Viral Hepatitis Overview Quiz

Viral Hepatitis Overview

• Viral hepatitis is a viral infection of the liver.
• Relevant types for dentistry include Hep A, B, and C.

Hepatitis A

• Caused by the hepatitis A virus.
• Transmission is faecal-oral, meaning it's spread through contaminated food or drink.
• Common in areas with poor sanitation.
• Symptoms typically resolve within a few months.
• No specific treatment, focus is on relieving symptoms.
• Prevented through vaccination, especially before travel to high-risk areas.

Hepatitis B

• Caused by the hepatitis B virus (HBV).
• A common infection worldwide.
• Spreads through blood, from infected mothers to babies, unprotected sex, sharing needles, razors, or toothbrushes.
• 5% of infected individuals become chronic carriers.
• Some develop cirrhosis and liver cancer.
• In children, HBV can persist for years, causing significant liver damage.
• 90% of infected babies develop chronic hepatitis.
• Vaccination for healthcare workers is crucial.
• Vaccination added to the child immunization list after 2017.

Hepatitis B - Body Fluid Concentrations

• HBV is not detectable in urine, feces, sweat, tears, and breast milk.
• HBV concentration is high in blood, serum, and wound exudates.
• HBV concentration is moderate in semen, vaginal fluid, and saliva.

Hepatitis B - Transmission

• Very infectious, more so than HIV.
• Can survive outside the human body for up to 7 days.
• People with chronic HBV can have high amounts of the virus in their blood.
• Not spread by hugging, kissing, sneezing, coughing, or sharing eating utensils.
• After a needlestick injury, the risk of HBV seroconversion is 1 in 3 if not vaccinated, compared to 1 in 300 for HIV.

Hepatitis B - Pathogenesis

• Incubation period: 45-180 days (average 60 days)
• Virus enters liver cells (hepatocytes) via the bloodstream.
• Immune response to viral antigens on hepatocyte surfaces drives the clinical syndrome.
• 5% of infected individuals become chronic carriers, at higher risk of liver cancer (hepatocellular carcinoma).
• Hepatitis B surface antibody likely provides lifelong immunity.

Hepatitis B - Symptoms

• May be asymptomatic.
• Symptoms typically appear 2-3 months after exposure.
• Flu-like symptoms (tiredness, fever, aches), loss of appetite, nausea, diarrhea, stomach pain, and jaundice may occur.
• Acute Hepatitis B symptoms usually resolve within 1-3 months, though some cases can last longer (6 months or more).

Hepatitis B - Diagnosis

• Blood tests (serological tests) are used; Hep B antigens as a marker of infection.
• Hep B antibodies to track recovery.
• The virus can persist at low levels even after recovery; Reactivation is possible, especially with depressed immune systems.

Hepatitis B - Treatment

• Emergency treatment (Hep B vaccination and immunoglobulin) after exposure.
• Acute Hepatitis B: rest, pain relievers, and symptom relief (e.g., metoclopramide for nausea).
• Chronic Hepatitis B: peginterferon (stimulates immune response) and antiviral medication (e.g., tenofovir, entecavir) to suppress HBV replication; side effects can include nausea, vomiting, and dizziness.

Hepatitis B - Treatment/Prevention Continued

• Avoid unprotected sex.
• Vaccinate partners against Hepatitis B.
• Avoid sharing needles, toothbrushes, or razors.
• Maintain a healthy diet.
• Avoid alcohol.

Hepatitis B - Prevention

• Vaccination for those at increased risk of HBV infection (3 doses, monthly).
• Immune response: 50% after one dose, 95% after three.
• Protection lasts for more than 15 years, varying on the initial antibody response.

Hepatitis B - Prevention (Continued)

• Hepatitis B immunoglobulin to protect those exposed to Hep B (most effective within 48 hours).
• Screening of blood donors and blood/body fluid precautions.

Hepatitis B - Remember

• Hepatitis B infection carries a significant mortality risk.
• Healthcare professionals are at risk and should be immunized.
• Treat all patients as potential carriers of HBV, implementing universal precautions.
• Always wear PPE, as saliva to eye exposure is a potential infection route.
• Avoid needlestick injuries and report them.

Hepatitis C

• Single-stranded RNA virus.
• Similar pathogenesis, symptoms, and transmission routes to HBV (e.g., occupational transmission via needlestick or blood splash).
• No vaccine available.
• Long-term complications include cirrhosis, liver failure, and liver cancer.
• Chronic Hep C is treated with direct-acting antiviral medications (e.g., ribavirin, simeprevir, sofosbuvir) for 8–12 weeks (sometimes in combination).
• Side effects can include nausea and insomnia.
• Lifestyle changes (e.g., healthy diet, exercise, avoiding alcohol and smoking; not sharing razors or toothbrushes; not sharing needles).

Hepatitis D and E

• Hepatitis D is a delta virus that only infects people already infected with HBV – leading to chronic infections and increased liver damage.
• Hepatitis E is an RNA virus similar to Hep A transmitted by the faecal-oral route, but with a vaccine available.

Test your knowledge about viral hepatitis, including the main types such as Hepatitis A, B, and C. Learn about their causes, transmission, prevention methods, and implications for dental practice. This quiz is essential for understanding the impact of these infections in a healthcare setting.