Viral Hepatitis Flashcards
How is hepatitis A and E transmitted?
- transmitted by the fecal oral route
How is hepatitis B, C and delta spread?
- parenteral transmission
___ hepatitis must have a co-infection with hepatitis B
delta
How is hep A transmitted?
- fecal oral route
- person to person
- ingestion of contaminated food or water
What are the most common risk factors associated with hepatitis 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
Incubation of hepatitis A is approx. how many days?
- 28 days (ranges from 15-50)
Patients begin to shed the virus _______ after exposure
1-2 weeks
What is the progression of acute hepatitis?
- 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
What is the progression in the levels of liver enzymes with a hepatitis A infection?
- liver enzymes increase within the beginning few weeks of the infection, and peak around the 4th week – normalize by the 8th week
What are the symptoms likely experienced by children under 6 years old with HAV?
likely asymptomatic
What are the symptoms likely experiences by older children and adults?
- most present with symptoms lasting under 2 months, 70% of adults experience jaundice
What are the symptoms likely experienced in adults that have an HAV infection?
- peak viral shedding precedes GI symptoms in older adults
Is HAV a chronic infection?
- no, it does not
- some patients can experience symptoms for up to 9 months
What are the potential complications of a HAV infection?
- relapsing hepatitis
- cholestatic hepatitis
- fulminant hepatitis
The majority of patients have clinical resolution by _____, nearly all by _____
2 months
6 months
What is the treatment of an HAV infection?
- 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
What is the dosing of a hep A vaccine?
- 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
What are the AE of HAV?
- 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
When should the injection of Hep A not be given?
- it should be postponed in the case of moderate to severe acute illness (minor illness with or without fever may receive the vaccine however)
When is the human immune globulin recommended to be used instead of the hep A vaccine?
- 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
What should be done for a patients that has come to you after being exposure if they come to you after 14 days?
- 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)
What are the non-pharms that can be suggested for travellers to prevent HAV?
- 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
How does transmission of hep B occur?
- sexually
- parenterally
- perinatally
Hep B virus remains stable in the environment for up to _____
7 days
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
What is the incubation period for HBV?
- 60 to 90 days
What percentage of infections are asymptomatic?
- 50% of adults and 90% of children are asymptomatic
When symptoms do happen in a hep B infection, what are they typically?
- anorexia, abdominal pain, N/V, jaundice
How long does the initial infection of HBV usually last?
- may last up to 3 months
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)
Chronic carriers of hep B have an increased risk of developing what?
- cirrhosis and hepatocellular carcinoma
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
Has to be AT LEAST ____ months between the first dose and the last dose of hep B
4 months
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
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
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
Is alcohol safe to consume with hep B?
- no, no alcohol is safe to consume with hep B
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
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
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
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)
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
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
Is there any way to precent hep C?
- no
- there is also no post exposure prophylaxis with it
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
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
