Hepatitis Overview and Causes

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Questions and Answers

What is the primary route of transmission for Hepatitis A?

Faecal-oral route (correct)

Inhalation of droplets

Direct skin contact

Blood transfusions

Which genotypes of Hepatitis E are primarily transmitted through faecally-contaminated water?

Genotype 7 and 8

Genotype 1 and 2 (correct)

Genotype 5 and 6

Genotype 3 and 4

What is a key distinguishing feature regarding the vaccines for Hepatitis B and C?

Neither Hepatitis B nor C has a vaccine

Only Hepatitis C has a vaccine

Both have effective vaccines available

Only Hepatitis B is vaccine preventable (correct)

What is the average incubation period for Hepatitis C?

8 weeks Signup and view all the answers

Which of the following groups is most commonly associated with the transmission of Hepatitis A in developed countries?

Household or sexual contacts of known cases Signup and view all the answers

What does a positive Anti Hepatitis B core IgM (Anti-HBc IgM) indicate?

Acute infection Signup and view all the answers

If a person has only positive Anti-HBs, what does this indicate?

Resolved infection or vaccination Signup and view all the answers

What does the presence of Hepatitis B DNA indicate?

Presence of replicating virus Signup and view all the answers

Which serological marker is usually the first detectable antibody to appear after infection?

Antibody to HBc (HBcAb) Signup and view all the answers

What is a likely interpretation if a patient shows positive HBsAg and negative Anti HBs?

Chronic hepatitis B infection Signup and view all the answers

What is the main type of virus responsible for Hepatitis A?

RNA virus Signup and view all the answers

Which of the following correctly describes Hepatitis B?

DNA virus that infects hepatocytes Signup and view all the answers

Which hepatitis virus requires the surface antigen of Hepatitis B for propagation?

Hepatitis D Signup and view all the answers

What type of hepatitis virus is Hepatitis C?

RNA virus with at least 6 distinct genotypes Signup and view all the answers

Which of the following is NOT a recognized cause of hepatitis?

Fibrosis Signup and view all the answers

What is the role of Hepatitis B surface antigen in viral propagation?

It allows Hepatitis D to successfully replicate. Signup and view all the answers

Which factor is essential for the laboratory diagnosis of viral hepatitis infections?

Detection of viral RNA or DNA Signup and view all the answers

What type of immunity is thought to primarily cause liver damage in Hepatitis A infections?

Cellular immunity Signup and view all the answers

Which group of individuals is at a higher risk for severe complications related to chronic liver disease?

Injecting drug users Signup and view all the answers

What is the primary goal of antiviral therapy for chronic Hepatitis B infection?

Reduction of Hepatitis B DNA below detectable levels Signup and view all the answers

What is the recommended course for Hepatitis B vaccination?

Three doses in total Signup and view all the answers

Which type of prophylaxis is recommended immediately after high-risk sexual exposure to Hepatitis B?

Passive immunization with immunoglobulin Signup and view all the answers

What does the presence of Anti-HBs indicate after vaccination for Hepatitis B?

Successful vaccination response Signup and view all the answers

Which of the following is NOT a component of the prevention strategy for Hepatitis B?

Avoidance of high-fat diets Signup and view all the answers

When managing chronic Hepatitis C infection, what is the recommended approach for acute infections?

No post-exposure prophylaxis is recommended Signup and view all the answers

What is a critical monitoring method for patients with chronic Hepatitis B?

Regular ultrasounds for liver cancer Signup and view all the answers

What is indicated by a positive Anti Hep B core total (IgG)?

Resolved Hepatitis B infection Signup and view all the answers

What is the main preventive measure for Hepatitis A?

Vaccination and sanitation Signup and view all the answers

What does a positive HCV RNA test indicate?

Active Hepatitis C virus replication Signup and view all the answers

Which of the following statements about Hepatitis C antibodies is true?

Anti-HCV remains positive even after the infection clears Signup and view all the answers

Which group is recommended for post-exposure passive immunization for Hepatitis A?

