This document provides an overview of hepatitis A-E viruses. It discusses the source and route of transmission for each virus type. Hepatitis A is transmitted via the fecal-oral route, while hepatitis B-D are transmitted via blood and blood-derived body fluids. Hepatitis E is also transmitted via the fecal-oral route. The viruses differ in their ability to cause chronic infection, with hepatitis B and C most likely to result in chronic infection. Prevention strategies include immunization, screening of blood donors, and ensuring safe drinking water and food hygiene.
A highly contagious liver infection caused by the hepatitis A virus.
Hepatitis A is preventable by vaccine. It spreads from contaminated food or water or contact with someone who is infected.
Symptoms include fatigue, nausea, abdominal pain, loss of appetite and low-grade fever.
The condition clears up on its own in one or two months. Rest and adequate hydration can help.
The hepatitis E virus is mainly transmitted through drinking water contaminated with faecal matter.
Symptoms include jaundice, lack of appetite and nausea. In rare cases, it may progress to acute liver failure.
Hepatitis E usually resolves on its own within four to six weeks. Treatment focuses on supportive care, rehydration and rest.
A highly contagious liver infection caused by the hepatitis A virus.
Hepatitis A is preventable by vaccine. It spreads from contaminated food or water or contact with someone who is infected.
Symptoms include fatigue, nausea, abdominal pain, loss of appetite and low-grade fever.
The condition clears up on its own in one or two months. Rest and adequate hydration can help.
The hepatitis E virus is mainly transmitted through drinking water contaminated with faecal matter.
Symptoms include jaundice, lack of appetite and nausea. In rare cases, it may progress to acute liver failure.
Hepatitis E usually resolves on its own within four to six weeks. Treatment focuses on supportive care, rehydration and rest.
Hepatitis a-g
What is hepatitis?
Hepatitis is inflammation of the liver. Inflammation is swelling that happens when tissues of the body are injured or infected. It can damage your liver. This swelling and damage can affect how well your liver functions.
Hepatitis can be an acute (short-term) infection or a chronic (long-term) infection. Some types of hepatitis cause only acute infections. Other types can cause both acute and chronic infections.
What causes hepatitis?
There are different types of hepatitis, with different causes:
Viral hepatitis is the most common type. It is caused by one of several viruses -- hepatitis viruses A, B, C, D, and E. In the United States, A, B, and C are the most common.
Alcoholic hepatitis is caused by heavy alcohol use
Toxic hepatitis can be caused by certain poisons, chemicals, medicines, or supplements
Autoimmune hepatitis is a chronic type in which your body's immune system attacks your liver. The cause is not known, but genetics and your environment may play a role.
How is viral hepatitis spread?
Hepatitis A and hepatitis E usually spread through contact with food or water that was contaminated with an infected person's stool. You can also get hepatitis E by eating undercooked pork, deer, or shellfish.
Hepatitis B, hepatitis C, and hepatitis D spread through contact with the blood of someone who has the disease. Hepatitis B and D may also spread through contact with other body fluids. This can happen in many ways, such as sharing drug needles or having unprotected sec.
Viral hepatitis is a systemic disease primarily involving the liver.
Hepatotropic viruses : liver is the target organ and the main site of virus replication
Hepatitis A virus (HAV)
hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Hepatitis D virus (HDV, delta virus)
Hepatitis E virus (HEV).
