience Hepatitis A infections in developed countries?
Among the following, which population is least likely to experience Hepatitis A infections in developed countries?
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Which statement accurately describes Hepatitis B compared to Hepatitis C?
Which statement accurately describes Hepatitis B compared to Hepatitis C?
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What is a major characteristic that differentiates the Hepatitis viruses from one another?
What is a major characteristic that differentiates the Hepatitis viruses from one another?
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What mode of transmission is primarily associated with high prevalence areas for hepatitis B?
What mode of transmission is primarily associated with high prevalence areas for hepatitis B?
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What are the clinical features that might signify an infection with hepatitis A in adults?
What are the clinical features that might signify an infection with hepatitis A in adults?
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Which of the following best describes the typical laboratory findings in patients presenting with symptomatic viral hepatitis?
Which of the following best describes the typical laboratory findings in patients presenting with symptomatic viral hepatitis?
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What is true regarding patients infected with hepatitis B regarding liver function tests?
What is true regarding patients infected with hepatitis B regarding liver function tests?
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During what timeframe is a hepatitis B e antigen (HBeAg) detectable?
During what timeframe is a hepatitis B e antigen (HBeAg) detectable?
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What factor increases the risk of symptomatic hepatitis A infection as individuals age?
What factor increases the risk of symptomatic hepatitis A infection as individuals age?
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Which practice significantly contributes to the parenteral transmission of hepatitis viruses?
Which practice significantly contributes to the parenteral transmission of hepatitis viruses?
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What complication may arise in cases of fulminant disease related to hepatitis infections?
What complication may arise in cases of fulminant disease related to hepatitis infections?
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What is the primary goal of antiviral therapy in chronic Hepatitis B treatment?
What is the primary goal of antiviral therapy in chronic Hepatitis B treatment?
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In which scenario is passive immunisation specifically recommended?
In which scenario is passive immunisation specifically recommended?
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Which method is most effective for monitoring liver cancer in patients with chronic Hepatitis B?
Which method is most effective for monitoring liver cancer in patients with chronic Hepatitis B?
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What factor is essential for determining who should receive the Hepatitis B vaccine?
What factor is essential for determining who should receive the Hepatitis B vaccine?
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What is a significant complication of chronic Hepatitis E infection in transplant patients?
What is a significant complication of chronic Hepatitis E infection in transplant patients?
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Which intervention is included in standard precautions to prevent the spread of Hepatitis B?
Which intervention is included in standard precautions to prevent the spread of Hepatitis B?
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Which of the following statements about Hepatitis C management is accurate?
Which of the following statements about Hepatitis C management is accurate?
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What is the significance of achieving a titre level of >10 IU/ml in Hepatitis B vaccination?
What is the significance of achieving a titre level of >10 IU/ml in Hepatitis B vaccination?
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What does a negative result for Hepatitis C antibody (Anti-HCV) indicate in an individual with symptoms of an acute infection?
What does a negative result for Hepatitis C antibody (Anti-HCV) indicate in an individual with symptoms of an acute infection?
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In the context of Hepatitis A prevention, what is the role of passive immunization?
In the context of Hepatitis A prevention, what is the role of passive immunization?
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Which laboratory marker is consistently positive in individuals with chronic Hepatitis C infection?
Which laboratory marker is consistently positive in individuals with chronic Hepatitis C infection?
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What is the correct post-exposure management for contacts of Hepatitis A cases?
What is the correct post-exposure management for contacts of Hepatitis A cases?
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In the serological evaluation of Hepatitis B, which result would suggest a patient has an active infection?
In the serological evaluation of Hepatitis B, which result would suggest a patient has an active infection?
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Which statement about Hepatitis C infection is true regarding antivirus antibodies?
Which statement about Hepatitis C infection is true regarding antivirus antibodies?
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What is the primary preventive measure for reducing the acquisition of Hepatitis A?
What is the primary preventive measure for reducing the acquisition of Hepatitis A?
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For whom is the Hepatitis A vaccine particularly recommended?