High-risk individuals over 60 years within 2 weeks of exposure Signup and view all the answers

What can be concluded if a patient has a positive Hep Be Ab test?

The person has cleared the Hepatitis B virus Signup and view all the answers

What is the primary treatment approach for Hepatitis A?

Supportive care Signup and view all the answers

In the context of Hepatitis C testing, what does a negative HCV antigen indicate?

No current infection Signup and view all the answers

What does the presence of Hepatitis B core antibody IgG (Anti-HBc IgG) usually indicate?

Resolved infection or vaccination Signup and view all the answers

Which serological marker is indicative of a replicating virus in a Hepatitis B infection?

HBsAg Signup and view all the answers

In a patient with positive HBsAg and positive Anti-HBc IgM, what is the likely stage of Hepatitis B infection?

Acute infection Signup and view all the answers

What is the likely interpretation of positive Anti HBs without other Hepatitis B markers?

Vaccinated without prior infection Signup and view all the answers

If a patient has positive Hep Be Ag and negative Hep Be Ab, what does this indicate?

Chronic infection with active viral replication Signup and view all the answers

Which of the following groups has the highest likelihood of being exposed to Hepatitis E in developed countries?

Adults handling undercooked pork Signup and view all the answers

What is a significant difference between the transmission of Hepatitis A and Hepatitis E?

Hepatitis E can infect both humans and animals. Signup and view all the answers

Given the different incubation periods, which statement is true regarding Hepatitis related diseases?

Hepatitis A and E both have a similar incubation period of around 30 days. Signup and view all the answers

How does the incubation period of Hepatitis B differ from that of Hepatitis A?

Hepatitis B has a longer range for its incubation period. Signup and view all the answers

What role does the presence of contaminated water play in the epidemiology of Hepatitis E?

It is a significant factor in outbreaks following poor sanitation. Signup and view all the answers

What is the primary characteristic of the hepatitis D virus?

It is an incomplete viral particle that requires Hepatitis B for propagation. Signup and view all the answers

Which hepatitis virus is recognized as a non-cytopathic virus?

Hepatitis A virus Signup and view all the answers

What is a distinguishing feature of Hepatitis C regarding its genotypes?

There are at least 6 distinct genotypes without cross protection. Signup and view all the answers

Which viral forms are associated with Hepatitis B?

The infectious 'Dane' particle and its variants. Signup and view all the answers

Which symptom is most commonly associated with viral hepatitis infections?

Jaundice indicating liver dysfunction Signup and view all the answers

Which type of infection is characterized by RNA viruses, specifically in relation to Hepatitis viruses?

Hepatitis A and E are classified as RNA viruses. Signup and view all the answers

What is the mechanism by which hepatitis B activates the immune response?

By expressing viral proteins on surface cells to trigger the immune response. Signup and view all the answers

Which factor is critical for the laboratory diagnosis of hepatitis infections?

Detection of specific serological markers in patient blood. Signup and view all the answers

Which of the following strategies for preventing Hepatitis B involves the immediate administration of immunoglobulin?

Passive immunization Signup and view all the answers

What is the primary aim of antiviral therapy for chronic Hepatitis B infection?

To prevent progression to cirrhosis or cancer Signup and view all the answers

What is the recommended minimum level of Anti-HBs titres for effective protection post-vaccination?

10 IU/ml Signup and view all the answers

Which patient group is specifically advised to reduce immunosuppression in the management of Hepatitis E?

Transplant patients Signup and view all the answers

Which of the following is NOT a component of the prevention strategy for Hepatitis B?

Regular liver function testing Signup and view all the answers

Which method is used for monitoring liver cancer in patients with chronic Hepatitis B infection?

Ultrasound and Alpha Feta Protein testing Signup and view all the answers

Which group is classified as at greater risk for severe complications from hepatitis-related conditions?

Injecting drug users Signup and view all the answers

What is a distinguishing feature of the added protection offered by vaccination against Hepatitis B?

Development of Anti-HBs only Signup and view all the answers

What does a positive Anti HCV result indicate in the context of Hepatitis C infection?

