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DIIS > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

What are the 3 most common causes of viral hepatitis?

A

HAV (Hep A)

HBV (Hep B)

HCV (Hep C)

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2
Q

Acute Viral Hepatitis

A

A short-term infection that occurs within the first 6 months after someone is exposed to the virus. If the initial attack is not severe and not prolonged, the liver will heal itself with no long-term damage.

An extensive, severe acute hepatitis infection can cause the liver to be totally destroyed. The common term for this is “acute fulminant hepatitis,” acute liver failure, or acute hepatic failure

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3
Q

Hepatitis A

A

A single strand RNA virus; Picornavirus

Most people feel sick for several months, but usually recover completely with no lasting liver damage

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4
Q

How is Hep A transmitted?

A

The fecal-oral route is most common

Can be transmitted through blood (needle sharing) but is rare

Can be detected in saliva with some animals, but not humans

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5
Q

How long can Hep A survive outside of the body?

A

Months

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6
Q

Can Hep A develop into chronic infection?

A

No

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7
Q

Is there a vaccine for Hepatitis A?

A

Yes

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8
Q

Hepatitis B

A

A double strand DNA virus; Orthohepadnavirus

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9
Q

How is Hep B transmitted?

A

HBV is transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood

Can be spread from mother to infant at birth

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10
Q

Where is Hep B found in the body?

A

Highest concentrations found in blood and lower concentrations in semen, vaginal secretions, and wound exudates

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11
Q

How long can Hep B survive on inanimate surfaces?

A

days

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12
Q

Can Hep B develop into a chronic infection?

A

Yes

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13
Q

Can Hep B be prevented through vaccination?

A

Yes

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14
Q

Hepatitis C

A

Single strand RNA virus; Hepacivirus

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15
Q

Which Hepatitis is the most common in the US?

A

Hep C

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16
Q

How is Hep C transmitted?

A

Transmitted most efficiently through percutaneous exposure to infected blood (transfusion, drug injections). Less frequently through perinatal and sexual exposures

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17
Q

Can Hep C develop into chronic infections?

A

Yes

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18
Q

Can Hep C be prevented?

A

No vaccine exists

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19
Q

Can Hep C be treated?

A

Yes, through safe, effective, and curative therapies

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20
Q

Hepatitis D

A

Single strand RNA virus; Deltavirus

Only occurs among people who are infected with HBV. Needs the helper function of HBV to replicate

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21
Q

Is Hep D common in the US?

A

No

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22
Q

How is Hep D transmitted

A

Through percutaneous or mucosal contact with infectious blood

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23
Q

Is there a vaccine for Hep D?

A

No, but it can be prevented in persons who are not already HBV infected by getting the Hep B vaccine (since Hep D needs Hep B to replicate)

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24
Q

What are signs and symptoms of Viral hepatitis infections?

A
  • fever
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • clay-colored stool
  • join pain
  • jaundice
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25
Q

Is viral hepatitis always symptomatic?

A

No, it can be asymptomatic and people can still be infectious.

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26
Q

When does the CDC recommend Hep A vaccination?

A

For all children at age one

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27
Q

What is the incubation period of Hep A?

A

approximately 28 days, with a range of 15-50 days

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28
Q

When does Hep A shed in high concentrations?

A

Sheds in high concentrations in feces from 2 weeks before to 1 week after onset of clinical illness. This is the most likely period to transmit HAV, but people remain infectious for up to several weeks afterwards. For practical purposes, people are considered infectious 2 weeks before to one week after onset of clinical illness

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29
Q

Does HAV produce symptoms?

A

HAV produces symptoms in around 80% of adults. Most infants and children are asymptomatic, presumably because their less mature immune system responds to the infection with less inflammation

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30
Q

How long do HAV symptoms last?

A

Usually less than 2 months, but 10-15% of symptomatic persons have prolonged or relapsing disease for up to 6 months

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31
Q

Can you be reinfected with HAV?

