Hepatitis Overview May 2024 PDF

Viral Hepatitis Dr.Aseel M. AbdulMajeed Specialist dentist  Introduction  Today, viral hepatitis has become a silent epidemic worldwide.  It is the major cause of liver cirrhosis and liver carcinoma.  What is hepatitis?  Hepatitis refers to an inflammatory condition of the live...

Viral Hepatitis Dr.Aseel M. AbdulMajeed Specialist dentist  Introduction  Today, viral hepatitis has become a silent epidemic worldwide.  It is the major cause of liver cirrhosis and liver carcinoma.  What is hepatitis?  Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis.  These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, toxins, and alcohol. Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A: fecal-oral transmission B: sexual fluids & blood to blood C: blood to blood D: travels with B E: fecal–oral transmission Symptoms of all types of viral hepatitis are similar , frequently asymptomatic, and can include one or more of the following: Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Gray-colored bowel movements Joint pain Jaundice.  In a dental/medical office, infections can be expedited through several routes, including direct or indirect contact with blood, oral fluids, droplet splatter, and aerosols.  A dentist/ health care provider can play a major role in the prevention of hepatitis by considering each and every patient as a potential carrier of hepatitis.  The aim of the present review is to increase the awareness among health care personnels, especially dental practitioners, so as to reduce the burden of hepatitis in their community. Hepatitis A virus (HAV): an RNA picornavirus , endemic in many developing countries. Typically, the virus causes a self-limited infection of less than two months’ duration, which confers immunity when resolved. Hepatitis A HAV has remained infectious on environmental surfaces for more than a month Incubation Period : 15 to 50 days (average: 28 days) Needs supportive treatment Hepatitis A transmission  HAV is transmitted through ingestion of fecal matter, even in microscopic amounts, from  close contact with an infected person.  sexual contact with an infected person.  ingestion of contaminated food or drinks. Prevention  Vaccination  Hand hygiene  Proper food handling  Disinfection of contaminated surfaces The hepatitis B virus (HBV) is an encapsulated DNA virus that replicates within the hepatocyte. HBV is transmitted by percutaneous or mucosal exposure to the body fluids of an infected person.  HBV can Incubation remains Period HBV is 50–100 infectious 45 to 160 days times more outside the (average: 120 infectious body (in dried days) than HIV blood (for up to 7 days. Persons with chronic infection (e.g., those with persistent hepatitis B surface antigen [HBsAg] in the serum for at least 6 months following acute infection) ; serve as the main reservoir for HBV transmission  HBV is transmitted through :  Percutaneous (i.e., needle sticks), the most efficient modes of HBV transmission but account for only a minority of HBV infections among HCP.  Mucosal (i.e., direct contact with mucous membranes), or non-intact skin (e.g., psoriasis, eczema, burns, wounds, cuts, and scratches) exposure to infectious blood or body fluids.  In several investigations of HBV outbreaks, most infected HCP could not recall an overt percutaneous exposure. Adults at Risk for HBV Infection  Injection-drug use  Sexual (heterosexual and MSM) exposure  Household contacts.  Developmentally disabled persons in long-term-care facilities.  Correctional facilities  Persons at risk for occupational exposure to HBV.  Hemodialysis patients  Persons with HCV infection , or/and HIV  Persons with chronic liver disease  Travelers to countries where HBV is endemic  Persons with diabetes (low immunity)  Prevention  Vaccination  Avoid unprotected sex  Avoid percutaneous or mucosal contact with infected blood, body fluids, and items that have been in contact with potentially infected blood or body fluids, such as needles and other equipment used to inject drugs. HCV is an RNA virus with great molecular heterogeneity. Viral diversity is one of the challenges to vaccine development; in addition to the unclear immune responses that lead to viral clearance. Chronic HCV infection is the leading cause of liver- related death and hepatocellular carcinoma in the Western world.  Incubation Period:14 to 180 days (average: 45 days) No vaccine available  HCV Survival  On surfaces for up to 6 weeks at room temperature  In water at low temperatures for up to 5 months.  Commercially available disinfectants reduced the infectivity of HCV to undetectable levels with 1-propanol as the most effective disinfectant. PREVENTION No vaccine for primary prevention of hepatitis C.  Standard Precautions remain the foundation of protection against transmission of HCV and other infectious agents during patient care in the dental setting.  Advice to health Advice to Patients care providers Not to share sanitary and household Avoid items which percutaneous may carry exposure to traces of blood infected blood Not to reuse injecting or snorting equipment Laboratory findings Hepatitis A  is diagnosed by the: presence of elevated IgM anti-HAV for 2-4 weeks during the acute phase of the infection.  later by rise in IgG anti-HAV that indicates the convalescent phases. When testing for hepatitis B, order: Ordering all 3 tests allows determination of susceptibility; immunity through vaccination or past infection; or active infection (acute or chronic), If chronic hepatitis B’ If acute hepatitis B is suspected, IgM antibody to the hepatitis B core antigen (IgM anti-HBc) can also be ordered to support clinical suspicion. However, it can be elevated in a flare of chronic hepatitis B infection. Test results and their interpretation Tests Results Interpretation Susceptible to HBsAg negative infection anti-HBc negative (vaccination is anti-HBs negative recommended) HBsAg negative Immune due to anti-HBc positive resolved infection anti-HBs positive HBsAg negative Immune due to anti-HBc negative hepatitis B anti-HBs positive vaccination Test results and their interpretation Tests Results Interpretation HBsAg positive anti-HBc positive Acute HBV infection IgM anti-HBc * positive *(high titer) anti-HBs negative HBsAg positive anti-HBc positive Chronic HBV infection anti-HBs negative Interpretation possibilities : 1. resolved HBV infection HBsAg negative 2. false positive result anti-HBc positive 3. resolving acute HBV anti-HBs negative infection 4. Low level chronic infection Testing for Hepatitis C Infection includes:  Detecting ‘antibodies’ to the virus (HCV Ab) or viral RNA in the blood. There is a window period of 2 – 4 weeks after initial infection for the HCV RNA (and it may take 2 – 6 months) for the HCV Ab to be detectable.  Testing is usually undertaken by a medical practitioner, & should only be performed after an open discussion and the provision of informed consent, and any results should be given to the patient in person.  References  MMWR 2018: Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices  MMWR 2013: CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Post exposure Management.  AJN 2015: Viral Hepatitis: New U.S. Screening Recommendations, Assessment Tools, and Treatments  Hepatitis C Support Project 2015 Environmental Stability of HCV: How Long Does HCV Live Outside the Body and What Kills It?  JADA 2013: Hepatitis C virus ;An overview for dental health care providers  ASHM 2012: Hepatitis B and Primary Care Providers  ASHM 2012: Dental and Orofacial Health and Hepatitis C.