Prior exposure, regardless of current infection status Signup and view all the answers

Which method is most effective for post-exposure prophylaxis for Hepatitis A?

Vaccination combined with immunoglobulin Signup and view all the answers

Which of the following indicates that a Hepatitis C infection has been cleared?

Negative Anti-HCV and Negative HCV RNA Signup and view all the answers

In the context of Hepatitis A, what is the primary mode of prevention?

A combination of hygiene, sanitation, and vaccination Signup and view all the answers

What conclusion can be drawn from a patient who shows positive Anti Hep B core total (IgG)?

Resolved Hepatitis B infection Signup and view all the answers

What does a positive Hepatitis C antigen (HCV ag) test indicate in a patient?

Acute or chronic infection Signup and view all the answers

Which statement best describes the role of Hepatitis B surface antibody (Anti-HBs)?

Indicates immunity from infection Signup and view all the answers

Which group of individuals is recommended for pre-exposure vaccination against Hepatitis A?

Travelers to endemic countries only Signup and view all the answers

Study Notes

Hepatitis - Causes

Hepatitis is inflammation of the liver.
There are infectious and non-infectious causes of hepatitis.
Infectious causes include:
- Bacterial, viral, and other
Non-infectious causes include:
- Drugs, alcohol, vascular, autoimmune, metabolic.

Viral Hepatitis

Hepatitis A, B, C, D (with B), and E are all viral causes of hepatitis.
Other viral causes include: cytomegalovirus, Epstein Barr virus, rubella, and yellow fever (Africa, South America).

Hepatitis A

RNA virus - enteroviruses (picornavirus).
Virus not cytopathic in itself, but thought to be caused by cellular immunity.
Humans only - virus shed in faeces.
Transmission:
- Primarily person-to-person via faecal-oral route.
- Also - contaminated food and water.
Incubation period (time from infection to symptoms): 30 days (range 15-50).
Period of Infectiousness 2 weeks before - 1 week after onset of symptoms.
Worldwide:
- Highest levels: developing countries (almost all children have antibodies indicating prior infection).
- Developed countries most commonly seen in:
  - Travellers to endemic countries.
  - Household or sexual contacts of known cases.
  - gbMSM.
  - Occasional foodborne outbreaks.

Hepatitis B

DNA virus - infects hepatocytes.
Expresses viral proteins on the surface which triggers the cellular immune response.
3 virus forms: Dane particle, Spherical form & filaments.
- Infectious “Dane” Particle
- Filaments & Spheres contain surplus virus envelope (contain HBsAg) but lack DNA.
Hepatitis D: incomplete viral particle, defective RNA virus, uses hepatitis B surface antigen for propagation.

Hepatitis C

RNA virus (flavivirus).
At least 6 distinct genotypes (1-6).
Genotypes do not cross-protect, meaning a person can be reinfected with another genotype.

Hepatitis E

RNA virus
Four genotypes with different geographic distribution and epidemiology:
- Genotypes 1 and 2: humans, transmitted via faecally-contaminated water in developing countries.
- Genotypes 3 (dominant in Europe) and 4: humans, pigs and other mammals.
Transmission to humans:
- Via food: undercooked/raw pig and game meat, processed pork and shellfish (genotype 3).
- Spread directly through handling animals, particularly pigs.
- Contaminated water (when poor sanitation, outbreaks post flooding – monsoons/storms).
Incubation period: 30-40 days post exposure (ie similar to hepatitis A and shorter than hepatitis B or C).

Hepatitis B & C

Hepatitis B is vaccine-preventable but Hepatitis C is not.
Hepatitis B incubation period: 1-6 months.
Hepatitis C incubation period: 8 weeks (average).
Transmission to humans:
- Perinatally.
- Sexually.
- Blood-borne.

Hepatitis B Serology Overview

HBcAb (HB core antibody) is the first detectable antibody to appear after infection.
- HBcAb (IgM) = acute infection.
- HBcAb (IgG) = usually positive for life.
Anti-HBs (Anti-Hepatitis B surface antibody) is usually the last hepatitis B antibody to appear.
- Positive = usually indicator that initial infection resolved.
- If Anti-HBs is the only positive HBV marker, the person has been vaccinated.

