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Part 2 Revision > Hepatitis A > Flashcards

Hepatitis A Flashcards

1
Q

How many genotypes of HAV?

A

Three (I, II, III with subgenotypes IA, IB, IC, IIA, IIB, IIIA, IIIB)

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2
Q

When is the highest risk of trasnmission of HAV?

A

In the prodromal phase prior to symtom onset, which lasts about one week

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3
Q

Why is HAV so stable in the environmnet?

A

It can withstand, dryiingm low pH, detergents

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4
Q

How long do symptoms persist in HAV infection?

A

2-8 weeks

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5
Q

What percentage of adults and children have symptomatic HAV?

A

Adults >70%, children <30%

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6
Q

What percetage of patients with HAV have relapsoing hepatitis?

A

12% have relapsing hepatitis, 7% have prolonged cholestatis with pruritis and fatigue

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7
Q

What are the 5 presentations of HAV?

A

1) Asymptomatic 2) Hepatitis (jaundice etc) 3) Cholestatic hepatitis 4) Relapsing hepatitis 5) Fulminant hepatitis

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8
Q

What are symptoms of acute liver failure in HAV?

A

Rapid deterioration in liver function, hepatitic encephalopahty, loss of cognitiive brain fucntion, motor dysfunction

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9
Q

What % of patients with acute liver failure from HAV recover?

A

70% recover spontaneously with conservative therapty (fluidsm treating hypoglycaemia and elevtrolyte imbalacne, Abx and rest) 30% require liver transplant

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10
Q

What are the signs of severe acute liver failure?

A

Deterioration of hepatic systemic function - coagulopathy, reduced INR, rising creatinine, drop in serum albumin, rising blood ammonia and hepatitic encepahlopahty

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11
Q

What are extra-hepatitic manifestations of HAV?

A

Acute kidney injury, cryoglobulinaemia, cholecysisits, pancreatitis, pleural effusion, pneumonitiis, haemolysis, rahs, reactive arthrititis, neurological (mononeuritis, GBS, transverse myeltitis, neuritis)

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12
Q

Who is at risk of severe disease with HAV?

A

1) Patients with chronic liver disease 2) Severely immunosuppressed 3) Elderly (>50 y!!)

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13
Q

How long does viraemia and feacal shedding last in HAV infection?

A

Viraemia can last several months, faecel shedding can last for 6 months, and RNA detected in liver for up to 12 m

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14
Q

Is HAV IgM likely to be positive at onset of symptoms?

A

Can be falsely negative if collected <5 days post symptom onset

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15
Q

What region of the HAV genone is used for RT-PCR and what is used for genotyping?

A

PCR = 5’ NCR and genotyping = VP1-pX

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16
Q

What type of HAV vaccines are available in the UK?

A

Inactivated, either monovalent or combined with HBV or typhoid

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17
Q

Vaccine schedule for HAV vaccine

A

Primary dose gives 1 years protection, 2 doses 6-12 m apart >25 y immunity

18
Q

What age is HAV vaccine licensed for?

A

Over 1 year

19
Q

What is the antibody titre conisidered immune post HAV vaccine

A

20 mI/ml

20
Q

What are Havrix, Avaxim and Vaqta?

A

Monovalent HAV vaccines

21
Q

What are Twinrix and Ambirix?

A

HAV and HBV dual vaccine

22
Q

What does ViATIM vaccine protect against?

A

HAV and typhoid

23
Q

Who would get HAV vaccine as pre-exposure prophylaxis?

A

Travellers, severe or chronic illness, haemophiliacs, MSM, PWID, lab workers, sewage workers, staff and residents at large residential institutions, people working with primates. Consider in: healthcare workers, staff at daycare facilities, food handlers

24
Q

How affective is HNIG as PEP following HAV exposure?

A

80-90% effective if administered within 14 days

25
Q

How long does HNIG last as passive immunisation for HAV?

A

4-6 months

26
Q

How long must you wait between giving HNIG and administering a live vaccine?

A

3 months

27
Q

When would you test for HAV IgG in a contact?

A

To avoid giving HNIG unneccessarily - and only if you can get a result within 3 days and within the PEP window (either post contact or within 7 days of vaccine)

28
Q

What is the infectious period of HAV?

A

2 weeks prior to first symptoms until 1 week post jaundice (or other symptoms if no jaundice)

29
Q

Who would be considered immune post HAV contact? And what PEP would you consider?

A

Patients with 1) previous lab confirmed HAV infection, 2) 2 vaccines in the last 10 years 3) 1 vaccine in the last 12 months. No PEP

30
Q

Who would be considered ‘primed’ post HAV contact? And what PEP would you consider?

A

Patients with 1) 2 vaccines >10 years ago 2) 1 vaccine >12 months ago. Vaccine only, no HNIG

31
Q

How would you manage the index case of HAV outbreak?

A

Advise good hand hygeine! Exclude for 7 days from onset of jaundice, identify possible source, risk assessment and questionnaire

32
Q

If a patient is vaccinated for HAV as a contact, can you still administer HNIG?

A

Yes, but only within 7 days of vaccine

33
Q

HAV PEP for healthy 1-59 year olds

A

Within 14 d: vaccine only. After 14 d: vaccinate up to 8 weeks post exposure only if >1 case in household

34
Q

HAV PEP for healthy <1 year old identified within 14 days

A

Not at nursery: vaccinate nappy changers. At nursery: vaccinate if >2 months

35
Q

PEP for healthly 1 year old identified >14 days post contact

A

Reinforce hygeine, if not possible, exclude for 30 days. If unable to exclude, vaccinate all contacts at nursery aged >2 months

36
Q

HAV PEP for >60 year olds

A

Vaccine and HNIG (within 14 days)

37
Q

HAV PEP for immunosuppressed contacts

A

Vaccine and HNIG (within 14 days)

38
Q

HAV PEP for patients with chronic liver disease

A

Vaccine and HNIG (within 28 days)

39
Q

HAV PEP for food handler

A

Within 14 days: vaccinate. >14 days: move duties til 30 days post exposure

40
Q

Which groups of people are at increased risk of spreading HAV?

A

A) People with doubfful personal hygeine B) All <5 years who atttend childcare C) Food handlers D) Clinical and social care staff

41
Q

What vaccine coverage is required to disrupt transmission in a HAV outbreak?

A

40% vaccine coverage (assuming an R0 of 1.6)

42
Q

Why should haemophiliacs be vaccinated against HAV?

A

HAV transmission has been associated with Factor VIII and IX, as HAV can withstand the inactivation process

Part 2 Revision (35 decks)

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