Viral hepatitis Flashcards
What is Hepatitis A?
Hepatitis A is typically a benign, self-limiting disease, with a serious outcome being very rare.
What is the incubation period for Hepatitis A?
The incubation period is 2-4 weeks.
What type of virus causes Hepatitis A?
Hepatitis A is caused by an RNA picornavirus.
How is Hepatitis A transmitted?
Transmission is by faecal-oral spread, often in institutions.
Does Hepatitis A cause chronic disease?
No, it doesn’t cause chronic disease.
What are the common features of Hepatitis A?
Common features include flu-like prodrome, abdominal pain (typically right upper quadrant), tender hepatomegaly, jaundice, and deranged liver function tests.
Are complications common in Hepatitis A?
Complications are rare and there is no increased risk of hepatocellular cancer.
Is there a vaccine for Hepatitis A?
Yes, an effective vaccine is available. After the initial dose, a booster dose should be given 6-12 months later.
Who should be vaccinated against Hepatitis A?
People travelling to or residing in areas of high or intermediate prevalence (aged > 1 year), people with chronic liver disease, patients with haemophilia, men who have sex with men, injecting drug users, and individuals at occupational risk (e.g., laboratory workers, staff of large residential institutions, sewage workers, people who work with primates).
What type of virus is Hepatitis B?
Hepatitis B is a double-stranded DNA hepadnavirus.
How is Hepatitis B spread?
It is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child.
What is the incubation period for Hepatitis B?
The incubation period is 6-20 weeks.
What are the features of Hepatitis B?
Features include fever, jaundice, and elevated liver transaminases.
What are the complications of Hepatitis B infection?
Complications include chronic hepatitis (5-10%), fulminant liver failure (1%), hepatocellular carcinoma, glomerulonephritis, polyarteritis nodosa, and cryoglobulinaemia.
Who is vaccinated against Hepatitis B in the UK?
Children born in the UK are vaccinated as part of the routine immunisation schedule at 2, 3, and 4 months of age.
Who are considered at-risk groups for Hepatitis B vaccination?
At-risk groups include healthcare workers, intravenous drug users, sex workers, close family contacts of individuals with Hepatitis B, individuals receiving regular blood transfusions, chronic kidney disease patients, prisoners, and chronic liver disease patients.
What is the composition of the Hepatitis B vaccine?
The vaccine contains HBsAg adsorbed onto aluminium hydroxide adjuvant and is prepared from yeast cells using recombinant DNA technology.
What percentage of adults fail to respond to the Hepatitis B vaccine?
Around 10-15% of adults fail to respond or respond poorly to 3 doses of the vaccine.
What factors increase the risk of poor response to the Hepatitis B vaccine?
Risk factors include age over 40 years, obesity, smoking, alcohol excess, and immunosuppression.
Who should be tested for anti-HBs levels?
Testing for anti-HBs is recommended for those at risk of occupational exposure and patients with chronic kidney disease.
How should anti-HBs levels be interpreted?
Anti-HBs levels interpretation:
- > 100 mIU/ml: Adequate response, no further testing required, booster at 5 years.
- 10 - 100 mIU/ml: Suboptimal response, one additional vaccine dose should be given.
- < 10 mIU/ml: Non-responder, test for current or past infection, give further vaccine course.
What is the first-line treatment for Hepatitis B?
Pegylated interferon-alpha used to be the only treatment available, reducing viral replication in up to 30% of chronic carriers.
What factors predict a better response to pegylated interferon treatment?
Better response is predicted by being female, < 50 years old, low HBV DNA levels, non-Asian, HIV negative, and high degree of inflammation on liver biopsy.
What antiviral medications are used for Hepatitis B management?
Examples include tenofovir, entecavir, and telbivudine (a synthetic thymidine nucleoside analogue).
What screening is offered to pregnant women regarding hepatitis B?
All pregnant women are offered screening for hepatitis B.
What should babies born to mothers with chronic hepatitis B receive?
