Viral Hepatitis Flashcards
1
Q
How is hepatitis A and E transmitted?
A
- transmitted by the fecal oral route
2
Q
How is hepatitis B, C and delta spread?
A
- parenteral transmission
3
Q
___ hepatitis must have a co-infection with hepatitis B
A
delta
4
Q
How is hep A transmitted?
A
- fecal oral route
- person to person
- ingestion of contaminated food or water
5
Q
What are the most common risk factors associated with hepatitis A?
A
- international travellers
- household or sexual contact with someone that has hep A
- men who have sex with men
- users of illegal drugs
- patients with chronic liver disease
6
Q
Incubation of hepatitis A is approx. how many days?
A
- 28 days (ranges from 15-50)
7
Q
Patients begin to shed the virus _______ after exposure
A
1-2 weeks
8
Q
What is the progression of acute hepatitis?
A
- starts with prodromal period: nonspecific flu-like symptoms (some may be mild) such as anorexia, fatigue, malaise
- acute illness with abrupt onset of: anorexia, N/V, malaise, fever, headache, right upper quadrant abdominal pain
- icteric hepatitis: dark urine, light coloured stools, worsening of systemic sx, pruritus
9
Q
What is the progression in the levels of liver enzymes with a hepatitis A infection?
A
- liver enzymes increase within the beginning few weeks of the infection, and peak around the 4th week – normalize by the 8th week
10
Q
What are the symptoms likely experienced by children under 6 years old with HAV?
A
likely asymptomatic
11
Q
What are the symptoms likely experiences by older children and adults?
A
- most present with symptoms lasting under 2 months, 70% of adults experience jaundice
12
Q
What are the symptoms likely experienced in adults that have an HAV infection?
A
- peak viral shedding precedes GI symptoms in older adults
13
Q
Is HAV a chronic infection?
A
- no, it does not
- some patients can experience symptoms for up to 9 months
14
Q
What are the potential complications of a HAV infection?
A
- relapsing hepatitis
- cholestatic hepatitis
- fulminant hepatitis
15
Q
The majority of patients have clinical resolution by _____, nearly all by _____
A
2 months
6 months
16
Q
What is the treatment of an HAV infection?
A
- there are none!
- we do have prevention and prophylaxis available to us
- we give a booster to ensure that we have prolonged immunity to hep A
17
Q
What is the dosing of a hep A vaccine?
A
- give an intramuscular infection with schedule of- 1 dose of HAV vaccine (primary immunization) with a booster dose 6-36 months later (timeframe is product dependent)
- recommended for individuals over 6 months old for those at risk of the infection
18
Q
What are the AE of HAV?
A
- generally well tolerated
- if a reaction does happen it is usually mild and transient soreness or redness at the injection site
- less common: headache, irritability, malaise, fatigue, GI sx
19
Q
When should the injection of Hep A not be given?
A
- it should be postponed in the case of moderate to severe acute illness (minor illness with or without fever may receive the vaccine however)
20
Q
When is the human immune globulin recommended to be used instead of the hep A vaccine?
A
- used as the post exposure immunoprophylactic option
- recommended for infants under the age of 6 months, patients with contraindications to hep A vaccine or when hep A vaccine is not available
- should be given in addition to the hep A vaccine in patients theatre immunocompromised or with chronic liver disease
- may also be given in addition to hep A vaccine in susceptible adults, those over 60 years old and are household/close contacts of an individual with hep A
21
Q
What should be done for a patients that has come to you after being exposure if they come to you after 14 days?
A
- efficacy is unknown if the immunization is given over 14 days after exposure, but efficacy is unknown if over 14 days since exposure (no recommendation after that time)
22
Q
What are the non-pharms that can be suggested for travellers to prevent HAV?
A
- safe food and water
- waiting and drinking: boil it, cook it or peel it or leave it
- eat foods that are hot and well cooked
- avoid raw or undercooked meats and fish, including shellfish
- drink water only if it has been boiled or disinfected
- swimming an bathing- avoid swallowing water while bathing, showering or swimming - frequent handwashing
- soap and warm water for at least 20 seconds
- alcohol based hand sanitizer if soap and water is not available
23
Q
How does transmission of hep B occur?
