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Practice bulletins > #86 Viral Hepatitis in Pregnancy > Flashcards

#86 Viral Hepatitis in Pregnancy Flashcards

1
Q

What kind of a virus is hepatitis A?

A

RNA virus

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2
Q

What is the incubation period of Hepatitis A?

A

Average 28d (range 15-50d)

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3
Q

Where does hepatitis A replicate in humans and how is it transmitted?

A

Replicates in liver. Fecal-oral transmission (secreted in bile > feces)

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4
Q

Who is often an asymptomatic carrier of hepatitis A and can infect others?

A

Children!

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5
Q

How long can hepatitis A last in the environment?

A

Months

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6
Q

How can you inactive Hepatitis A in the environment/food?

A

Heating foods >185F for 1 minute or disinfecting surfaces with dilute bleach

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7
Q

What is prognosis for Hepatitis A infection?

A

Case fatality <1%. No chronic hepatitis A infection. 10-15% of symptomatic individuals can have relapsing disease up to 6 months

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8
Q

What kind of a virus is Hepatitis B?

A

DNA virus

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9
Q

What does the presence of hepatitis B e Ag represent?

A

extremely high viral inoculum and active virus replication.

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10
Q

How is Hepatitis B transmitted?

A

Parenteral and sexual contact

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11
Q

How long does Hepatitis B last in the environment?

A

Approximately 7 days

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12
Q

Approximately what %tage of the frequent sexual contacts of infected individuals will themselves become infected

A

25%

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13
Q

What is the risk of Hepatitis B from a blood transfusion?

A

1 in 137,000

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14
Q

Mortality rate with Hepatitis B?

A

1%

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15
Q

What percentage of adults infected with Hepatitis B become chronically infected?

A

10-15%

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16
Q

What percentage of adults infected with Hepatitis B experience complete resolution of their symptoms and develop protective level of antibodies?

A

85-90%

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17
Q

What are possible complications of chronic Hepatitis B?

A

chronic hepatitis, cirrhosis, chronic liver disease, hepatocellular carcinoma

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18
Q

What are the principal risk factors for Hepatitis C infection?

A

Blood transfusions, IV drug use

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19
Q

What is the risk of hepatitis C from blood transfusion?

A

Less than 1 in 1,000,000

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20
Q

What is the incubation period of hepatitis C?

A

30-60 days

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21
Q

How often are hepatitis C infections asymptomatic?

A

75% of the time

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22
Q

How often do hepatitis C infections become chronic?

A

50%

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23
Q

What outcomes are associated with chronic hep C infection?

A

B cell lymphoma, cryoglobulinemia, chronic active hepatitis, cirrhosis. Relationship to hepatocellular carcinoma in controversial.

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24
Q

How is Hepatitis D transmitted?

A

Through blood. In conjunction with or after infection with Hepatitis B.

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25
Q

What are risks of chronic Hepatitis D?

A

70–80% ultimately develop cirrhosis and portal hypertension, 15% of whom develop an unusually rapid progression to cirrhosis within 2 years of the initial onset of acute illness.

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26
Q

Mortality rate of hepatitis D?

A

25%

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27
Q

Prognosis of Hepatitis E?

A

self-limited viral infection followed by recovery; the incubation period is 3–8 weeks, with a mean of 40 days

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28
Q

What is maternal mortality rate with Hepatitis E in 3rd trimester?

A

As high as 20%

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29
Q

What is in hepatitis A vaccine?

A

Inactivated hepatitis A

30
Q

What is in hepatitis B vaccine? Is it safe to administer in pregnancy?

A

Recombinant protein nonviral antigen. Yes

31
Q

How effective is the hepatitis A vaccine?

A

94-100% immunogenic after first dose. Highly effective!

32
Q

What can you do if someone has known exposure to hepatitis A?

A

Immunoglobulin is available for post-exposure prophylaxis given in addition to Hepatitis A vaccine. Studies starting to look at administering only the vaccine for post exposure prophylaxis

33
Q

Who should be vaccinated against hepatitis B?

A

All individuals with risk factors (eg health care workers). Groups at increased risk: hemodialysis patients, IV drug users, >1 sexual partner during the past 3mo, recent STD diagnosis, clients and staff in centers for the developmentally delayed, and international travelers who will be in high or intermediate prevalence areas for HBV infection

34
Q

How effective is Hepatitis B vaccine?

A

Results in seroconversion of 95% of people

35
Q

Where should the Hep B vaccine be administered?

A

Deltoid muscle. Lower rates of conversion when given intragluteal or intradermal.