Babies born to mothers who are chronically infected with hepatitis B should receive a complete course of vaccination + hepatitis B immunoglobulin.
What is being evaluated in relation to hepatitis B treatment during pregnancy?
Studies are currently evaluating the role of oral antiviral treatment (e.g. Lamivudine) in the latter part of pregnancy.
Does caesarean section reduce vertical transmission rates of hepatitis B?
There is little evidence to suggest caesarean section reduces vertical transmission rates.
Can hepatitis B be transmitted via breastfeeding?
Hepatitis B cannot be transmitted via breastfeeding (in contrast to HIV).
What is the first marker to appear in hepatitis B serology?
Surface antigen (HBsAg) is the first marker to appear and causes the production of anti-HBs.
What does the presence of HBsAg imply?
HBsAg normally implies acute disease (present for 1-6 months).
What does HBsAg presence for more than 6 months indicate?
If HBsAg is present for > 6 months, it implies chronic disease (i.e. Infective).
What does Anti-HBs indicate?
Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease.
What does Anti-HBc signify?
Anti-HBc implies previous (or current) infection.
What is the significance of IgM anti-HBc?
IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months.
What is the significance of IgG anti-HBc?
IgG anti-HBc persists.
What does HBeAg indicate?
HBeAg results from breakdown of core antigen from infected liver cells and is a marker of infectivity.
What does HBsAg indicate regarding infection status?
HBsAg = ongoing infection, either acute or chronic if present > 6 months.
What does a positive anti-HBs with all others negative indicate?
Previous immunisation: anti-HBs positive, all others negative.
What does a positive anti-HBc and negative HBsAg indicate?
Previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative.
What does a positive anti-HBc and positive HBsAg indicate?
Previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive.
What does a negative anti-HBc indicate?
Anti-HBc = caught, i.e. negative if immunized.
What is Hepatitis C?
Hepatitis C is likely to become a significant public health problem in the UK in the next decade, with around 200,000 people chronically infected.
Who are at risk for Hepatitis C?
At risk groups include intravenous drug users and patients who received a blood transfusion prior to 1991 (e.g. haemophiliacs).
What type of virus causes Hepatitis C?
Hepatitis C is an RNA flavivirus.
What is the incubation period for Hepatitis C?
The incubation period is 6-9 weeks.
What is the risk of transmission during a needle stick injury?
The risk of transmission during a needle stick injury is about 2%.
What is the vertical transmission rate of Hepatitis C from mother to child?
The vertical transmission rate is about 6%, higher if there is coexistent HIV.
Is breastfeeding contraindicated in mothers with Hepatitis C?
Breastfeeding is not contraindicated in mothers with Hepatitis C.
What is the risk of transmitting Hepatitis C during sexual intercourse?
The risk is probably less than 5%.
Is there a vaccine for Hepatitis C?
There is no vaccine for Hepatitis C.
What percentage of patients develop features after exposure to Hepatitis C?
Only around 30% of patients will develop features such as transient rise in serum aminotransferases, jaundice, fatigue, and arthralgia.
What is the investigation of choice to diagnose acute Hepatitis C infection?
HCV RNA is the investigation of choice.
What happens to patients who spontaneously clear the Hepatitis C virus?
Patients who spontaneously clear the virus will continue to have anti-HCV antibodies.
What percentage of patients clear the virus after an acute Hepatitis C infection?
Around 15-45% of patients will clear the virus after an acute infection.
How is chronic hepatitis C defined?
Chronic hepatitis C is defined as the persistence of HCV RNA in the blood for 6 months.
What are potential complications of chronic hepatitis C?
Complications include rheumatological problems, eye problems, cirrhosis, hepatocellular cancer, cryoglobulinaemia, porphyria cutanea tarda, and membranoproliferative glomerulonephritis.
What is the aim of treatment for chronic Hepatitis C?
The aim of treatment is sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy.
