Hepatitis

Question 1

Viral causes of Hepatitis

Answer 1

Hep A, B, D, C, E
Human herpes viruses (HSV, VZV, CMV, EBV)

Question 2

Which viral hepatitis are the most common contributers to liver disease and why

Answer 2

B & C because they go chronic

Question 3

Non viral causes of hepatitis

Answer 3

Spirochetes (leptospirosis, syphilis)
Mycobacteria (tb)
Bacteria e.g. bartonella
Parasites e.g. toxoplasma

Question 4

Global burden/trends of hep

Answer 4

Going up
B especially going up as no cure
C now a cure - so starting to come down
Chronic Hep B: 296 million
Chronic Hep C: 60 million

Question 5

Hep B Transmission

Answer 5

Blood borne
Mother to child
Household contact
Blood products
Iatrogenic
Occupational
Sexual
IVDU

Question 6

Natural history of Hep B
In immunocompetent adults

Answer 6

Acute infection either leads to spontaneous resolution (95%) (risk of reactivation if immunosuppressed) or chronic HepB infection (5%).
25% Chronic hep B leads to cirrhosis. Then may lead to HCC or decompensated cirrhosis

Question 7

Symptoms of decompensated cirrhosis

Answer 7

Jaundice
Ascites
Encephalopathy
Coagulopathy
Hypoalbuminaemia
Variceal bleeding

Question 8

Hep B natural history in neonates and infants

Answer 8

10% spontaneous resolution
90% chronic HBV infection

Question 9

Hep D

Answer 9

defective RNA virus
requires HBsAg presence to replicate
Transmission: blood borne - most common = blood products, iatrogenic or IVDU

Question 10

Hep C transmission

Answer 10

Blood borne - blood & bodily fluids
mother to child
household contact
blood products
iatrogenic
occupational
MSM
injecting drug use
tattoos, piercings

Question 11

Hep C Natural history in immunocompetent

Answer 11

30% spontaneous resolution
70% chronic –> cirrhosis & HCC

Question 12

Hep E

Answer 12

Endemic in UK
Faeco-oral transmission
- contaminated food and water
- undercooked meat

chronic - rare

Question 13

Hep A

Answer 13

Very low prev UK
Faeco-oral transmission
- contaminated food and water
- linked to poor access to WASH
- In high income countries: travel, MSM & IVDU
.35% fulminant hep
No chronic disease
Lifelong immunity post exposure

Question 14

What is elimination of disease

Answer 14

reduction to 0 incidence in defined geographical location, continued intervention measures recquired

Question 15

What is elimination of infection

Answer 15

Reduction to zero of incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts; continued measures to prevent re-establishment of transmission are required.
e.g. poliomyelitis

Question 16

What is eradication

Answer 16

Permanent reduction to zero of worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.
e.g. smallpox

Question 17

What is extinction

Answer 17

doesn’t even exist in labs etc

Question 18

Indicators of eradicability

Answer 18

• effective intervention available to interrupt transmission of agent
• practical diagnostic tools to determine levels of infection that can lead to transmission
• humans are essential for lifecycle: independent reservoir/environmental amplification makes v difficult to control

Question 19

Measures to eradicate Hep B

Answer 19

• Universal childhood hep V vaccination
• PEP for neonates with positive mothers
• Screening of blood products
• Single use sterile medical equipment
• safe disposal of sharps & body waste
• needle syringe exchange
• opiate substitution therapy
• safe sex education & condoms
• vaccination of high risk
• screening & immunisation of susceptible contacts
• patient education
• treatment as prevention

Question 20

potential measures to eradicate Hep C

Answer 20

No vaccine
- screening blood products
- sterile medical equipment
- universal precautions
- safe disposal
- needle exchange
- opiate therapy
- safe sex & condoms
- screening of contacts
- patient education
- DAA (treatment)
- treatment as prevention

Question 21

5 core WHO strategy interventions for viral hep

Answer 21

• Vaccines (ABE)
• Prevention of mother to child transmission of HBV
• Injection, blood & surgical safety
• harm reduction for IVDU
• Treatment (B&C)

Question 22

Barriers to hep B elimination

Answer 22

• immigrant population
• stigma
• low education levels
• low resources (expand)
• lack of political priority

Question 23

Barriers to Hep C elimination

Answer 23

• difficult to engage at risk population (mostly IVDU)
• Conflicting priorities
• lack of awareness
• stigma
• cost of treatment
• lack of resources
• lack of political priority