Hepatitis Overview and Causes
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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?

    <p>8 weeks</p> Signup and view all the answers

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

    <p>Household or sexual contacts of known cases</p> Signup and view all the answers

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

    <p>Acute infection</p> Signup and view all the answers

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

    <p>Resolved infection or vaccination</p> Signup and view all the answers

    What does the presence of Hepatitis B DNA indicate?

    <p>Presence of replicating virus</p> Signup and view all the answers

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

    <p>Antibody to HBc (HBcAb)</p> Signup and view all the answers

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

    <p>Chronic hepatitis B infection</p> Signup and view all the answers

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

    <p>RNA virus</p> Signup and view all the answers

    Which of the following correctly describes Hepatitis B?

    <p>DNA virus that infects hepatocytes</p> Signup and view all the answers

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

    <p>Hepatitis D</p> Signup and view all the answers

    What type of hepatitis virus is Hepatitis C?

    <p>RNA virus with at least 6 distinct genotypes</p> Signup and view all the answers

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

    <p>Fibrosis</p> Signup and view all the answers

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

    <p>It allows Hepatitis D to successfully replicate.</p> Signup and view all the answers

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

    <p>Detection of viral RNA or DNA</p> Signup and view all the answers

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

    <p>Cellular immunity</p> Signup and view all the answers

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

    <p>Injecting drug users</p> Signup and view all the answers

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

    <p>Reduction of Hepatitis B DNA below detectable levels</p> Signup and view all the answers

    What is the recommended course for Hepatitis B vaccination?

    <p>Three doses in total</p> Signup and view all the answers

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

    <p>Passive immunization with immunoglobulin</p> Signup and view all the answers

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

    <p>Successful vaccination response</p> Signup and view all the answers

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

    <p>Avoidance of high-fat diets</p> Signup and view all the answers

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

    <p>No post-exposure prophylaxis is recommended</p> Signup and view all the answers

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

    <p>Regular ultrasounds for liver cancer</p> Signup and view all the answers

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

    <p>Resolved Hepatitis B infection</p> Signup and view all the answers

    What is the main preventive measure for Hepatitis A?

    <p>Vaccination and sanitation</p> Signup and view all the answers

    What does a positive HCV RNA test indicate?

    <p>Active Hepatitis C virus replication</p> Signup and view all the answers

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

    <p>Anti-HCV remains positive even after the infection clears</p> Signup and view all the answers

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

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

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

    <p>The person has cleared the Hepatitis B virus</p> Signup and view all the answers

    What is the primary treatment approach for Hepatitis A?

    <p>Supportive care</p> Signup and view all the answers

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

    <p>No current infection</p> Signup and view all the answers

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

    <p>Resolved infection or vaccination</p> Signup and view all the answers

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

    <p>HBsAg</p> 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?

    <p>Acute infection</p> Signup and view all the answers

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

    <p>Vaccinated without prior infection</p> Signup and view all the answers

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

    <p>Chronic infection with active viral replication</p> Signup and view all the answers

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

    <p>Adults handling undercooked pork</p> Signup and view all the answers

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

    <p>Hepatitis E can infect both humans and animals.</p> Signup and view all the answers

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

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

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

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

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

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

    What is the primary characteristic of the hepatitis D virus?

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

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

    <p>Hepatitis A virus</p> Signup and view all the answers

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

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

    Which viral forms are associated with Hepatitis B?

    <p>The infectious 'Dane' particle and its variants.</p> Signup and view all the answers

    Which symptom is most commonly associated with viral hepatitis infections?

    <p>Jaundice indicating liver dysfunction</p> Signup and view all the answers

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

    <p>Hepatitis A and E are classified as RNA viruses.</p> Signup and view all the answers

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

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

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

    <p>Detection of specific serological markers in patient blood.</p> Signup and view all the answers

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

    <p>Passive immunization</p> Signup and view all the answers

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

    <p>To prevent progression to cirrhosis or cancer</p> Signup and view all the answers

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

    <p>10 IU/ml</p> Signup and view all the answers

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

    <p>Transplant patients</p> Signup and view all the answers

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

    <p>Regular liver function testing</p> Signup and view all the answers

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

    <p>Ultrasound and Alpha Feta Protein testing</p> Signup and view all the answers

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

    <p>Injecting drug users</p> Signup and view all the answers

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

    <p>Development of Anti-HBs only</p> Signup and view all the answers

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

    <p>Prior exposure, regardless of current infection status</p> Signup and view all the answers

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

    <p>Vaccination combined with immunoglobulin</p> Signup and view all the answers

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

    <p>Negative Anti-HCV and Negative HCV RNA</p> Signup and view all the answers

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

    <p>A combination of hygiene, sanitation, and vaccination</p> Signup and view all the answers

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

    <p>Resolved Hepatitis B infection</p> Signup and view all the answers

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

    <p>Acute or chronic infection</p> Signup and view all the answers

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

    <p>Indicates immunity from infection</p> Signup and view all the answers

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

    <p>Travelers to endemic countries only</p> 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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