A

No. Once HAV resolves, protective antibodies develop and give lifelong immunity and protection against reinfection

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32
Q

Hep A Vaccination info

A
  • A 2 dose series given 6 months apart
  • licensed in the US for persons 12 months of age and older
  • Vaccine is preferred for post-exposure in most individuals
  • Vaccine provides immunity for at least 25 years in adults and at least 14-22 years in children
  • Can be given to immunocompromised patients
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33
Q

HAV Immune globulin

A

Immune Globulin (IG) may be used for short-term protection (approximately 1 month), both pre and post exposure. Must be administered within 2 weeks after exposure for maximum protection

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34
Q

Hep A vaccine for infants 6-11 months traveling outside US

A

Travel sized dose should be given. Does not affect the need for the 2 dose Hep A vaccination at age 1

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35
Q

Postexposure Prophylaxis for Hep A

A

The hep A vaccine should be used after exposure for those over age 12 months.

For those over age 40 and those immunocompromised, IG may be given in addition to the vaccine

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36
Q

How is Hep A diagnosed?

A

Hep A is confirmed by a positive serologic test for immunoglubulin M antibody (IgM anti-HAV)

or

Nucleid acid amplication test for hepatitis A virus RNA

Can also be confirmed if person meets the clinical case definition and occurs ina person who has an epidemiologic link with a person who has laboratory-confirmed Hep A (e.g. household or sexual contact with an infected person during the 15-50 days before onset of symptoms)

37
Q

Is pre-vaccination serological testing required?

A

No. Previous immunity does not cause adverse reactions to the vaccination

38
Q

Is Hep A screening recommended?

A

No, because Hep A cannot develop into a chronic or lifelong infection

39
Q

Is post vaccination Hep A testing recommended?

A

No, because of the high rate of vaccine response. Also, not all tests have the sensitivity to detect low anti-HAV concentrations after vaccination

40
Q

Treatment of HAV

A

There is no specific medication available to treat Hep A. Best addressed through supportive treatment including rest, adequate nutrition, and fluids. Can take a few months to feel better

41
Q

How infectious is Hep B?

A

50 - 100 times more infectious than HIV

42
Q

Can HBV be transmitted during burth?

A

Yes

43
Q

Can HBV be transmitted via saliva?

A

Saliva has been implicated in transmission only when biting has taken place

44
Q

Is HBV spread through food, water, sharing utensils, breastfeeding, kissing, or coughing?

A

No

45
Q

Risk of HBV infection in travelers

A

Generally low, except for travelers in regions where the prevalence of chronic HBV infection is intermediate or high

46
Q

What is the incubation period of HBV?

A

Time from exposure to symptom onset can range from 6 weeks to 6 months

Most symptoms begin an average of 90 days after exposure to HBV

47
Q

Is HBV chronic?

A

It can be, or can resolve and give lifelong immunity

48
Q

When should people be vaccinated for HBV?

A

At birth or after

49
Q

If a person has been infected with Hep B, does the vaccine provide protection against the disease?

A

No

50
Q

When are booster doses of HBV vaccine recommended?

A
  • Infants born to HBsAg-positive mothers
  • hemodialysis patients
  • health care personnel (when anti-Hb levels decline to <10 miu)
  • immunocompromised persons
51
Q

Can pregnant women receive the HBV vaccine?

A

Yes. There is no live virus in the Hep B Vaccine

52
Q

Can immunocompromised persons receive the Hep B Vaccine?

A

Yes. A larger vaccine dose might be required to produce an antibody result.

Serologic testing of hemodiaylsis patients and immunocompromised patients is recommended 1-2 months after administration of the final dose of the primary vaccine series.

53
Q

Postexposure Prohylaxis for Hep B

A

Both PEP (passive-active postexposure prohpylaxis) with Hep b immunoglobulin (HBIG) and Hep B Vaccination
and
active PEP with hep b vaccination alone

have both been demonstrated to be highly effective in preventing transmission after exposure to HBV.

54
Q

HBsAg-Positive Exposure

A

If previously vaccinated, should receive a single vaccine booster dose.

If unvaccinated, should receive HBIG and Hep B Vaccine as soon as possible (preferably within 24 hours)

If in process of being vaccinated, should received appropriate dose of HBIG and complete the vaccine series.

55
Q

Exposure to someone with unknown HBsAg Status

A

If vaccinated, no action needed

If not fully vaccinated, should complete series

If unvaccinated, should receive Hep B vaccine

56
Q

What is the first line of screening for Hep B?

