L34 Acute hepatitis

Question 1

Route of transmission of hepatitis A-E?

Answer 1

Hepatitis A & E : fecal-oral route
Hepatitis B-D: 
- Vertical
- Percutaneous
- Per-mucosal

Question 2

What are the sources of the virus Hepatitis A?

Answer 2

• Faeces

- Seafood

Question 3

What are the sources of the virus Hepatitis E?

Answer 3

• Faeces

- Zoonosis (pig)

Question 4

What are the sources of the virus Hepatitis B-D?

Answer 4

• Blood

- Body fluid

Question 5

Which type of hepatitis acute/chronic will Hepatitis A-E cause?

Answer 5

A & E - Acute

B-D - Chronic

Question 6

Describe the fecal-oral route transmission in Hepatitis A (3).

Answer 6

1. Shellfish: bioaccumulation of toxin
2. Human-to-human: food handler, MSM
3. Blood exposure (rare)

Question 7

Describe the fecal-oral route transmission in Hepatitis E.

Answer 7

Via contaminated food (e.g. genotype 4 in pig livers)

Question 8

The incubation period for hepatitis A?

Answer 8

2-6 weeks

Question 9

Which of the following about Hep A is incorrect?
A. Not all infections of Hep A go through acute hepatitis
B. Children are mostly asymptomatic
C. Adults risk of infection increases with age
D. It is common to have fulminant hepatitis
E. Full recovery is possible and life-long immunity is gained

Answer 9

D

- rare!

Question 10

What are the symptoms of acute hepatitis in hep A infection?

Answer 10

1. Jaundice
2. Malaise
3. Fever

Question 11

What is the most useful marker for laboratory diagnosis in hepatitis A and E?

Answer 11

Anti-HAV/HEV IgM!!

Question 12

Incubation period for Hep E?

Answer 12

5 weeks

Question 13

The illness severity of Hep E _______ (increases/decreases) with age.

Answer 13

increases

Question 14

What is the case-fatality rate in Hep E infection? (2)

Answer 14

1. Low overall

2. High in pregnant women (genotype 1)

Question 15

Direct detection of Hep A and Hep E can be done, i.e. faecal shedding occurs before Sx onset, but of short duration in Hep A.

How about in Hep E? (compared to Hep A)

Answer 15

Direct detection by qPCR possible because of longer faecal shedding, overlap with symptoms onset.

Question 16

Epidemiology of Hep A: endemic in ____________ countries, disease rate varies (most affected during ___________).

Answer 16

Developing;

childhood > asymptomatic and immune afterwards

Question 17

Which of the following about Hep A is incorrect?
A. There is low endemicity of Hep A in HK
B. Hep A is usually transmitted by travellers in HK
C. Cases shift to older age
D. There is no seasonality of the spread of Hep A
E. There is no sexual pre-dominance of Hep A

Answer 17

D

- Jan-Mar

Question 18

Which of the following about Hep E is incorrect?
A. It is endemic in both developing and developed countris
B. Most common is Genotype 1 in HK
C. There is an increasing trend (c.f. Hep A) in Hong Kong
D. There is a male predominance of Hep E
E. People of all age is infected
F. There is the seasonality of the spread of Hep E: Feb-May (infection in Winter with prolonged incubation period)

Answer 18

B

• Genotype 4 is the MC in HK, infect humans and pigs > spread via zoonosis

Question 19

Viral hepatitis is a notifiable disease. T/F?

Answer 19

T

Question 20

How can people be protected by vaccination from Hep A? (3)

Answer 20

1. Monovalent vaccine: inactivated, 2 doses
2. Bivalent vaccine (+HBV): inactivated, 3 doses (not included in Childhood immunization program)
3. Pre-exposure prophylaxis for travelers: protection starts ~ 4 weeks after 1st dose

Question 21

How to prevent Hep E infection in Hong Kong?

Answer 21

• Hygiene: clean drinking water and ice, cooked food, fruits and vegetables
• Animal reservoir: well-cooked pig internal organs
• Vaccine is not available in HK