S44 Viral Hepatitis Flashcards
Acute Viral Infection
Non-specific
Malaise, fatigue, nausea, anorexia, low grade fever, and arthralgia
Chronic Viral Infection
Usually asymptomatic
Fatigue, malaise, low-grade fever, anorexia, and weight loss
Disease Progression
Pruritus, dark urine, and jaundice
Can lead to cirrhosis and hepatocellular carcinoma
Types of Hepatitis
Source is Feces
A and E
Types of Hepatitis
Source is Blood/bloody fluids
B, C and D
Types of Hepatitis
Route of transmission
Fecal Oral
A and E
Types of Hepatitis
Route of transmission
Fecal Oral Percutaneous / permucosal
B, C and D
Types of Hepatitis
Chronic infection
No
A and E
Types of Hepatitis
Chronic infection
Yes
B, C and D
Types of Hepatitis
Prevention
Pre/post exposure immunization
A, B and D
Types of Hepatitis
Prevention
Blood donor screening; risk behavior modification
C
Types of Hepatitis
Prevention
Ensure safe drinking water
E
Fecal-oral spread: hygiene, drug use, high risk sexual activity, travelers, day care, food
Vaccine-preventable
A
Sexually transmitted – 100x more infectious than HIV
Blood-borne (sex, injection drug use, mother-child, and health care)
B
Blood borne (injection drug use primarily) – 4-5x more common than HIV NOT vaccine-preventable
C
How is HCV most commonly transmitted in the US?
Healthcare
Mother-child
Injection drug use
Fecal-oral
HAV
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
HAV Etiology
RNA virus of the Picornaviridae family
Heating foods to ≥ 85°C , disinfecting with bleach, or chlorination of water will inactivate virus
HAV Acute infections
signs and symptoms
Non-specific features: fever, malaise, anorexia, nausea, jaundice and abdominal discomfort
Severity depends on age and co-morbidities
HAV Acute infections
Laboratory Findings
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
HAV Acute infections
Treatment
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
Prevention: Recommendations for HAV Vaccination
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
Available Vaccines
Intramuscular injection
HAVRIX®
Age
dosage
number
schedule
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
Available Vaccines
Intramuscular injection
VAQTA®
Age
dosage
number
schedule
1-18
0.5 mL
2
0, 6-18 months
≥19
1 mL
2
0, 6-18 months
Available Vaccines
Intramuscular injection
TWINRIX®*
Age
dosage
number
schedule
≥18
1 mL
3
0, 1, 6 months
Post-exposure Prophylaxis
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
Post-exposure Prophylaxis
Age
dosage
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
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?
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
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?
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
HAV Key Points
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