A

Testing with Hep B surface antigen (HBsAg)

Other serologic markers may be recommended depending upon the risk and population.

57
Q

What is the treatment for HBV?

A

For acute HBV infection, no specific medication is available

For chronic HBV infection, several antiviral drugs are approved

58
Q

What is the most common form of Hepatitis?

A

Hepatitis C

59
Q

When do most people develop symptoms from HCV?

A

Usually years, sometimes decades later

60
Q

How is HCV Transmitted?

A

HCV is highly infectious and most efficiently transmitted through percutaneous (puncture through the skin) exposure to infected blood or blood-containing body fluids.

Not spread by sneezing, hugging, coughing, food / water

4-7% risk through pregnancy

61
Q

What is the incubation period for Hep C?

A

14 to 180 days (average 45 days)

62
Q

Is Hep C chronic?

A

Yes. 15-25% will clear the virus on their own, the rest will develop a chronic infection

63
Q

Contributing factors to chronic HCV infection

A
  • increased alcohol intake
  • alcoholic liver disease
  • > 50 years old
  • nonalcoholic fatty liver disease
  • HBV or HIV coinfection
  • being on immunosuppresive therapy
  • Being male
64
Q

Does recovering from HCV provide immunity?

A

No.

Replication of HCV can result in changes that evade the immune response. As a result, no protective antibodies develop and lifelong immunity is not conferred even if the infection is resolved

65
Q

S/S of Hep C

A

Persons newly infected with HCV typically are asymptomatic or have mild symptoms that are unlikely to prompt a visit to a healthcare professional.

Even chronic infection might be asymptomatic. Symptoms may not develop until advanced liver disease, 20 -30 years later

66
Q

Is there a vaccine for Hep C?

A

No

Post exposure prophylaxis with immune globulin is not effective (unlike HAV and HBV)

Best methods are:
Primary prevention - keep people from getting infected
Secondary prevention - Early identification of disease and appropriate care and treatment

67
Q

Clinical criteria for acute Hep C

A
  • An illness with discrete onset of any sign or symptom consistent with acute viral hepatitis, AND
  • Jaundice or a peak elevated serum alanine aminotransferase (ALT) level >200 IU/L during the period of acute illness

Lab testing needed to determine if infection is HCV

68
Q

HCV Antibody Test

A

Hep C anti bodies (anti-HCV IgG)

Once a person has been infected, future tests will always have results positive for anti-HCV

69
Q

Hep B can be spread through which of the following ways?

a. Contaminated food or water
b. Coughing and sneezing
c. Perinatal infection
d. Breastfeeding

A

c. Perinatal infection

Also via:

  • unprotected sex
  • sharing needles
  • contact with blood or open sores
  • sharing razors or toothbrushes
70
Q

Yellowing of the skin or eyes is a symptom of hepatitis called:

a. Pumice
b. Anemia
c. Jaundice

A

c. Jaundice

71
Q

Which form of hepatitis is transmitted by the fecal-oral route?

a. Hep A
b. Hep B
c. Hep C

A

a. Hep A

72
Q

True or False:

There is no vaccination available for hepatitis A

A

False

73
Q

True or False

Hepatitis C Virus (HCV) is the most common chronic blood borne infection in the United States

A

True.

74
Q

To reduce the risk of transmission, HCV-positive persons should be advised to:

a. Not share eating utensils or drinking glasses
b. Cover cuts and sores on the skin
c. Avoid hugging and holding hands

A

b. Cover cuts and sores on the skin

  • Also don’t donate blood, organs, tissue, or semen
  • Don’t share toothbrushes / razors
75
Q

True or False

Prevention and control of HCV requires vaccination of people in identified risk groups, such as intravenous drug users

A

False.

No vaccine for Hep c

76
Q

The body depends on the liver to handle this function:

a. Regulate the heart rate
b. Regulative digestive function
c. Regulate, synthesize, store and secrete nutrients

A

c. Regulate, synthesize, store and secrete nutrients

77
Q

True or False:

Hepatitis B vaccine should not be given to people with a compromised immune system

A

False.

