Viral Hepatitis - A, B, C, D, E Detail

Viral Hepatitis - A, B, C, D, E

Hepatitis A: is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.

Hepatitis B: is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

Hepatitis C: is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person.

Hepatitis D: is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. Hepatitis D virus (HDV) is found in the blood of persons infected with the virus.

Hepatitis E: is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as hepatitis A virus. Hepatitis E, however, does not occur often in the United States.

Viral Hepatitis A

SIGNS & SYMPTOMS	Adults will have signs and symptoms more often than children.
	jaundice fatigue abdominal pain loss of appetite	nausea diarrhoea fever
CAUSE	Hepatitis A virus (HAV)
LONG-TERM EFFECTS	There is no chronic (long-term) infection. Once you have had hepatitis A you cannot get it again. About 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6-9 month period.
TRANSMISSION	HAV is found in the stool (feces) of persons with hepatitis A.  HAV is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A.
PERSONS AT RISK OF INFECTION	Household contacts of infected persons Sex contacts of infected persons Persons, especially children, living in areas with increased rates of hepatitis A during the baseline period from 1987-1997. Persons travelling to countries where hepatitis A is common Men who have sex with men Injecting and non-injecting drug users
PREVENTION	Hepatitis A vaccine is the best protection. Short-term protection against hepatitis A is available from immune globulin. It can be given before and within 2 weeks after coming in contact with HAV.  Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food.
VACCINE RECOMMENDATIONS	Vaccine is recommended for the following persons from 12 months of age and older: Travelers to areas with increased rates of hepatitis A Men who have sex with men Injecting and non-injecting drug users Persons with clotting-factor disorders (e.g. haemophilia) Persons with chronic liver disease Children living in areas with increased rates of hepatitis A during the baseline period from 1987-1997.
TRENDS & STATISTICS	Occurs in epidemics both nationwide and in communities During epidemic years, the number of reported cases reached 35,000. In the late 1990s, hepatitis A vaccine was more widely used and the number of cases reached historic lows. One-third of Americans have evidence of past infection (immunity).

 

Viral Hepatitis B

SIGNS & SYMPTOMS	About 30% of persons have no signs or symptoms. Signs and symptoms are less common in children than adults.
	jaundice fatigue abdominal pain	loss of appetite nausea, vomiting  joint pain
CAUSE	Hepatitis B virus (HBV)
LONG-TERM EFFECTS WITHOUT VACCINATION	Chronic infection occurs in: 90% of infants infected at birth 30% of children infected at age 1 - 5 years  6% of persons infected after age 5 years  Death from chronic liver disease occurs in: 15-25% of chronically infected persons
CONTRAINDICATIONS TO VACCINE	A serious allergic reaction to a prior dose of hepatitis B vaccine or a vaccine component is a contraindication to further doses of hepatitis b vaccine. The recombinant vaccines that are licensed for use in the United States are synthesized by Saccharomyces cerevisiae (common bakers' yeast), into which a plasmid containing the gene for HBsAg has been inserted. Purified HBsAg is obtained by lysing the yeast cells and separating HBsAg from the yeast components by biochemical and biophysical techniques. Persons allergic to yeast should not be vaccinated with vaccines containing yeast.
TRANSMISSION	Occurs when blood from an infected person enters the body of a person who is not infected. HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission), by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth. Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus (HCV) or HIV.
RISK GROUPS	Persons with multiple sex partners or diagnosis of a sexually transmitted disease Men who have sex with men Sex contacts of infected persons Injection drug users Household contacts of chronically infected persons	Infants born to infected mothers Infants/children of immigrants from areas with high rates of HBV infection country listing Health care and public safety workers Haemodialysis patients
PREVENTION	Hepatitis B vaccine is the best protection. If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission. If you are pregnant, you should get a blood test for hepatitis B; Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth. Do not shoot drugs; if you shoot drugs, stop and get into a treatment programme; if you can't stop, never share drugs, needles, syringes, water, or "works", and get vaccinated against hepatitis A and B. Do not share personal care items that might have blood on them (razors, toothbrushes). Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices. If you have or had hepatitis B, do not donate blood, organs, or tissue. If you are a health care or public safety worker, get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps.
VACCINE RECOMMENDATIONS	Hepatitis B vaccine available since 1982 Routine vaccination of 0-18 year olds Vaccination of risk groups of all ages
TREATMENT & MEDICAL MANAGEMENT PubMed Article on Adefovir dipivoxil treatment (e antigen-positive) NEJM Article on Adefovir dipivoxil treatment (e antigen-negative) NEJM Article on Peginterferon Alfa-2a, Lamivudine, and the Combination for HBeAg-Positive Chronic Hepatitis B AASLD Update of Chronic Hepatitis B Recommendations FDA article on entecavir	HBV infected persons should be evaluated by their doctor for liver disease. Adefovir dipivoxil, interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, and entecavir are five drugs used for the treatment of persons with chronic hepatitis B. These drugs should not be used by pregnant women. Drinking alcohol can make your liver disease worse.
TRENDS & STATISTICS	Number of new infections per year has declined from an average of 260,000 in the 1980s to about 73,000 in 2003. Highest rate of disease occurs in 20-49-year-olds. Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination.  Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.