36
Q

What should someone with hepatitis B exposure who is unvaccinated (or vaccinated with no seroconversion) do for post exposure prophylaxis?

A

Passive immunization with HBIG and start immunization series

37
Q

Up to what time period can you give postexposure prophylaxis for Hepatitis B after sexual encouter?

A

HBIG up to 14 days

38
Q

What are the typical symptoms of acute hepatitis?

A

Fatigue, malaise, anorexia, nausea, RUQ or epigastric pain

39
Q

What are typical physical findings in acute hepatitis?

A

Jaudice, upper abdominal tenderness, hepatomegaly. Dark urine, acholic/gray stools.

40
Q

What are the typical signs of end stage liver disease?

A

Jaundice, muscle wasting, spider angiomas, ascites, palmar erythema, hepatic encephalopathy

41
Q

In pregnant patients with acute hepatitis, who should be admitted?

A

Those with encephalopathy, coagulopathy, or severe debilitation

42
Q

Can you treat pregnant women with acute hepatitis as an outpatient?

A

Yesz

43
Q

What precautions should you give a pregnant woman with acute hepatitis?

A

Ensure good PO intake, avoid upper abdominal trauma, reduce level of activity, avoid intimate contact with household/sexual partners until these partners receive prophylaxis

44
Q

What do you see on histology for viral hepatitis?

A

Hepatocellular injury and inflammatory infiltrate

45
Q

What test do you send to look for hepatitis A?

A

Hepatitis A IgM

46
Q

What antibody/antigen testing is associated with chronic carrier state of Hepatitis B?

A

HBSAg pos, HBSAb neg.

47
Q

What predicts chronic carrier state in heptitis B?

A

Hepatitis B Ag pos >20wks

48
Q

What is the serologic window in hepatitis B infection?

A

When HBSAg is being cleared and undectable, but HBSAb has not yet risen to detectable levels

49
Q

How can you diagnose hepatitis B during serologic window?

A

Check HBCAb

50
Q

How long is IgM anti-HBc present?

A

6 months

51
Q

When can you detect HCV antibody?

A

6-10 weeks after clinical illness

52
Q

What is the earliest way to detect hepatitis C infection?

A

Viral RNA test by PCR

53
Q

Can persistent viremia and end organ damage occur from hepatitis D in the presence of IgG antibodies to hepatitis D?

A

Yes

54
Q

How is hepatitis E diagnosed?

A

The presence of antibodies in patient with risk factors

55
Q

What is the risk of perinatal hepatitis B transmission in women with HBsAg without prophylaxis for neonate?

A

10-20%

56
Q

What is the frequency of vertical transmission with women who are both HBsAg and HBeAg positive without neonatal prophylaxis?

A

90%

57
Q

What is the risk of chronic hepatitis and its sequelae from adult-acquired hepatitis B?

A

5-10%

58
Q

What is the risk of chronic infection with hepatitis B when acquired perinatally?

A

85-95%

59
Q

What is more risky for the neonate: if mom acquires hepatitis B in first or third trimester?

A

Third trimester. Risk of infection 80-90% vs up to 10%

60
Q

What should be given to an infant with a mother who is Hep B positive or Hep B status unknown?

A

Hep B vaccine and HBIG within 12 hours after birth. Two more doses of vaccine prior to 6 months

61
Q

How much does passive and active prophylaxis against hepatitis B decrease the risk of perinatal transmission?

A

85-95% efficacy

62
Q

What is the risk of vertical transmission of hepatitis C in a woman with viremia?

A

2-8%

63
Q

What other risk factor(s) increases the risk of vertical transmission of hepatitis C?

A

Coinfection with HIV raises risk to as much as 44%. Others include high viral load, prolonged rupture of membranes (>6hrs), internal fetal monitoring.

64
Q

When does vertical transmission of hepatitis B most often occur (prenatal, intrapartum, post partum)?

A

Intrapartum. 85-95% caused by exposure to infected gential tract sections and blood

65
Q

Is active/chronic hepatitis B or C a contraindication to amniocentesis?

A

Does not seem to increase risk of infecting infant, but data is limited. Recommend noninvasive screening options

66
Q

Is hepatitis infection a contraindication to breast feeding?

A

No

67
Q

Is hepatitis A vaccine safe in pregnancy?

A

Yes

68
Q

What can be offered to a pregnant woman with hepatitis A exposure?

A

Post exposure prophylaxis with immunoglobulin and vaccine

69
Q

What is the risk of infection per injury with HBV-infected blood?

A

20-30%

70
Q

What is the risk of infection per injury with HIV-infected blood?

A

0.3%

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