3 - Hepatitis Flashcards
Which hepatitis viruses are transmitted through fecal-oral contamination?
A and E
Which hepatitis viruses are transmitted parenterally?
B, C, and delta
What is important to note about delta hepatitis?
Must have a co-infection w/ hepatitis B
How can the hepatitis A virus be killed?
Only with extreme high temperatures, not extreme cold temps
Is the hepatitis A or hepatitis B virus able to survive in the environment for longer?
Hepatitis A (can survive for months)
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
What is the incubation period for hepatitis A?
Approx. 28 days (range 15-50 days)
When do px infected w/ hep A begin to shed the virus?
1-2 weeks after exposure
What are the stages of acute hepatitis A?
- Prodromal period
- Acute illness w/ abrupt onset
- Icteric hepatitis
What are sx of the prodromal period of hepatitis A?
Flu-like sx (some may be mild) like anorexia, nausea, fatigue, malaise
What are sx of hepatitis A w/ acute illness w/ abrupt onset?
- Anorexia
- Nausea, vomiting
- Malaise
- Fever
- Headache
- Right upper quadrant abdominal pain
What are sx of icteric hepatitis?
- Dark urine
- Light-coloured stools
- Worsening of sx
- Pruritus
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
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
Can HAV result in a chronic infection?
No
What some possible complications associated w/ hepatitis A?
- Relapsing hepatitis
- Cholestatic hepatitis
- Fulminant hepatitis
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
How can hepatitis A be prevented?
- Vaccination
- Human immune globulin
What is the dosing for the hepatitis A vaccine?
Intramuscular injection w/ one dose (primary immunization) and then booster 6-36 months later
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