Hepatitis C Laboratory Diagnosis

Hepatitis C antibody (Anti-HCV): positive 2-6 months after exposure to Hepatitis C and will remain positive even if the patient has cleared the infection.
Hepatitis C antigen (HCV ag): positive in acute and chronic infection.
- Acute (infectious): negative or positive for Anti-HCV, positive for HCV ag, and positive for HCV RNA.
- Chronic (infectious): positive for Anti-HCV, positive for HCV ag, and positive for HCV RNA.
- Infection cleared (non-infectious): positive for Anti-HCV, negative for HCV ag, and negative for HCV RNA.
Hepatitis C virus (HCV) RNA: positive in acute and chronic infection.

Hepatitis B Management

Acute infection: supportive therapy
Chronic infection:
- Patient education.
- Vaccination.
- Antiviral therapy: aim to prevent progression to cirrhosis/liver failure/cancer but can’t eradicate the virus.
- Goal: reduce Hepatitis B DNA below detectable levels and seroconversion of e antigen to e antibody.
- Monitor for liver cancer (ultrasound, alpha feta protein).
- Transplant (fulminant hepatitis, End Stage Chronic Hepatitis).

Hepatitis A Management

Treatment = supportive care.
Prevention:
- Hygiene.
- Advice to travellers.
- Sanitation.
- Vaccination.

Hepatitis A Prevention

Vaccination
- Inactivated (not live) vaccine.
- Post-exposure: management of contacts of cases and for outbreak control.
- Pre-exposure: travellers to endemic countries, chronic liver disease, injecting drug users, gbMSM, workers exposed to raw untreated sewage.
Passive Immunisation (immunoglobulin) = Post-exposure prophylaxis:
- Given within 2 weeks of exposure to be effective.
- Used in addition to or instead of the vaccine.
- For persons aged over 60 years > 12 months and at risk of severe complications (those with chronic liver disease, including chronic hepatitis B or C infection).

Hepatitis E Management

Acute infection usually self-limiting = symptomatic treatment.
Chronic infection in transplant patients:
- Reduce immunosuppression.
- Antivirals.

Hepatitis B Prevention

Strategy varies with high and low prevalence areas.
Standard precautions & avoidance of risk factors:
- Safe sex.
- Screen blood products.
- Clean needles/disposable.
- Good practice (standard precautions): hand hygiene, gloves, goggles, aprons, safe disposal of sharps.
Passive Immunisation (Immunoglobulin)= Post-exposure prophylaxis:
- Immunoglobulin (as soon as possible): neonates, needle-stick if no vaccine or inadequate antibodies, after high risk sexual exposure.
- Vaccine given along with the immunoglobulin.
Pre-exposure prophylaxis: vaccination.
- Cloned surface antigen (HBsAg).
- Therefore, you develop antibodies to HBsAg only i.e. Anti-HBs.
- There is no Hep B core antigen, so you WILL NOT have detectable Anti Hep B core.
- Course of
  - 3 doses.
  - Titres >10 IU/ml – ideally >100 IU/ml of Anti-HBs.
- Who gets vaccinated:
  - High risk groups (e.g. healthcare staff).
  - Part of national immunisation program.

Hepatitis C Management

Acute infection: No post-exposure prophylaxis.

Hepatitis Causes

Hepatitis is the inflammation of the liver.
Hepatitis can be caused by infectious and non-infectious agents.
Infectious agents include bacterial, other, and viral.
Viral causes include: Hepatitis A, B, C, D, and E; Cytomegalovirus; Epstein Barr virus; Rubella; Yellow fever.
Non-infectious agents include: Drugs; Alcohol; Vascular; Autoimmune; Metabolic.