But they may need a larger dose

78
Q

Treatment for both acute HBV infection and chronic HBV infection is rest, nutrition and fluids, rather than medication

A

False.

No treatment for acute, but chronic HBV has antiviral drugs available

79
Q

Which of these products has NOT been approved for hepatitis B prevention?

a. Hepatitis B isolated serum (HBIS)
b. Hepatitis B immune globulin (HBIG)
c. Hepatitis B vaccine

A

a. Hepatitis B isolated serum (HBIS)

80
Q

True or False

People with chronic HBV infection invariably develop liver disease

A

False

May be asymptomatic with no liver disease

81
Q

Which of the following is true regarding hepatitis?

a. Hepatitis refers to any viral infection of the liver, regardless of which viral family caused it
b. Hepatitis can result from both infectious and non-infectious causes
c. There are five major hepatitis viruses, three of which are prevalent in the US.
d. All of the above.

A

d. All of the above

82
Q

Which is true about Hepatitis transmission?

a. hep A is transmitted by the fecal oral route and can spread through close physical contact or contaminated food
b. Hep B is transmitted through contact with infectious blood, often through sex
c. Hep C is transmitted through infected blood, often through injection drug use.
d. Hep D is transmitted through infectious blood and is acquired with HBV
e. Hep E is transmitted through the oral fecal route and is often spread through contaminated water
f. B and D
g. All of the above

A

g. All of the above

83
Q

Which are true statements about acute and chronic hepatitis?

a. If the initial attack of acute viral hepatitis is not severe and not prolonged, the liver will heal itself with no long term damage
b. Symptoms of chronic viral hepatitis will always develop in 1-2 years
c. Acute Hepatitis is a short term infection that occurs within the first six weeks of exposure to the virus
d. Hepatitis A, B, and C can develop into a chronic or lifelong infection
e. A and D
f. All of the above

A

a. If the initial attack of acute viral hepatitis is not severe and not prolonged, the liver will heal itself with no long term damage

84
Q

Which of the following are symptoms of viral hepatitis?

a. Vomiting
b. Abdominal pain
c. Grey-colored bowel movements
d. Join pain
e. Jaundice
f. All of the above

A

f. All of the above

85
Q

Which statement is not true regarding Hepatitis testing?

a. Hepatitis A must be confirmed by a positive serologic test for immunoglobulin M antibody to hepatitis A virus
b. Hepatitis infection can be confirmed if a case meets the clinical case definition and occurs in a person who has an epidemiological link with a person who has laboratory confirmed hepatitis
c. Hepatitis B serologic testing can be complex and involves measurement of several HBV-specific antigens and antibodies
d. The first line of screening for chronic infection, however, is generally done with Hepatitis B surface antigen (HBsAg)
e. There is no reliable test available for Hep C

A

e. There is no reliable test available for Hepatitis C

86
Q

Which type of viral hepatitis is not vaccine preventable?

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. None of the above

A

c. Hepatitis C

87
Q

Which is not true of treatment for hepatitis?

a. There is no medication for hepatitis A
b. Hepatitis A infection can be treated with antiviral drugs and interferon
c. Rest, nutrition, and fluids are the only treatments for acute hepatitis A and B
d. Acute HCV can be treated with antiviral medication, including ribavirin
e. None of the above

A

b. Hepatitis A infection can be treated with antiviral drugs and interferon

88
Q

People who test positive for HCV should be counseled with the following messages:

a. HCV positive women do not need to avoid pregnancy or breastfeeding

b. To reduce the risk for transmission to others, HCV positive persons should be advised to
- not donate blood, organs, tissue, or semen
- not share any personal items that might have blood on them
- cover cuts and sores on the skin to keep from spreading infectious blood or secretions

c. HCV positive persons with one long-term, steady sex partner need to adopt safer sexual practices
d. To protect their liver, HCV positive persons should be adivsed to avoid drinking alcohol and taking any new medicines, except OTC and herbal / natural remedies
e. A and B
f. All of the above

A

e. A and B

89
Q

Hepatitis A vaccine and hepatitis B vaccine are recommended for which of the following?

a. Men who have sex with men
b. Users of injection drugs
c. Persons with chronic liver disease
d. All of the above

A

d. All of the above.

DIIS (13 decks)

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