3 - Hepatitis Flashcards by Anna Van Dekerkhove

Which hepatitis viruses are transmitted through fecal-oral contamination?

A and E

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Which hepatitis viruses are transmitted parenterally?

B, C, and delta

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What is important to note about delta hepatitis?

Must have a co-infection w/ hepatitis B

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How can the hepatitis A virus be killed?

Only with extreme high temperatures, not extreme cold temps

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Is the hepatitis A or hepatitis B virus able to survive in the environment for longer?

Hepatitis A (can survive for months)

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What are the risk factors for hepatitis A?

International travelers
Household or sexual contact w/ HAV infected person
Users of illegal drugs
Px w/ chronic liver disease

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What is the incubation period for hepatitis A?

Approx. 28 days (range 15-50 days)

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When do px infected w/ hep A begin to shed the virus?

1-2 weeks after exposure

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What are the stages of acute hepatitis A?

Prodromal period
Acute illness w/ abrupt onset
Icteric hepatitis

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What are sx of the prodromal period of hepatitis A?

Flu-like sx (some may be mild) like anorexia, nausea, fatigue, malaise

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What are sx of hepatitis A w/ acute illness w/ abrupt onset?

Anorexia
Nausea, vomiting
Malaise
Fever
Headache
Right upper quadrant abdominal pain

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What are sx of icteric hepatitis?

Dark urine
Light-coloured stools
Worsening of sx
Pruritus

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What happens to liver enzymes during hepatitis A?

Increase w/in the first few weeks of infection, peak is about 4th week, and normalize by 8th week

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How do symptoms of hepatitis A differ in age groups?

< 6 y/o are likely asymptomatic
Older children and adults have sx lasting < 2 months
In adults, peak viral shedding precedes GI sx

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Can HAV result in a chronic infection?

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What some possible complications associated w/ hepatitis A?

Relapsing hepatitis
Cholestatic hepatitis
Fulminant hepatitis

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What is the treatment for hepatitis A?

Majority of px have clinical resolution by 2 months, nearly all by 6 months
Non-specific tx, general supportive care

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How can hepatitis A be prevented?

Vaccination

- Human immune globulin

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What is the dosing for the hepatitis A vaccine?

Intramuscular injection w/ one dose (primary immunization) and then booster 6-36 months later

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Who should receive a hepatitis A vaccine?

Individuals >/ 6 m/o at risk of infection or severe hepatitis A, or those wanting to decrease risk of acquiring hep A

What are adverse events from the hepatitis A vaccine?

Generally well tolerated

- Mild and transient soreness or redness at injection site

Can the hep A and hep B vaccines be given to pregnant women?

Yes b/c is an inactivated vaccine

Patients who have ____ can not receive the hep A or hep B vaccine

Moderate to severe acute illness

How should receive human immune globulin?

Infants < 6 m/o
Px w/ contraindication to hep A vaccine
If hep A vaccine unavailable
Should be given in addition to hep A vaccine in immunocompromised or px w/ chronic liver disease

When should human immune globulin be given when used for post-exposure prophylaxis?

As soon as possible after exposure (no more than 14 days after exposure)

What are some non-pharms for hep A prevention?

- Eat and drink safe food and water (fully cooked food, boiled water) - Frequent handwashing

How is hep B transmitted?

Percutaneous or mucosal contact w/ blood and biological fluids containing the virus

What are some risk factors for contracting hep B?

- Infants exposed during child birth - Sexual contact - Injection drug use - Household contact of HBV-positive px - Procedures w/ percutaneous exposure if tools are not sterilized

Can HBV be transmitted through breastfeeding?

Not through the milk, only if nipples are cracked and blood is present

What is the incubation time for HBV?

Average 60-90 days

What are sx of hep B?

- Majority are asymptomatic | - Sx include anorexia, abdominal pain, N/V

How long can acute illness of hep B last?

Up to 3 months, but most have spontaneous clearing after 4-8 weeks

Which group of px has the highest risk of becoming a chronic HBV carrier?

Infants

What do chronic HBV carriers have an increased risk of?

Developing cirrhosis and hepatocellular carcinoma

What is the tx for acute hepatitis B?

No specific tx; only treated if signs of liver damage (ex: jaundice)

How can hep B be prevented?

Vaccine

What is the dosing schedule for monovalent hepatitis B vaccine?

Intramuscular injection beginning w/ one dose at month 0, then repeated at month 1 and month 6

What are indications of the hepatitis B vaccine?

- People working in healthcare setting, correctional facilities - Sexual or household contacts of HBV carrier

What are adverse events associated w/ hep B vaccine?

- Well tolerated | - Mild and transient irritability, headache, fatigue, redness and injection site

Who should receive the hep B vaccine as post-exposure prophylaxis?

- Infant of mother w/ acute or chronic hepatitis - Percutaneous or mucosal exposure to blood or body fluids that may contain HBV - Sexual or household contacts of individual w/ acute hepatitis B or who is a chronic carrier

What are some non-pharms for hep B prevention?

- All chronic HBV patients should be educated to prevent viral transmission - Sexual and household contacts require vaccination - Chronic HBV px should avoid alcohol and get immunized against HAV to prevent further liver damage

What is the dosing for the hep A and hep B combination vaccine?

IM injection at month 0, 1, and 6

How is hep C transmitted?

- Blood borne - Sexual contact - Perinatal transmission from mother to child

What are risk factors for HCV?

- Injection drug use - Blood transfusion - Healthcare associated transmission (rare) - Prisoners, homeless, IV drug users are high risk

What are the sx of acute hep C?

- Most asymptomatic | - Sx may include anorexia, abdominal pain, fatigue, nausea, dark urine, jaundice

Can acute hep C turn into a chronic infection?

Yes, in up to 85% of px

What can chronic HCV cause?

Cirrhosis and hepatocellular cancer, leading to liver transplant

What is the tx for hep C?

Oral regiment w/ duration of 6-12 weeks or up to 24-48 weeks | - High cure rate (>90%)

What are some non-pharms for tx of hep C?

- Chronic HCV px should vaccinate against hep A and B - Avoid alcohol - Eat well balanced diet - Exercise regularly - Avoid smoking