Hepatitis Viruses

Question 1

What Hepatitis viruses are blood borne?

Answer 1

Hep B, Hep C and Hep D

Question 2

What type of genome is Hep A?

Answer 2

single stranded RNA genome

Question 3

How is Hep A transmitted?

Answer 3

faecal - oral route
person - person
water borne
Food borne

Question 4

What are the clinical features of Hep A?

Answer 4

Incubation period of 2 - 7 weeks.
No chronic disease
Low mortality

Question 5

How do you diagnose Hep A?

Answer 5

Anti-HAV antibodies in the blood
IgG in the blood
HAV antigens in faeces

Question 6

What type of genome is Hep B?

Answer 6

Partially double stranded DNA genome

Question 7

What are the characteristics of Hep B?

Answer 7

Hepadnavirus - virus affects the liver

Very infectious - especially if the individual is E antigen positive.

Common in the younger generation

Question 8

What type of particles are present in Hep B? - describe them.

Answer 8

Dane particles - spherical

DNA genome in the centre.
Viral casting of excessive surface antigens

Question 9

How is Hep B transmitted?

Answer 9

Blood borne - IV drug use

Perinatal - infected mother transmits the disease to their baby when blood mixes during childbirth.

Sexual transmission - homo and hetro

Question 10

Define a carrier.

Answer 10

An individual who tests positive for surface antigens for longer than 6 months but hasn’t developed antibodies against the virus.

Question 11

How can individuals be immunised against Hep B?

Answer 11

Passive immunisation - Antibodies against Hep B are given to the individual at high risk.

Active immunisation - Hep B surface antigen absorbed on to a aluminium hydroxide adjuvant is given intramuscularly.

Question 12

When is passive immunisation used?

Answer 12

Used In an non-immune individual with a single acute exposure.

Question 13

When must the passive immunisation be used after exposure to hep B?

Answer 13

Within 48 hours

Question 14

How many dosages are required in active hep B immunisation? When must each dose be administered?

Answer 14

3 dosages

Initial dose - a dose 1 month later - a dose 6 months later

Question 15

When must an individual be tested for response to the active vaccination against Hep B?

Answer 15

2 - 4 months after the last dosage of the vaccination.

Question 16

What are non-responders to the active Hep B vaccination given?

Answer 16

HBIG (if working in the occupational setting)

Suppressing the viral load via;
Nucleoside analogues
Nucleotide analogues
Immunomodulatory agents

Question 17

What is indicated if the Hep B antibodies are found in someones blood?

Answer 17

That the individual has been vaccinated.

That the individual has had the virus before.

Question 18

What is indicated if the Hep B E antigens are found in someones blood?

Answer 18

That the individual still has an active and persistent form of Hep B and is at great risk of chronic liver disease.

Question 19

How many genotypes of Hep C are there?

Answer 19

6

Question 20

Is there a vaccine for Hep C?

Answer 20

No - too many genotypes and the surface antigens are constantly evolving.

Question 21

What kind of genotype is Hep C?

Answer 21

Enveloped RNA virus

Question 22

What are the clinical feature of Hep C? (How does hep C present?)

Answer 22

Both acute and Chronic is Subclinical

25% present with jaundice in acute Hep C.

Question 23

How is Hep C transmitted?

Answer 23

Blood borne:
Iv drug
Transplantation

Vertical transfer - mother to child

Sexually transmitted

Question 24

What tools are used to diagnose Hep C?

Answer 24

Anti-HCV test - detects antibodies to determines if the patient has been exposed to hep C

Viral genotyping - determines which genotype of Hep C.

Viral load test - determines how many viral particles are in the blood

HCV RNA - determines if the virus is active

Question 25

What are the outcomes of Hep C?

Answer 25

Treated at the acute stage = resolution

Stable chronic disease

or;

Chronic disease can progress to;
Cirrhosis 
Hepatocellular cancer 
Liver disease 
Death

Question 26

What is the treatment for Hep C?

Answer 26

Interferon alpha combined with:
Ribavirin
telprevir - treatment of genotype 1

Second generation protease inhibitors:
Sofosbuvir

Question 27

What does Hep B commonly co-infect with?

Answer 27

Hep D (Hep D requires B for replication)

Question 28

How is Hep D transmitted?

Answer 28

Blood borne
Parental
Sexually transmitted
Alongside Hep B

Question 29

How do you vaccinate against Hep D?

Answer 29

Hep B vaccinations prevents Hep D.

Question 30

What are the outcomes of Hep D?

Answer 30

Co-infection with Hep B = commonly resolution.

Super-infection = commonly chronicity, which leads to cirrhosis and hepatocellular cancer.

Question 31

How is Hep E transmitted?

Answer 31

Faecally contaminated water.

Question 32

What is the outcome of Hep E?

Answer 32

No chronic disease

Question 33

How long is the incubation period for Hep A?

Answer 33

2 - 7 weeks