Viral Hepatitis E

SIGNS & SYMPTOMS	Highest attack rate among persons aged 15-40 years
	jaundice fatigue abdominal pain	loss of appetite nausea, vomiting dark (tea colored) urine
CAUSE	Hepatitis E virus (HEV)
LONG-TERM EFFECTS WITHOUT VACCINATION	There is no chronic (long-term) infection Hepatitis E is more severe among pregnant women, especially in third trimester
TRANSMISSION	HEV is found in the stool (feces) of persons and animals with hepatitis E. HEV is spread by eating or drinking contaminated food or water. Transmission from person to person occurs less commonly than with hepatitis A virus Most outbreaks in developing countries have been associated with contaminated drinking water.
RISK GROUPS	Travelers to developing countries, particularly in South Asia and North Africa	Rare cases have occurred in the United States among persons with no history of travel to endemic countries
PREVENTION	Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food Avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruits or vegetables that are not peeled or prepared by the traveller.
TREATMENT & MEDICAL MANAGEMENT	Treatment is supportive
TRENDS & STATISTICS	Hepatitis E remains uncommon in the United States. Routine surveillance data are not available.

Viral Hepatitis C

SIGNS & SYMPTOMS	80% of persons have no signs or symptoms.
	jaundice fatigue dark urine	abdominal pain  loss of appetite nausea
CAUSE	Hepatitis C virus (HCV)
LONG-TERM EFFECTS	Chronic infection: 55%-85% of infected persons Chronic liver disease: 70% of chronically infected persons Deaths from chronic liver disease: 1%-5% of infected persons may die Leading indication for liver transplant
TRANSMISSION	Occurs when blood from an infected person enters the body of a person who is not infected.  HCV is spread through sharing needles or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.
Recommendations for testing based on risk for HCV infection	Persons at risk for HCV infection might also be at risk for infection with hepatitis B virus (HBV) or HIV. Recommendations for Testing Based on Risk for HCV Infection PERSONS RISK OF INFECTION  TESTING RECOMMENDED? Injecting drug users High Yes Recipients of clotting factors made before 1987 High Yes Haemodialysis patients Intermediate Yes Recipients of blood and/or solid organs before 1992 Intermediate Yes People with undiagnosed liver problems Intermediate Yes Infants born to infected mothers Intermediate After 12-18 mos. old Healthcare/public safety workers Low Only after known exposure People having sex with multiple partners Low No People having sex with an infected steady partner Low No Anyone who wants to get tested should ask their doctor.
PREVENTION	There is no vaccine to prevent hepatitis C. Do not shoot drugs; if you shoot drugs, stop and get into a treatment programme; if you can't stop, never share needles, syringes, water, or "works", and get vaccinated against hepatitis A & B. Do not share personal care items that might have blood on them (razors, toothbrushes). If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B. Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices. HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B. If you are HCV positive, do not donate blood, organs, or tissue.
TREATMENT & MEDICAL MANAGEMENT	HCV positive persons should be evaluated by their doctor for liver disease. Interferon and ribavirin are two drugs licensed for the treatment of persons with chronic hepatitis C.  Interferon can be taken alone or in combination with ribavirin. Combination therapy, using pegylated interferon and ribavirin, is currently the treatment of choice. Combination therapy can get rid of the virus in up to 5 out of 10 persons for genotype 1 and in up to 8 out of 10 persons for genotype 2 and 3.  Drinking alcohol can make your liver disease worse.
STATISTICS & TRENDS	Number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003. Most infections are due to illegal injection drug use. Transfusion-associated cases occurred prior to blood donor screening; now occurs in less than one per 2 million transfused units of blood. Estimated 3.9 million (1.8%) Americans have been infected with HCV, of whom 2.7 million are chronically infected. The risk for perinatal HCV transmission is about 4% If coinfected with HIV the risk for perinatal infection is about 19%

The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission. 

 

Viral Hepatitis D

SIGNS & SYMPTOMS
	jaundice fatigue abdominal pain loss of appetite	nausea, vomiting joint pain dark (tea colored) urine
CAUSE	Hepatitis D virus (HDV)
LONG-TERM EFFECTS WITHOUT VACCINATION	HDV can be acquired either as a co-infection (occurs simultaneously) with hepatitis B virus (HBV) or as a superinfection in persons with existing chronic HBV infection. HBV-HDV co-infection: may have more severe acute disease and a higher risk (2%-20%) of developing acute liver failure compared with those infected with HBV alone HBV-HDV superinfection chronic HBV carriers who acquire HDV superinfection usually develop chronic HDV infection progression to cirrhosis is believed to be more common with HBV/HDV chronic infections
TRANSMISSION	Occurs when blood from an infected person enters the body of a person who is not immune. HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission); By sharing drugs, needles, or "works" when "shooting" drugs; Through needlesticks or sharps exposures on the job; or From an infected mother to her baby during birth.
RISK GROUPS	Injection drug users Men who have sex with men Haemodialysis patients Sex contacts of infected persons	Health care and public safety workers Infants born to infected mothers (very rare)
PREVENTION	Hepatitis B vaccination HBV-HDV coinfection pre- or post-exposure prophylaxis (hepatitis B immune globulin or vaccine) to prevent HBV infection HBV-HDV superinfection education to reduce risk behaviours among persons with chronic HBV infection
VACCINE RECOMMENDATIONS	Hepatitis B vaccine should be given to prevent HBV/HDV co-infection
TREATMENT & MEDICAL MANAGEMENT	Acute HDV infection Supportive care Chronic HDV infection interferon-alfa liver transplant
TRENDS & STATISTICS	Routine surveillance data are not available.