1 / 36

The Alphabet of Hepatitis

The Alphabet of Hepatitis. Stephanie Johnson, MD Physician’s Lab of NW Iowa. Definition of Hepatitis. Inflammation of the liver Symptoms similar for all types of hepatitis:

joy-short
Download Presentation

The Alphabet of Hepatitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Alphabet of Hepatitis Stephanie Johnson, MD Physician’s Lab of NW Iowa

  2. Definition of Hepatitis • Inflammation of the liver • Symptoms similar for all types of hepatitis: Fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, gray-colored bowel movements, dark urine, joint pain and/or jaundice

  3. Causes of Hepatitis • Viral/Bacterial • Alcohol • Medications/Toxins • Metabolic Syndrome • Autoimmune • Congenital errors • Familial causes

  4. Viral Hepatitis • Hepatitis A, B, C, etc • Cause • Epidemiology • Prevention • Diagnosis • Treatment • Risk

  5. Hepatitis A

  6. Hepatitis A: Cause • “Infectious hepatitis” • Hepatitis A Virus • Humans are the only reservior • Communicability: 2 weeks before to one week after onset. • Community epidemics

  7. Hepatitis A: Epidemiology • Fecal/oral route • Contaminated food or drink • Travelers to regions with intermediate to high rates of Hepatitis A • Incubation period 15 to 50 days (avg 28) • Illness usually resolves within 2 months, rarely 6 months

  8. Hepatitis A: Prevention • Good hand washing at food establishments. • Vaccine 2 doses 6 months apart for those at increased risk for those 12 months to 40 years of age. (travelers, adoptive parents of international children, high risk sexual behaviors) • Immunoglobulin for those greater than 40 years of age or immunocompromised.

  9. Hepatitis A: Diagnosis • IgM anti-HAV • Abrupt onset • Jaundice, gray stools, exposure

  10. Hepatitis A: Treatment • No medication for those infected. • Immunoglobulin within 2 weeks to those exposed to disease • Supportive treatment • Should not work in food service, day care, health care while infective.

  11. Hepatitis A: Risk • No potential for chronic infection • Rare fulminant hepatitis (death rate 0.3%) • Work loss (avg 27 days) • 11-22% hospitalized • 33% of people in US with IgG HAV

  12. * Actual acute cases estimated to be 2.0 times the number of reported cases in any year * Underlying or contributing cause of death in most recent year available (2010)

  13. Hepatitis B

  14. Hepatitis B: Cause • “Serum hepatitis” • small, double-shelled virus in the family Hepadnaviridae • Humans are the only host. Blood, sex, shared needles, household contacts • Resilient (survives up to 7 days on surfaces) • Acute and chronic hepatitis

  15. Hepatitis B: Epidemiology • 2 billion infected worldwide • 350 million chronically infected • Incubation period 45 to 160 days • Prodromal 3-10 days, icteric 1-3 wks • 50% asymptomatic • Most clear infection, 5% chronic • 90% of infants infected at birth are chronically infected.

  16. Hepatitis B: Prevention

  17. Hepatitis B: Prevention • Hepatitis B vaccine of infants or at risk adults • 3 doses usually 2 months apart for infants • 3 doses initial, 1 month, 6 month for adults • Hep B Immunoglobulin to infants born to women positive for HBsAg • No boosters recommended. • Donated blood tested.

  18. Hepatitis B: Diagnosis • Serologic testing: Hepatitis B Surface Antigen= active infection (acute or carrier) • Anti-HBs: Indicates recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. • Anti-HBc: Appears at the onset of symptoms in acute hepatitis B and persists for life.

  19. Hepatitis B: Treatment • No specific therapy for acute Hep B • Chronic hep B: Interferon A clears 25-50% of chronic infections. • Post-exposure: HBIG and vaccine if no immunity

  20. Hepatitis B: Risk • 25% of chronically infected die prematurely from cirrhosis or liver cancer. • Infants born of infected mothers carry a high risk of chronic infection. • Persons from Asia and Africa are at higher risk of chronic infection. Children adopted from high risk countries should be tested.

  21. Hepatitis B overview • In the US, infant immunization has decreased new cases of Hepatitis B. • Most new cases are sexually spread so testing of unvaccinated adults recommended. • Estimated that up to 5% of Iowans are infected.

  22. Hepatitis C: Cause • Non A/non B hepatitis

  23. Hepatitis C: Epidemiology • Persons at risk: • IV drug users, • clotting factor <1987, • blood transfusions or donated organs <1992, • hemodialysis, • known exposures to HCV, • infants born to infected mothers, • HIV infected persons.

  24. Hepatitis C: Epidemiology • 17,000 new infections 2010 most asymptomatic. • 3.2 million with chronic HCV in US • Incubation period: 14 to 180 days • 15-25 % clear the infection • 75-85% chronic infection • 5-20% develop cirrhosis over 20-30 years

  25. Hepatitis C: Prevention • No vaccine • Don’t share needles • Safe blood supply

  26. Hepatitis C: Diagnosis • One time antibody testing now recommended for all persons born 1945-1965. • Frequent false positives in low incidence population. Need RNA testing to confirm. • Hep C antibody: Negative=no infection. Positive=past or current infection • Hep C RNA: Positive=current infection

  27. Hepatitis C: Treatment • Acute: antivirals and supportive • Chronic: monitor for signs of disease progression. Some treated with ribaviron and pegylated interferon alpha. Since May 2011, some direct anti-viral agents, protease • Side effects, pill burden, cost

  28. Hep C Genotype • Genotype 1a occurs in 50-60% of patients in the United States; this type is difficult to eradicate using current medications • Genotype 1b occurs in 15-20% of patients in the United States; subtype 1b is also difficult to eradicate using current medications; this type is most prevalent in Europe, Turkey, and Japan • Genotype 1c occurs in less than 1% of patients in the United States • Genotypes 2a, 2b, and 2c occur in 10-15% of patients in the United States; these subtypes are widely distributed and are most responsive to medication • Genotypes 3a and 3b occur in 4-6% of patients in the United States; these subtypes are most prevalent in India, Pakistan, Thailand, Australia, and Scotland • Genotype 4 occurs in less than 5% of patients in the United States; it is most prevalent in the Middle East and Africa • Genotype 5 occurs in less than 5% of patients in the United States; it is most prevalent in South Africa • Genotype 6 occurs in less than 5% of patients in the United States; it is most prevalent in Southeast Asia, particularly Hong Kong and Macao

  29. Hepatitis C: Risk • Of those chronically infected, 5-20% develop cirrhosis over 20-30 years. • 1-5% with die from cirrhosis or liver cancer • 12,000 persons in US/year die from HCV related illness • Most common reason for liver transplant

  30. Iowa Department of Public Health • All Hepatitis A, B, or C are reportable diseases in Iowa.

  31. http://www.youtube.com/watch?feature=player_embedded&v=--MgUtdOQiAhttp://www.youtube.com/watch?feature=player_embedded&v=--MgUtdOQiA

More Related