Enterically:
virus is spread from person-to-person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis E. This type of transmission is called "fecal-oral." For this reason, the virus is more easily spread in areas where there are poor sanitary conditions
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Viral Hepatitis - Historical Perspectives
“Infectious” A Enterically
E
transmitted
Viral hepatitis NANB
Parenterall
“Serum” B D C y
transmitted
F, G, TTV
? other
3. Type of Hepatitis
A B C D E
Source of feces blood/ blood/ blood/ feces
virus blood-derived blood-derived blood-derived
body fluids body fluids body fluids
Route of fecal-oral percutaneous percutaneous percutaneous fecal-oral
transmission permucosal permucosal permucosal
Chronic no yes yes yes no
infection
Prevention pre/post- pre/post- blood donor pre/post- ensure safe
exposure exposure screening; exposure drinking
immunization immunization risk behavior immunization; water
modification risk behavior
modification
5. Hepatitis A Virus
Naked RNA virus
Related to enteroviruses, formerly known as
enterovirus 72, now put in its own family: heptovirus
One stable serotype only
Difficult to grow in cell culture: primary marmoset cell
culture and also in vivo in chimpanzees and
marmosets
4 genotypes exist, but in practice most of them are
group 1
6. Hepatitis A - Clinical
Features
Incubation period: Average 30 days
Range 15-50 days
Jaundice by <6 yrs, <10%
age group: 6-14 yrs, 40%-50%
>14 yrs, 70%-80%
Complications: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Chronic sequelae: None
7. Hepatitis A Infection
Typical Serological Course
Symptoms Total anti-
HAV
Titre ALT
Fecal
HAV
IgM anti-HAV
0 1 2 3 4 5 6 1 2
2 4
Months after exposure
8. Hepatitis A Virus Transmission
Close personal contact
(e.g., household contact, sex contact,
child day care centers)
Contaminated food, water
(e.g., infected food handlers, raw
shellfish)
Blood exposure (rare)
(e.g., injecting drug use, transfusion)
9. Global Patterns of
Hepatitis A Virus Transmission
Disease Peak Age
Endemicity Rate of Infection Transmission Patterns
High Low to Early Person to person;
High childhood outbreaks uncommon
Moderate High Late Person to person;
childhood/ food and waterborne
young adults outbreaks
Low Low Young adults Person to person;
food and waterborne
outbreaks
Very low Very low Adults Travelers; outbreaks
uncommon
10.
11. Laboratory Diagnosis
Acute infection is diagnosed by the detection of HAV-IgM
in serum by EIA.
Past Infection i.e. immunity is determined by the detection
of HAV-IgG by EIA.
Cell culture – difficult and take up to 4 weeks, not
routinely performed
Direct Detection – EM, RT-PCR of faeces. Can
detect illness earlier than serology but rarely
performed.
12. Hepatitis A Vaccination Strategies
Epidemiologic Considerations
Many cases occur in community-wide outbreaks
no risk factor identified for most cases
highest attack rates in 5-14 year olds
children serve as reservoir of infection
Persons at increased risk of infection
travelers
homosexual men
injecting drug users
13. Hepatitis A Prevention - Immune
Globulin
Pre-exposure
travelers to intermediate and high
HAV-endemic regions
Post-exposure (within 14 days)
Routine
household and other intimate contacts
Selected situations
institutions (e.g., day care centers)
common source exposure (e.g., food prepared by
infected food handler)
15. Hepatitis B Virus - Virology
Double stranded DNA virus,the + strand not complete
Replication involves a reverse transcriptase.
Complete Dane particle 42 nm, 28 nm electron dense core, containing HBcAg
and HBeAg. The coat and the 22 nm free particles contain HBsAg
At least 4 phenotypes of HBsAg are recognized;
adw, adr, ayw and ayr.
The HBcAg is of a single serotype
Hepatitis B virus (HBV) has been classified into 8 genotypes (A-H).
Genotypes A and C predominate in the US. However, genotypes B and D are also
present in the US. Genotype F predominates in South America and in Alaska, while
A, D and E predominate in Africa. Genotype D predominates in Russia and in all its
prior dominions, while in Asia, genotypes B and C predominate.
Available data suggests that genotype produces a milder disease, respond better to
IFN therapy, and is less likely to develop hepatocellular carcinoma.
It has not yet been possible to propagate the virus
in cell culture.