A
- sexually
- parenterally
- perinatally
24
Q
Hep B virus remains stable in the environment for up to _____
A
7 days
25
What are the risk factors of a hep B infection?
- infants exposed during child birth
- sexual contact
- injection drug use
- household contact of HBV positive patient
- procedures with percutaneous exposure
- one third of those with HBV have no identifiable risk factors
26
What is the incubation period for HBV?
- 60 to 90 days
27
What percentage of infections are asymptomatic?
- 50% of adults and 90% of children are asymptomatic
28
When symptoms do happen in a hep B infection, what are they typically?
- - anorexia, abdominal pain, N/V, jaundice
29
How long does the initial infection of HBV usually last?
- may last up to 3 months
30
Most people will have spontaneous clearing of HBV after _____
4-8 weeks
| -- there is some risk of becoming a chronic carrier however (higher in infants and those that are immunocompromized)
31
Chronic carriers of hep B have an increased risk of developing what?
- cirrhosis and hepatocellular carcinoma
32
What is the dosing schedule for the vaccine of hep B?
- an IM injection beginning with one dose of HbV vaccine (month 0), repeated at month 1 and month 6
33
Has to be AT LEAST ____ months between the first dose and the last dose of hep B
4 months
34
What are some of the AE that can be experienced after a HBV?
- mild and transient reactions most common: irritability, headache, fatigue, pain and redness at the injection site
35
What is the effect of giving hep B post-exposure?
- provides 90% protection
| - hep B immunoglobulin may help with increased protection by providing short term passive immunity
36
Hep B post exposure prophylaxis should be offered to who?
- infant or mother with acute or chronic hepatitis infection
- percutaneous or mucosal exposure to: blood or bodily fluids that may contain hep B virus
- sexual or household contacts of an individual with acute hepatitis B or is a chronic carrier
37
Is alcohol safe to consume with hep B?
- no, no alcohol is safe to consume with hep B
38
What are some of the non-pharm suggestions to make to patients surrounding HBV prevention?
- all chronic HBV patients should be educated to prevent rural transmission
- sexual and household contacts require vaccination
- chronic HBV patients need to prevent further liver damage, therefore must avoid alcohol and get immunized agains HAV
- remind to consult with health care provider before using any new medications (rx and OTC) and natural health products
39
What is the dosing for Twinrix?
- dosing: intramusclar injection usually at month 0, 1 and 6 (rapid schedule is an option as well)
- available as twinrix and twinrix junior
40
What is the transmission of HCV?
- bloodborne (exposure to contaminated needles/syringes, blood or blood products, procedures with blood exposure, being shaved if there is contaminated equipment)
- sexual contact
- perinatal transmission from mother to child
41
What are the risk factors for HCV infection?
- injection drug use
- blood transfusion(historical, increased screening as of 1992 has decreased this risk)
- healthcare associated transmission rates
- high risk populations (prisoners, homeless)
42
What is the clinical presentation of HCV?
- 80% are asymptomatic
- if symptoms: anorexia, abdominal pain, fatigue, nausea, dark urine, jaundice
- up to 85% of those with an acute infection develop chronic HCV infection
- 10-20% of chronically infected will develop severe liver disease
- HCV is the major cause of cirrhosis and hepatocellular cancer, leading cause of needing a liver transplant in the US
- --- progression to end stage liver disease is slow, generally develops over 20 years after infection
43
What is the treatment of HCV?
- there are now oral regimens with durations of 6-12 weeks to 24-48 weeks
- few AE
- high cure rate (>90%)
- genotype of hepatitis C virus will determine with therapy is most effective
44
Is there any way to precent hep C?
- no
| - there is also no post exposure prophylaxis with it
45
What are some of the non-pharm suggestions with treating hepatitis C?
- chronic HCV patient- need to vaccinate against hepatitis A or B
- lifestyle things:
- -- avoid alcohol
- -- eat a well balanced diet and routinely exercise
- -- avoid smoking
46
What is things that can be done for prevention of HCV ?
- avoid being blood, oral or semen donors
- minimize blood or mucous exposure (avoid sharp razors, toothbrushes and cover open wounds)
- if using illegal drugs, avoid sharing paraphernalia
- -- there is no vaccine available
- -- there is also no immunoglobulin option