For whom is the Hepatitis A vaccine particularly recommended?
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Which of the following accurately describes the hepatitis B virus?
Which of the following accurately describes the hepatitis B virus?
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What is the primary role of the hepatitis D virus?
What is the primary role of the hepatitis D virus?
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Which of the following is characteristic of hepatitis C genotypes?
Which of the following is characteristic of hepatitis C genotypes?
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Which hepatitis virus is classified as a non-cytopathic virus?
Which hepatitis virus is classified as a non-cytopathic virus?
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How is hepatitis E primarily classified?
How is hepatitis E primarily classified?
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Which of the following indicates the presence of excess hepatitis B virus envelope proteins?
Which of the following indicates the presence of excess hepatitis B virus envelope proteins?
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Which hepatitis viruses can co-infect with each other?
Which hepatitis viruses can co-infect with each other?
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What distinguishes hepatitis B from other hepatitis viruses?
What distinguishes hepatitis B from other hepatitis viruses?
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Study Notes
Hepatitis - Causes
- Inflammation of the liver
- Can be caused by both infectious and non-infectious agents.
- Infectious causes include bacteria, viruses, and other organisms.
- Non-infectious causes include drug use, alcohol consumption, vascular issues, autoimmune disorders, and metabolic conditions.
- Viral infections included Hepatitis A, B, C, and E.
- Other viral infections include Cytomegalovirus, Epstein-Barr virus, Rubella, and Yellow Fever.
Hepatitis A
- RNA virus that infects the liver
- Transmitted via the fecal-oral route, often through contaminated food or water.
- Incubation period of 30 days (range 15-50).
- Infectious for two weeks before to one week after the onset of symptoms.
- Primarily found in developing countries.
- In developed countries it is most commonly found in travellers to endemic countries, households with confirmed cases, sexual contacts of confirmed cases, and occasional foodborne outbreaks.
Hepatitis B
- DNA virus that infects hepatocytes (liver cells)
- Hepatitis B core, surface, and envelope antigens are produced.
- There are three virus forms: Dane particle, Spherical form, and filaments.
- Dane particles contain the entire viral genome and are the only infectious form.
- Spherical and filamentous forms lack DNA but have the virus envelope that contains the Hepatitis B surface antigen (HBsAg).
Hepatitis C
- RNA virus in the Flaviviridae family.
- At least 6 distinct genotypes (1-6) with no cross-protection.
- Transmission through blood-to-blood contact, primarily via contaminated needles, infected blood products, and sexual intercourse.
- Incubation period of 8 weeks (average).
Hepatitis D
- Incomplete viral particle
- Defective RNA virus.
- Requires Hepatitis B surface antigen (HBsAg) for propagation.
Hepatitis E
- RNA virus with four genotypes.
- Found predominantly in developing countries.
- Transmitted via contaminated water and food.
- Incubation period of 30-40 days.
Hepatitis B Serology
- Antibodies and antigens detected in serum
- Hepatitis B surface antigen (HBsAg): present in acute and chronic infections, indicates infectivity
- Hepatitis B e antigen (HBeAg): present in acute and chronic infections; high levels indicate high viral replication
- Hepatitis B e antibody (HBeAb): indicates the body is controlling infection & viral replication is decreasing
- Anti-Hepatitis B core IgM (HBcAb IgM): appears in acute infection, indicating recent infection
- Anti-Hepatitis B core total (IgG) (HBcAb IgG): usually positive for life, indicating prior exposure to the virus.
- Anti-Hepatitis B surface antibody (Anti-HBs): usually appears after the initial infection has resolved; can indicate vaccination.
Hepatitis B Serology Interpretation
- Patient A: Acute Hepatitis B infection.
- Patient B: Chronic Hepatitis B infection, with declining viral activity.
- Patient C: Resolved Hepatitis B infection.
- Patient D: Resolved Hepatitis B infection with immunity due to vaccination.
Hepatitis C Serology
- Anti-HCV: Indicates prior or current exposure to hepatitis C.
- HCVag: Indicates active infection.
- HCV RNA: Indicates active infection.
