It consist of Hepatitis D, its causes, risk factors, mode of transmisssion, sign & symptoms, diagnostic tests, prognosis, treatment and prevention.

1. Prepared by:
Prabita Shrestha

2. Introduction
• Hepatitis D, also referred to as hepatitis D virus (HDV) and
classified as Hepatitis delta virus, is a disease caused by a
small circular enveloped RNA virus.
• It is one of five known hepatitis viruses: A, B, C, D, and E.
• HDV is considered to be a sub-viral satellite because it can
propagate only in the presence of the hepatitis B virus (HBV).
• Transmission of HDV can occur either via simultaneous
infection with HBV (co-infection) or superimposed on chronic
hepatitis B or hepatitis B carrier state (super-infection).

3. Magnitude of the problem:

4. Magnitude of the problem:
• In the United States, HDV infection is observed more commonly among
patients with a history of intravenous drug use and in persons from the
Mediterranean basin.
• Approximately 15 million people are infected with HDV worldwide. Areas
with the highest prevalence include southern Italy; North Africa; the Middle
East; the Amazon Basin; and the American South Pacific islands of Samoa,
Hauru, and Hiue. China, Japan, Taiwan, and Myanmar (formerly Burma)
have a high prevalence of HBV infection but a low rate of HDV infection.
• HDV infection is more common in adults than in children. However, children
from underdeveloped, HDV-endemic countries are more likely to contract
HDV infection through breaks in the skin, due to the presence of skin
lesions.

5. Epidemiological features:
Infectious agent:
• Hepatitis D virus (HDV) is a virus-like particle consisting of
a coat of hepatitis B virus (HBV) surface antigen and a
unique internal antigen, the delta antigen.
• Reservoirs
Humans
• Host:
Humans
More common in adults than in children.

6. Period of Communicability
• Blood is potentially infectious during all phases of
active hepatitis D infection.
• Peak infectivity probably occurs just prior to onset
of acute illness, when particles containing the
hepatitis D antigen are readily detected in the
blood.

7. Mode of transmission:
This virus is transmitted by the same methods as HBV:
Direct transmission:
• exposure to infected blood and serous body fluids,
• contaminated needles, syringes or blood and plasma
product transfusions.
• Sexual transmission may also occur but is less common
than with hepatitis B.
• mother-to-baby transmission of hepatitis D virus at or
around the time of birth can occur, although this is
uncommon.

10. Sign and Symptoms:
• Fever
• Abdominal pain (especially in the right upper abdomen)
• Muscle and joint pain
• Rashes

11. Incubation period:
• Approximately two to eight weeks.

12. Complications of Hepatitis D:
• Scarring of liver (Cirrhosis)
• Liver disease
• Liver cancer
• Autoimmune manifestation

13. Diagnostic Tests:
• Anti-delta agent antibody test
• Liver biopsy
• Liver enzymes (blood test)

14. Prognosis:
 Persons with an acute HDV infection usually get
better over 2 to 3 weeks. Liver enzyme levels return
to normal within 16 weeks.
 About 10% of those who are infected may develop
long-term (chronic) liver inflammation (hepatitis).

15. Treatment:
• Liver transplantation is indicated in patients with fulminant
liver failure. Patients with evidence of fulminant liver failure
should be immediately transferred to a center capable of
performing a liver transplantation.
• No treatment for hepatitis D virus (HDV) has been approved.
• However, a study of the efficacy of peginterferon alfa-2a
found that treatment with or without adefovir over 48 weeks
resulted in sustained HDV RNA clearance in approximately
one fourth of patients.
• No vaccine is available for HDV, but the HBV vaccination is
effective against HDV.

16. Preventions:
 Exclusion of people with hepatitis D from childcare,
preschool, school and work is not necessary.
 Hepatitis B vaccination will prevent infection with hepatitis D.
Hepatitis B vaccination is recommended for infants and those
at a higher risk of acquiring hepatitis B infection and/or at
higher risk of severe infection. Vaccination for hepatitis B,
when given to newborn infants, is effective in preventing
hepatitis D (even if the mother has hepatitis D).
 Any open sores, cuts or abrasions should be covered with
waterproof dressings

17. Contd…
 Practice safer sex – use condoms consistently and correctly.
 Injecting drug users should never share injecting equipment.
 If required to handle blood or body fluids, the use of standard
precautions will reduce the risk of transmission of hepatitis D
virus.
 Infected health care workers must comply with the
requirements of their professional boards.
 Educate patient about safe injecting, safe sex and blood and
body fluid precautions.

18. References:
• http://emedicine.medscape.com/article/178038-
treatment
• http://www.healthline.com/health/delta-agent-
hepatitis-d
• http://www.who.int/csr/disease/hepatitis/whocdsc
srncs20011/en/index1.html
• http://www.healthline.com/health/delta-agent-
hepatitis-d#Complications6