What treatments are currently used for chronic Hepatitis C?
Currently, a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used.
What are the side effects of ribavirin?
Side effects include haemolytic anaemia and cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic.
What are the side effects of interferon alpha?
Side effects include flu-like symptoms, depression, fatigue, leukopenia, and thrombocytopenia.
What is the current public health concern regarding Hepatitis C in the UK?
Hepatitis C is likely to become a significant public health problem in the UK in the next decade, with around 200,000 people chronically infected.
Who are the at-risk groups for Hepatitis C?
At-risk groups include intravenous drug users and patients who received a blood transfusion prior to 1991 (e.g. haemophiliacs).
Are women in the UK currently screened for Hepatitis C during pregnancy?
Women in the UK are not currently screened for hepatitis C in the antenatal period.
What is the vertical transmission rate of Hepatitis C from mother to child?
The vertical transmission rate from mother to child is about 6%. The risk is higher with a high viral load or coexistent HIV.
What are the management guidelines for women with Hepatitis C in pregnancy?
There are no definitive guidelines; management is based on expert reviews. Standard drug therapy cannot be used due to teratogenicity.
How should HCV-positive pregnant women be monitored?
HCV-positive pregnant women should be monitored throughout pregnancy, with HCV RNA and LFTs done as early as possible.
What should be suspected if a pregnant woman with Hepatitis C develops jaundice?
If they develop jaundice or pruritus, suspect intrahepatic cholestasis of pregnancy and perform LFTs.
What is the recommendation regarding invasive procedures in pregnant women with Hepatitis C?
Invasive procedures should be minimized in both mother and fetus to prevent vertical transmission.
What does the evidence say about caesarean section vs vaginal delivery for preventing Hepatitis C transmission?
The evidence is inconclusive; it is not routine practice to offer a caesarean section for this purpose. Cochrane states: ‘Currently there is no evidence from randomised controlled trials upon which to base any practice recommendations regarding planned caesarean section versus vaginal delivery for preventing mother to infant Hepatitis C Virus transmission.’
How does exposure to maternal blood affect the risk of Hepatitis C transmission?
Exposure to maternal blood, such as due to perineal tears, significantly increases the risk of passing on the virus.
Is breastfeeding contraindicated for mothers with Hepatitis C?
Breastfeeding is not contraindicated in mothers with hepatitis C.
What type of virus is Hepatitis D?
Hepatitis D is a single stranded RNA virus.
How is Hepatitis D transmitted?
It is transmitted parenterally, similar to hepatitis B, through the exchange of bodily fluids.
What does Hepatitis D require for its replication?
Hepatitis D requires hepatitis B surface antigen to complete its replication and transmission cycle.
What is co-infection in the context of Hepatitis D?
Co-infection refers to simultaneous infection with Hepatitis B and Hepatitis D.
What is superinfection in the context of Hepatitis D?
Superinfection occurs when a hepatitis B surface antigen positive patient subsequently develops a hepatitis D infection.
What are the risks associated with superinfection of Hepatitis D?
Superinfection is associated with a high risk of fulminant hepatitis, chronic hepatitis status, and cirrhosis.
How is Hepatitis D diagnosed?
Diagnosis is made via reverse polymerase chain reaction of hepatitis D RNA.
What is the current treatment for Hepatitis D?
Interferon is currently used as treatment, but with a poor evidence base.
What type of virus is Hepatitis E?
RNA hepevirus
How is Hepatitis E primarily spread?
By the faecal-oral route
What is the incubation period for Hepatitis E?
3-8 weeks
In which regions is Hepatitis E most common?
Central and South-East Asia, North and West Africa, and Mexico
What is the mortality rate of Hepatitis E during pregnancy?
About 20%
Does Hepatitis E cause chronic disease?
No
Does Hepatitis E increase the risk of hepatocellular cancer?
No
Is there a vaccine available for Hepatitis E?
A vaccine is currently in development, but is not yet in widespread use