- Acute infection (infectious): Anti-HCV may be negative or positive, HCVag is positive, and HCV RNA is positive.
- Chronic infection (infectious): Anti-HCV is positive, HCVag is positive, and HCV RNA is positive.
- Infection cleared (non-infectious): Anti-HCV is positive, HCVag is negative, and HCV RNA is negative.
Hepatitis A Prevention
- Hygiene: Good handwashing practices and sanitation
- Traveller Advice: Educate travellers about potential risks and recommend vaccination or immunoglobulin if needed.
-
Vaccination: Inactivated vaccine available
- Post-exposure: Given to contacts of cases and for outbreak control.
- Pre-exposure: Recommended for travellers to endemic countries, people with chronic liver disease, injecting drug users, gbMSM, and workers exposed to raw untreated sewage.
Hepatitis A Immunoglobulin (Passive Immunization)
- Given as post-exposure prophylaxis
- Needs to be given within 2 weeks of exposure to be effective.
- Recommended for:
- Individuals over 60 years old
- Those at risk of severe complications (e.g., chronic liver disease, chronic hepatitis B or C infection)
Hepatitis B Prevention
- Standard Precautions: Hand hygiene, use of personal protective equipment, safe disposal of sharps.
- Safe Injections: Use of clean needles and disposable syringes.
- Blood Screening: Screen blood products to prevent transmission.
- Safe Sex: Safer sex practices to reduce the risk of transmission.
-
Passive Immunization: Immunoglobulin given for post-exposure prophylaxis.
- Recommended for:
- Neonates (at birth)
- Needle stick injuries in unvaccinated individuals or those with inadequate antibodies
- After high-risk sexual exposure
- Vaccine is also recommended along with immunoglobulin.
- Recommended for:
Hepatitis B Vaccination
- Pre-exposure prophylaxis using cloned Hepatitis B surface antigen (HBsAg).
- Vaccine Course: Three doses.
- Antibody Titers: Ideally > 100 IU/mL of anti-HBs.
- High Risk Groups: Healthcare workers, part of national immunisation program.
Hepatitis - Causes
- Hepatitis is inflammation of the liver.
- It can be caused by infectious or non-infectious agents.
- Infectious causes include bacterial, other, and viral agents.
- Viral subtypes include Hepatitis A, B, C, D, and E.
- Non-infectious causes include drugs, alcohol, vascular, autoimmune, and metabolic factors.
Hepatitis A
- It is an RNA virus, an enterovirus (picornavirus).
- It is not cytopathic in itself; cellular immunity is thought to cause liver damage.
- It is transmitted primarily person-to-person via the fecal-oral route.
- Transmission can also occur through contaminated food and water.
- The incubation period is 30 days (range 15-50).
- Period of infectiousness is 2 weeks before to 1 week after onset of symptoms.
Hepatitis B
- It is a DNA virus that infects hepatocytes.
- Viral proteins are expressed on the surface, triggering the cellular immune response.
- There are three virus forms: Dane particle, spherical form, and filaments.
- The Dane particle is the infectious particle.
Hepatitis C
- It is an RNA virus (flavivirus).
- There are at least six distinct genotypes (1-6).
- There is no cross-protection; individuals can be reinfected with another genotype.
Hepatitis D
- It is a defective RNA virus.
- Uses hepatitis B surface antigen for propagation.
Hepatitis E
- It infects both animals and humans.
- There are four genotypes with different geographic distributions and epidemiology.
- Genotypes 1 and 2 are transmitted via fecally-contaminated water in developing countries.
- Genotypes 3 and 4 are found in humans, pigs, and other mammals.
- Transmission to humans occurs through undercooked or raw pig and game meat, processed pork, shellfish (genotype 3), handling animals (particularly pigs), and contaminated water.
- Incubation period is 30-40 days post exposure.
Hepatitis B and C
- Hepatitis B is vaccine-preventable, while Hepatitis C is not.
- The incubation period for Hepatitis B is 1-6 months, compared to 8 weeks (average) for Hepatitis C.