Hepatitis A

Hepatitis A is caused by an RNA virus (enteroviruses, picornavirus).
The virus is not cytopathic in itself; it is believed that cellular immunity causes liver damage.
Hepatitis A virus is only found in humans.
Hepatitis A virus is spread through the faecal-oral route via person-to-person contact, contaminated food and water.
The incubation period of the infection is 30 days (range 15-50).
The period of infectiousness is 2 weeks before to 1 week after the onset of symptoms.
Hepatitis A is prevalent worldwide, especially in developing countries.
In developed countries, hepatitis A is most commonly seen in people traveling to endemic countries, those in close contact with known cases, gay bisexual men (gbMSM), and foodborne outbreaks.

Hepatitis B

Hepatitis B is caused by a DNA virus that infects hepatocytes.
The virus expresses viral proteins on its surface, which trigger the cellular immune response.
Hepatitis B has three virus forms: Dane particle (infectious, causes hepatitis), spherical form, and filaments (non-infectious, consist of surplus virus envelope containing HBsAg, lack DNA).
Hepatitis D is a defective RNA virus that requires hepatitis B for propagation.

Hepatitis E

Hepatitis E is caused by an RNA virus.
There are four genotypes of Hepatitis E, each with different geographic distributions.
Genotype 1 and 2 are found in humans and transmitted via faecally-contaminated water in developing countries.
Genotype 3 (dominant in Europe) and 4 are found in both humans, pigs, and other mammals.
Transmission to humans occurs through food (undercooked/raw pig and game meat, processed pork, and shellfish), handling animals (particularly pigs), and contaminated water.
The incubation period for Hepatitis E is 30-40 days.

Hepatitis B & C

Hepatitis B is vaccine-preventable and has an incubation period of 1-6 months.
Hepatitis C has no vaccine available and has an incubation period of 8 weeks.
Hepatitis B is transmitted through perinatal, sexual, and blood contact.
Hepatitis B virus (HBV) DNA indicates the presence of replicating virus.
Hepatitis B and C can be diagnosed via hepatitis B surface antigen (HBsAg) testing.

Hepatitis B Antibodies

Hepatitis B core antibody (HBcAb) is the first antibody to appear after infection and can be detected in acute or chronic infection.
Anti-HBs (surface antibody) usually appears last and indicates the resolution of infection.
Anti-HBs can also be present if a person has been vaccinated against hepatitis B.

Hepatitis C Antibodies

Hepatitis C antibody (Anti-HCV) is positive 2-6 months after exposure to the virus, even if the infection is cleared.
Hepatitis C antigen (HCV ag) is positive in acute and chronic infection.
Hepatitis C virus (HCV) RNA is also positive in acute and chronic infection.

Hepatitis A Treatment and Prevention

Treatment for hepatitis A is supportive care.

Hepatitis E Treatment and Prevention

Treatment for acute hepatitis E is supportive care.
Treatment for chronic hepatitis E in transplant patients includes reducing immunosuppression and antivirals.

Hepatitis B Treatment and Prevention

Treatment for acute hepatitis B is supportive.
Treatment for chronic hepatitis B includes patient education, vaccines, and antiviral therapy.
Antiviral therapy aims to prevent progression to cirrhosis, liver failure, and cancer but cannot eradicate the virus.
The goal of antiviral therapy is to reduce hepatitis B DNA levels and seroconvert e antigen to e antibody.
Patients with chronic hepatitis B should be monitored for liver cancer using ultrasound and alpha fetoprotein testing.
Liver transplant may be necessary for patients with fulminant hepatitis or end-stage chronic hepatitis.
Prevention strategies vary depending on the prevalence of hepatitis B in the area.
Standard precautions, safe sex, screening blood products, clean needles, good practice (hand hygiene, gloves, goggles, aprons, safe disposal of sharps), passive immunization (immunoglobulin), and vaccines are important for prevention.

Hepatitis C Treatment and Prevention

There is no post-exposure prophylaxis available for hepatitis C.

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Description

This quiz covers the causes and types of hepatitis, including both infectious and non-infectious factors. It delves into the specifics of viral hepatitis, particularly Hepatitis A, including its transmission, incubation, and symptoms. Test your knowledge on this crucial public health topic.