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Questions and Answers
Which of the following is not a characteristic of the Hepatitis B virus?
Which of the following is not a characteristic of the Hepatitis B virus?
What is the estimated number of people worldwide living with Hepatitis B and/or C?
What is the estimated number of people worldwide living with Hepatitis B and/or C?
Which of the following Hepatitis viruses is most likely to be found in pregnant women?
Which of the following Hepatitis viruses is most likely to be found in pregnant women?
What is the goal set by the World Health Organization (WHO) to eliminate viral hepatitis by?
What is the goal set by the World Health Organization (WHO) to eliminate viral hepatitis by?
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Which of the following is a less common virus that can cause hepatitis?
Which of the following is a less common virus that can cause hepatitis?
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What is the treatment option for Hepatitis C?
What is the treatment option for Hepatitis C?
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What is the primary purpose of an INR test in relation to Hepatitis B diagnosis?
What is the primary purpose of an INR test in relation to Hepatitis B diagnosis?
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Which of the following is NOT a type of Hepatitis B marker found in the blood of an infected person?
Which of the following is NOT a type of Hepatitis B marker found in the blood of an infected person?
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What is the primary mechanism of action of anti-viral medications in Hepatitis B management?
What is the primary mechanism of action of anti-viral medications in Hepatitis B management?
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Which population is at high risk of Hepatitis B transmission and requires regular vaccination?
Which population is at high risk of Hepatitis B transmission and requires regular vaccination?
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What is the primary component of the Hepatitis B vaccine?
What is the primary component of the Hepatitis B vaccine?
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According to the universal UK infant schedule, at what age is the Hepatitis B vaccine typically administered?
According to the universal UK infant schedule, at what age is the Hepatitis B vaccine typically administered?
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What is the primary mechanism of transmission for Hepatitis D virus?
What is the primary mechanism of transmission for Hepatitis D virus?
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Which of the following viruses is most commonly associated with vertical transmission?
Which of the following viruses is most commonly associated with vertical transmission?
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What is the incubation period for Hepatitis E virus?
What is the incubation period for Hepatitis E virus?
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Which of the following laboratory tests is a marker of hepatocyte damage?
Which of the following laboratory tests is a marker of hepatocyte damage?
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What is the primary route of transmission for Hepatitis C virus?
What is the primary route of transmission for Hepatitis C virus?
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Which of the following viruses is an enveloped single-stranded RNA virus?
Which of the following viruses is an enveloped single-stranded RNA virus?
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What is the chronicity rate for Hepatitis B virus infection in adults?
What is the chronicity rate for Hepatitis B virus infection in adults?
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Which of the following viruses is not commonly found in the West?
Which of the following viruses is not commonly found in the West?
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What is the primary mechanism of transmission for Hepatitis A virus?
What is the primary mechanism of transmission for Hepatitis A virus?
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What is the primary treatment option for Hepatitis E virus?
What is the primary treatment option for Hepatitis E virus?
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Study Notes
Hepatitis Viruses
- Hepatitis definition: Acute vs Chronic
- 5 main strains of hepatitis viruses: A, B, C, D, and E
- Each virus can cause similar symptoms, but they are transmitted differently and can affect the liver in different ways
Importance of Hepatitis
- Estimated 325 million people worldwide live with hepatitis B and/or C
- Disease burden and economic burden due to chronic hepatitis related liver cirrhosis, liver cancer, liver transplant, and mortality
- Hepatitis B is preventable due to vaccine, and universal vaccination was introduced to the UK infant schedule in 2017
- Hepatitis C is treatable with direct-acting antiviral drugs, and WHO set a target to eliminate viral hepatitis by 2030
Viral Structure
- Hepatitis A virus: non-enveloped RNA virus in the Picornavirus family
- Hepatitis B virus: enveloped partially double-stranded DNA virus in the Hepadnavirus family
- Hepatitis C virus: enveloped single-stranded RNA virus in the Flavivirus family
- Hepatitis D virus: defective virus that can't infect a hepatocyte unless already infected with HBV
- Hepatitis E virus: non-enveloped RNA virus in the Hepeviridae family
Hepatitis A
- RNA virus in the Picornaviridae family
- Oral-fecal route (contaminated water, bad hygiene areas, food, etc.)
- 114 million affected worldwide
- Incubation: 2-6 weeks
- Vaccine available
- Self-limiting, complications rare
- HAV IgM: active infection (primary infection)
- HAV IgG: recovery/vaccination
Hepatitis E
- RNA virus in the Hepeviridae family
- Oral-fecal route
- 28 million affected worldwide
- Incubation: 40 days
- Dangerous in pregnant women
- Self-limiting, off-licence Ribavarin (antiviral agent)
- HEV IgM: active infection
- HEV IgG: recovery
Hepatitis B
- Vertical transmission (75% globally)
- Sexual contact, IVDU, blood products, needlestick injuries
- Incubation: 6 weeks to 6 months
- Chronicity: 90% in infancy, 20% in older children, and <10% in adults
- Vaccine available
Hepatitis C
- IVDU (90%), sexual contact (<1%), infants born to HCV +ve, blood products prior to 1991, needlestick injuries
- Incubation: 2 weeks to 6 months
- Chronicity: 80%
- No vaccine available
Pathophysiology
- Acute infection after inoculation/ingestion of virus
- Virus enters hepatocytes, which are the main site of replication
- Triggers cellular immune response by the host's defence mechanisms
- Release of cytotoxic cytokines and natural killer cells
- Attack infected hepatocytes, leading to destruction and release of liver enzymes
- Oedema, necrosis, cholestasis, fibrosis, cirrhosis, and carcinoma
Signs and Symptoms
- No symptoms, malaise, lethargy, fever, nausea, anorexia, abdominal pain, jaundice, pruritis, dark urine, pale stools, hepatomegaly, tender
- Later signs of liver cirrhosis: palmar erythema, spider naevi, gynaecomastia, abdominal distension, caput medusae, encephalopathy
Investigations
- Blood tests
- Liver function tests: liver transaminases (ALT, AST), alkaline phosphatase, albumin, coagulation tests (INR, PT)
- Immunology: look for viral RNA via PCR or antigens/antibodies in the blood (IgM or IgG)
- Imaging: not usually required for diagnosis, but can use ultrasound, CT scan, and liver biopsy
Hepatitis B Serology
- Hepatitis B markers: HB surface antigen, HB surface antibody, HB core antibody, E antigen
- HB surface antigen: found in the blood of a person who is infected with HBV
Hepatitis B Management
- Refer anyone who is HBsAg positive to a gastroenterologist or Infectious disease specialist
- Anti-virals: suppress viral replication, e.g. entecavir, tenofovir, lamivudine
- Education regarding transmission
Hepatitis B Vaccination
- Genetically engineered surface Ag of the virus
- 3 doses + boosters if required
- Produces antibody response to surface antigen
- Universal UK infant schedule in 2017: 6 in 1 vaccine, given at 2, 3, and 4 months
- At-risk population: babies born to infected mothers, close family or sexual partner, receive regular blood transfusions or products, people whose work puts them at risk, prisoners, IVDU, and MSM
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Description
Learn about the 5 main strains of hepatitis viruses, their transmission, and effects on the liver. Understand the global impact and disease burden of hepatitis B and C.
