#86 Viral Hepatitis in Pregnancy Flashcards
What kind of a virus is hepatitis A?
RNA virus
What is the incubation period of Hepatitis A?
Average 28d (range 15-50d)
Where does hepatitis A replicate in humans and how is it transmitted?
Replicates in liver. Fecal-oral transmission (secreted in bile > feces)
Who is often an asymptomatic carrier of hepatitis A and can infect others?
Children!
How long can hepatitis A last in the environment?
Months
How can you inactive Hepatitis A in the environment/food?
Heating foods >185F for 1 minute or disinfecting surfaces with dilute bleach
What is prognosis for Hepatitis A infection?
Case fatality <1%. No chronic hepatitis A infection. 10-15% of symptomatic individuals can have relapsing disease up to 6 months
What kind of a virus is Hepatitis B?
DNA virus
What does the presence of hepatitis B e Ag represent?
extremely high viral inoculum and active virus replication.
How is Hepatitis B transmitted?
Parenteral and sexual contact
How long does Hepatitis B last in the environment?
Approximately 7 days
Approximately what %tage of the frequent sexual contacts of infected individuals will themselves become infected
25%
What is the risk of Hepatitis B from a blood transfusion?
1 in 137,000
Mortality rate with Hepatitis B?
1%
What percentage of adults infected with Hepatitis B become chronically infected?
10-15%
What percentage of adults infected with Hepatitis B experience complete resolution of their symptoms and develop protective level of antibodies?
85-90%
What are possible complications of chronic Hepatitis B?
chronic hepatitis, cirrhosis, chronic liver disease, hepatocellular carcinoma
What are the principal risk factors for Hepatitis C infection?
Blood transfusions, IV drug use
What is the risk of hepatitis C from blood transfusion?
Less than 1 in 1,000,000
What is the incubation period of hepatitis C?
30-60 days
How often are hepatitis C infections asymptomatic?
75% of the time
How often do hepatitis C infections become chronic?
50%
What outcomes are associated with chronic hep C infection?
B cell lymphoma, cryoglobulinemia, chronic active hepatitis, cirrhosis. Relationship to hepatocellular carcinoma in controversial.
How is Hepatitis D transmitted?
Through blood. In conjunction with or after infection with Hepatitis B.
What are risks of chronic Hepatitis D?
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.
Mortality rate of hepatitis D?
25%
Prognosis of Hepatitis E?
self-limited viral infection followed by recovery; the incubation period is 3–8 weeks, with a mean of 40 days
What is maternal mortality rate with Hepatitis E in 3rd trimester?
As high as 20%
What is in hepatitis A vaccine?
Inactivated hepatitis A
What is in hepatitis B vaccine? Is it safe to administer in pregnancy?
Recombinant protein nonviral antigen. Yes
How effective is the hepatitis A vaccine?
94-100% immunogenic after first dose. Highly effective!
What can you do if someone has known exposure to hepatitis 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
Who should be vaccinated against hepatitis B?
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
How effective is Hepatitis B vaccine?
Results in seroconversion of 95% of people
Where should the Hep B vaccine be administered?
Deltoid muscle. Lower rates of conversion when given intragluteal or intradermal.
What should someone with hepatitis B exposure who is unvaccinated (or vaccinated with no seroconversion) do for post exposure prophylaxis?
Passive immunization with HBIG and start immunization series
Up to what time period can you give postexposure prophylaxis for Hepatitis B after sexual encouter?
HBIG up to 14 days
What are the typical symptoms of acute hepatitis?
Fatigue, malaise, anorexia, nausea, RUQ or epigastric pain
What are typical physical findings in acute hepatitis?
Jaudice, upper abdominal tenderness, hepatomegaly. Dark urine, acholic/gray stools.
What are the typical signs of end stage liver disease?
Jaundice, muscle wasting, spider angiomas, ascites, palmar erythema, hepatic encephalopathy
In pregnant patients with acute hepatitis, who should be admitted?
Those with encephalopathy, coagulopathy, or severe debilitation
Can you treat pregnant women with acute hepatitis as an outpatient?
Yesz
What precautions should you give a pregnant woman with acute hepatitis?
Ensure good PO intake, avoid upper abdominal trauma, reduce level of activity, avoid intimate contact with household/sexual partners until these partners receive prophylaxis
What do you see on histology for viral hepatitis?
Hepatocellular injury and inflammatory infiltrate
What test do you send to look for hepatitis A?
Hepatitis A IgM
What antibody/antigen testing is associated with chronic carrier state of Hepatitis B?
HBSAg pos, HBSAb neg.
What predicts chronic carrier state in heptitis B?
Hepatitis B Ag pos >20wks
What is the serologic window in hepatitis B infection?
When HBSAg is being cleared and undectable, but HBSAb has not yet risen to detectable levels
How can you diagnose hepatitis B during serologic window?
Check HBCAb
How long is IgM anti-HBc present?
6 months
When can you detect HCV antibody?
6-10 weeks after clinical illness
What is the earliest way to detect hepatitis C infection?
Viral RNA test by PCR
Can persistent viremia and end organ damage occur from hepatitis D in the presence of IgG antibodies to hepatitis D?
Yes
How is hepatitis E diagnosed?
The presence of antibodies in patient with risk factors
What is the risk of perinatal hepatitis B transmission in women with HBsAg without prophylaxis for neonate?
10-20%
What is the frequency of vertical transmission with women who are both HBsAg and HBeAg positive without neonatal prophylaxis?
90%
What is the risk of chronic hepatitis and its sequelae from adult-acquired hepatitis B?
5-10%
What is the risk of chronic infection with hepatitis B when acquired perinatally?
85-95%
What is more risky for the neonate: if mom acquires hepatitis B in first or third trimester?
Third trimester. Risk of infection 80-90% vs up to 10%
What should be given to an infant with a mother who is Hep B positive or Hep B status unknown?
Hep B vaccine and HBIG within 12 hours after birth. Two more doses of vaccine prior to 6 months
How much does passive and active prophylaxis against hepatitis B decrease the risk of perinatal transmission?
85-95% efficacy
What is the risk of vertical transmission of hepatitis C in a woman with viremia?
2-8%
What other risk factor(s) increases the risk of vertical transmission of hepatitis C?
Coinfection with HIV raises risk to as much as 44%. Others include high viral load, prolonged rupture of membranes (>6hrs), internal fetal monitoring.
When does vertical transmission of hepatitis B most often occur (prenatal, intrapartum, post partum)?
Intrapartum. 85-95% caused by exposure to infected gential tract sections and blood
Is active/chronic hepatitis B or C a contraindication to amniocentesis?
Does not seem to increase risk of infecting infant, but data is limited. Recommend noninvasive screening options
Is hepatitis infection a contraindication to breast feeding?
No
Is hepatitis A vaccine safe in pregnancy?
Yes
What can be offered to a pregnant woman with hepatitis A exposure?
Post exposure prophylaxis with immunoglobulin and vaccine
What is the risk of infection per injury with HBV-infected blood?
20-30%
What is the risk of infection per injury with HIV-infected blood?
0.3%
