I: Viral Hepatitis

Question 1

Describe the relevance of hepatitis B in a global context in comparison to the UK.

Answer 1

There are 400 million people with Hep B worldwide with 4 million new cases each week.

In comparison, 1/1000 people in the UK are affected.

Question 2

How is a hepatitis B infection transmitted?

Answer 2

• Vertical transmission (75% of cases)
• Sexual contact
• IVDU
• HCW needle stick injuries

Question 3

Give some symptoms of acute Hep B.

Answer 3

• Jaundice
• Fatigue
• Abdominal pain
• Anorexia/ Nausea/ Vomiting

Question 4

Describe the relevance of hepatitis C in a global context in comparison to the UK.

Answer 4

There are 200 million people worldwide with Hep C however how many new cases there are each year are unknown as most people are untested.

In comparison, 1/200 people are thought to have Hep C however most are again untested.

Question 5

Where do Hepatitis viruses replicate?

Answer 5

Hepatocytes, hence why it leads to liver inflammation.

Question 6

Name the types of hepatitis viruses that can result in a chronic illness.

Answer 6

Hep B
Hep C
Hep D (only with Hep B)
Hep E (uncommon but possible)

Question 7

Name the types of hepatitis viruses that cannot result in a chronic illness.

Answer 7

Hep A
Hep E (rarely chronic)

Question 8

Does everyone who is infected with Hep B, end up with a chronic form of the virus?

Answer 8

No, in adults only up to 10% of infected patients become chronically infected.

Whereas in infants this increases to 90%.

Question 9

Describe the serology of Hepatitis B.

Answer 9

1. Surface antigen
2. e-antigen
3. Core antibody (IgM- core antigen cannot be seen on a blood screen, only on a liver tissue screen)
4. e-antibody
5. Surface antibody
6. core antibody (IgG)

Question 10

Describe the treatment available for Hep B.

Answer 10

Life long Antivirals however these aren’t required for everyone if a patient has a low viral load or no liver damage.

Question 11

Can you vaccinate against Hep B?

Answer 11

Yep, it’s formed from genetically engineered surface antigen.

Question 12

How would you expect a serology test of a patient with an acute Hep B infection to show?

Answer 12

• Surface antigen (HbsAg)
• Core antibody (IgM)
• Surface antibody (HbsAb)

Question 13

How would you expect a serology test of a patient with a past but cleared infection of Hep B infection to show?

Answer 13

• Core antibody (IgM)

- Surface antibody (HbsAb)

Question 14

How would you expect a serology test of a patient with a chronic Hep B infection to show?

Answer 14

• Surface antigen (HbsAg)

- Core antibody (IgM)

Question 15

How would you expect a serology test of a patient who has never been infected with a Hep B infection but has been vaccinated to show?

Answer 15

• Surface antibody (HbsAb)

Question 16

How is Hep C transmitted?

Answer 16

• IVDU
• Sexual contact
• Infants born to HVC positive mothers
• HCW needlestick injuries

Question 17

How many individuals with Hep C will be me chronically infected?

Answer 17

80%- these will get liver disease and hepatocellular carcinoma.

Question 18

What does the serology of Hep C test for?

Answer 18

Anti-Hep C antibody only, you will need to do a viral load PCR to see if they’re currently infected.

Question 19

Describe the symptoms of a patient with Hep C infection.

Answer 19

Usually none