- Transmission to humans for both Hepatitis B and C includes perinatal, sexual, and parenteral routes.
Hepatitis B - Epidemiology:
- In low prevalence areas, acute infection is sporadic in adults.
- Spread is primarily through sex and parenteral routes.
- In high prevalence areas, acute infection is found in infants and young children.
- Spread is through intrapartum and close household contact.
Clinical Presentation of Viral Hepatitis
- Patients may be asymptomatic or symptomatic.
- Symptomatic infections are often preceded by prodromal symptoms (fever, loss of appetite, nausea, fatigue, right upper quadrant abdominal pain).
- Other symptoms include dark urine, pale greasy stools, and jaundice (build-up of bilirubin).
- Abnormal liver function tests (LFTs) are seen in cases of viral hepatitis.
Hepatitis A Clinical Course
- Acute infection is generally asymptomatic in children.
- Risk of symptomatic infection increases with age and coinfection (e.g., hepatitis B).
- Fulminant disease (acute hepatitis failure) is unusual.
- It takes 6 months for chronic infection to develop.
Hepatitis B - Laboratory Diagnosis
- HBsAg (surface antigen) is positive in acute and chronic infection.
- Hep BeAg (e antigen) is detectable when the virus is actively reproducing.
- Hep Be Ab (e antibody) and anti Hep B core IgM are positive in current hepatitis B infection.
- Anti Hep B core total (IgG) and anti HBs (surface antibody) are positive in cleared infection.
Hepatitis C - Laboratory Diagnosis
- Hepatitis C antibody (Anti-HCV) is positive 2-6 months after exposure to hepatitis C.
- It remains positive even if infection has cleared.
- Hepatitis C antigen (HCV ag) is positive in acute and chronic infection.
- Hepatitis C virus (HCV) RNA is positive in acute and chronic infection.
Hepatitis A Treatment and Prevention
- Treatment is supportive care.
- Prevention includes hygiene, advice to travelers, sanitation, and vaccination.
Hepatitis A Vaccination
- It is an inactivated (not live) vaccine.
- Post-exposure: It is used for management of contacts of cases and outbreak control.
- Pre-exposure: It is recommended for travelers to endemic countries, at-risk individuals (chronic liver disease, injecting drug users, men who have sex with men, workers exposed to raw untreated sewage), and those over 60 years of age.
- Passive immunization (immunoglobulin) is a post-exposure prophylaxis option.
Hepatitis E Management and Prevention
- Acute infection is usually self-limiting; treatment is symptomatic.
- Chronic infection in transplant patients may require reducing immunosuppression and using antivirals.
Hepatitis B Treatment
- Acute infection requires supportive therapy.
- Chronic infection management includes patient education, vaccination, and antiviral therapy.
- Antiviral therapy aims to prevent progression to cirrhosis, liver failure, and cancer but cannot eradicate the virus.
- Goal of antiviral therapy is to reduce hepatitis B DNA below detectable levels and achieve seroconversion of e antigen to e antibody.
- Liver cancer monitoring (ultrasound, Alpha Feta Protein) is important.
- Transplantation is considered for fulminant hepatitis and end-stage chronic hepatitis.
Hepatitis B Prevention
- Strategies vary based on high and low prevalence areas.
- Prevention includes standard precautions (safe sex, screening blood products, clean needles/disposable equipment, hand hygiene, gloves, goggles, aprons, safe disposal of sharps), avoiding risk factors, and passive immunization (immunoglobulin) for post-exposure prophylaxis.
- Pre-exposure prophylaxis includes vaccination.
- Hepatitis B vaccine uses a cloned surface antigen (HBsAg) and induces antibodies to HBsAg (Anti-HBs).
Hepatitis C Management
- There is no post-exposure prophylaxis for acute infection.
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Description
This quiz covers the causes and types of hepatitis, focusing on both infectious and non-infectious agents. Learn about the various viruses, such as Hepatitis A and B, along with their transmission methods and characteristics. Test your knowledge about how these viruses affect the liver and their global prevalence.
