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7451 Infectious Disease > S44 Viral Hepatitis > Flashcards

S44 Viral Hepatitis Flashcards

1
Q

Acute Viral Infection

A

Non-specific

Malaise, fatigue, nausea, anorexia, low grade fever, and arthralgia

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2
Q

Chronic Viral Infection

A

Usually asymptomatic

Fatigue, malaise, low-grade fever, anorexia, and weight loss

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3
Q

Disease Progression

A

Pruritus, dark urine, and jaundice

Can lead to cirrhosis and hepatocellular carcinoma

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4
Q

Types of Hepatitis

Source is Feces

A

A and E

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5
Q

Types of Hepatitis

Source is Blood/bloody fluids

A

B, C and D

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6
Q

Types of Hepatitis
Route of transmission
Fecal Oral

A

A and E

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7
Q

Types of Hepatitis
Route of transmission
Fecal Oral Percutaneous / permucosal

A

B, C and D

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8
Q

Types of Hepatitis
Chronic infection
No

A

A and E

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9
Q

Types of Hepatitis
Chronic infection
Yes

A

B, C and D

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10
Q

Types of Hepatitis
Prevention
Pre/post exposure immunization

A

A, B and D

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11
Q

Types of Hepatitis
Prevention
Blood donor screening; risk behavior modification

A

C

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12
Q

Types of Hepatitis
Prevention
Ensure safe drinking water

A

E

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13
Q

Fecal-oral spread: hygiene, drug use, high risk sexual activity, travelers, day care, food
Vaccine-preventable

A

A

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14
Q

Sexually transmitted – 100x more infectious than HIV

Blood-borne (sex, injection drug use, mother-child, and health care)

A

B

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15
Q 
Blood borne (injection drug use primarily) – 4-5x more common than HIV
NOT vaccine-preventable
A

C

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16
Q

How is HCV most commonly transmitted in the US?

A

Healthcare
Mother-child
Injection drug use
Fecal-oral

17
Q

HAV

A

Transmitted through fecal-oral route, person-person, or consuming contaminated food/water
Beware of children
Prevalence linked to low socioeconomic status
Low mortality rate but highest amongst the elderly

18
Q

HAV Etiology

A

RNA virus of the Picornaviridae family

Heating foods to ≥ 85°C , disinfecting with bleach, or chlorination of water will inactivate virus

19
Q

HAV Acute infections

signs and symptoms

A

Non-specific features: fever, malaise, anorexia, nausea, jaundice and abdominal discomfort
Severity depends on age and co-morbidities

20
Q

HAV Acute infections

Laboratory Findings

A 
Increase ↑ ALT/AST with ALT>AST
Increase ↑ bilirubin 
Immunoglobulin (IgM), anti-HAV (+) 
HAV RNA in serum or stool 
Total anti-HAV (+) and IgM anti-HAV (-) denotes immunity
21
Q

HAV Acute infections

Treatment

A

No specific treatment options available

General supportive care

Most fully recover within 6 months, majority within 2 months

Practice good hand-hygiene to prevent transmission

22
Q

Prevention: Recommendations for HAV Vaccination

A

Children ≥ 12 months
Health care workers at drug rehabs, group homes, and facilities for the disabled
Men who have sex with men (MSM)
Injection and non-injection drug use
Chronic liver disease and/or HIV
Homeless/unstable housing
Currently or recently incarcerated
International travelers or close contact with an international adoptee
Anyone who would like immunity
Pregnant women who are at high risk for infection or for having severe outcomes

23
Q

Available Vaccines
Intramuscular injection
HAVRIX®

Age
dosage
number
schedule

A

Age 1-18
dosage 0.5 mL
number of doses 2
schedule 0, 6-12 months

Age ≥19
dosage 1 mL
number 2
schedule 0, 6-12 months

24
Q

Available Vaccines
Intramuscular injection
VAQTA®

Age
dosage
number
schedule

A

1-18
0.5 mL
2
0, 6-18 months

≥19
1 mL
2
0, 6-18 months

25
Q

Available Vaccines
Intramuscular injection
TWINRIX®*

Age
dosage
number
schedule

A

≥18
1 mL
3
0, 1, 6 months

26
Q

Post-exposure Prophylaxis

A

Vaccine is preferred for most because of long-term immunity

Common side effects: soreness/warmth at injection site, headache, fever, malaise, irritability, loss of appetite, drowsiness

27
Q

Post-exposure Prophylaxis

Age
dosage

A

For patients > 40 years or with underlying conditions, immunoglobulin is preferred in addition to vaccine

Only intramuscular injection is used
Dose: 0.1 ml/kg
Serious adverse effects are rare

28
Q

CT is a 35 year old female who is planning a trip to Cancun. She does not believe she has been vaccinated for HAV before due to her fear of shots. She also feels like she is not a risk because she will be on a resort.

How would you counsel this patient regarding getting vaccinated?

A

Majority of travel-related cases come from Central & South America and Mexico, therefore, patient is at risk of HAV infection

Given CT is traveling to an endemic area, the patient should be counseled on getting vaccinated to prevent HAV infection

It is unclear if she received the HBV vaccination, so it would be recommended to offer either HAVRIX® or VAQTA® today and again in 6 months

29
Q

KF is a 65 year female who is undergoing treatment for hepatitis C. She will be receiving her first dose of the HAVRIX® vaccine but is concerned about side effects. She also wants to know when to come back to complete the series.

How would you counsel this patient?

A

Most common side effects from the vaccine include: soreness/warmth at injection site, headache, fever, malaise, irritability, loss of appetite, drowsiness

The patient should be advised to return in 6-12 months to receive the second dose of the vaccine

30
Q

HAV Key Points

A

Transmitted via fecal-oral route

Self-limiting infection and does not become chronic

Treatment does not require anti-viral therapy, only supportive care

Easily preventable by vaccination

Outbreaks in hepatitis A almost nationwide

7451 Infectious Disease (7 decks)

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