16. Hepatitis B - Clinical Features
Incubation period: Average 60-90 days
Range 45-180 days
Clinical illness (jaundice): <5 yrs, <10%
5 yrs, 30%-50%
Acute case-fatality rate: 0.5%-1%
Chronic infection: <5 yrs, 30%-90%
5 yrs, 2%-10%
Premature mortality from
chronic liver disease: 15%-25%
17. Spectrum of Chronic Hepatitis B Diseases
1Chronic Persistent Hepatitis -
asymptomatic
2. Chronic Active Hepatitis -
symptomatic exacerbations of hepatitis
3. Cirrhosis of Liver
4. Hepatocellular Carcinoma
18. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Symptoms
HBeAg anti-HBe
Total anti-HBc
Titre
HBsAg IgM anti-HBc anti-HBs
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure
19. Progression to Chronic Hepatitis B Virus Infection
Typical Serologic Course
Acute Chronic
(6 months) (Years)
HBeAg anti-HBe
HBsAg
Total anti-HBc
Titr
e
IgM anti-HBc
0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
20. Outcome of Hepatitis B Virus Infection
100 by Age at Infection 100
80
80
Symptomatic Infection (%)
60 60
Chronic Infection
40 Chronic Infection (%) 40
) % not ce n c no h C
( i f I i r
20 20
Symptomatic Infection
0 0
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
Age at Infection
21. Global Patterns of Chronic
HBV Infection
High (>8%): 45% of global population
lifetime risk of infection >60%
early childhood infections common
Intermediate (2%-7%): 43% of global population
lifetime risk of infection 20%-60%
infections occur in all age groups
Low (<2%): 12% of global population
lifetime risk of infection <20%
most infections occur in adult risk groups
22.
23. Concentration of Hepatitis B
Virus in Various Body Fluids
Low/Not
High Moderate Detectable
blood semen urine
serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
24. Hepatitis B Virus
Modes of Transmission
Sexual - sex workers and homosexuals are
particular at risk.
Parenteral - IVDA, Health Workers are at
increased risk.
Perinatal - Mothers who are HBeAg positive are
much more likely to transmit to their offspring
than those who are not. Perinatal transmission is
the main means of transmission in high
prevalence populations.
25. Diagnosis
A battery of serological tests are used for the diagnosis of acute and
chronic hepatitis B infection.
HBsAg - used as a general marker of infection.
HBsAb - used to document recovery and/or immunity to HBV
infection.
anti-HBc IgM - marker of acute infection.
anti-HBcIgG - past or chronic infection.
HBeAg - indicates active replication of virus and therefore
infectiveness.
Anti-Hbe - virus no longer replicating. However, the patient can still
be positive for HBsAg which is made by integrated HBV.
HBV-DNA - indicates active replication of virus, more accurate than
HBeAg especially in cases of escape mutants. Used mainly for
monitoring response to therapy.
26. Treatment
Interferon - for HBeAg +ve carriers with chronic active hepatitis. Response
rate is 30 to 40%.
alpha-interferon 2b (original)
alpha-interferon 2a (newer, claims to be more efficacious and efficient)
Lamivudine - a nucleoside analogue reverse transcriptase inhibitor. Well
tolerated, most patients will respond favorably. However, tendency to relapse
on cessation of treatment. Another problem is the rapid emergence of drug
resistance.
Adefovir – less likely to develop resistance than Lamivudine and may be used
to treat Lamivudine resistance HBV. However more expensive and toxic
Entecavir – most powerful antiviral known, similar to Adefovir
Successful response to treatment will result in the disappearance of HBsAg,
HBV-DNA, and seroconversion to HBeAg.
27. Prevention
Vaccination - highly effective recombinant vaccines are now
available. Vaccine can be given to those who are at increased
risk of HBV infection such as health care workers. It is also
given routinely to neonates as universal vaccination in many
countries.
Hepatitis B Immunoglobulin - HBIG may be used to protect
persons who are exposed to hepatitis B. It is particular
efficacious within 48 hours of the incident. It may also be given
to neonates who are at increased risk of contracting hepatitis B
i.e. whose mothers are HBsAg and HBeAg positive.
Other measures - screening of blood donors, blood and body
fluid precautions.
28. Hepatitis C Virus
capsid envelop protease/helic RNA- RNA
e ase dependent polymerase
protein
c22 33c c-100
5’ 3’
cor E1 E2 NS NS NS NS
e 2 3 4 5
hypervariable
region
29. Hepatitis C Virus
Genome resembled that of a flavivirus
positive stranded RNA genome of around 10,000 bases
1 single reading frame, structural genes at the 5' end, the non-structural
genes at the 3' end.
enveloped virus, virion thought to 30-60nm in diameter
morphological structure remains unknown
HCV has been classified into a total of six genotypes (type 1 to
6) on the basis of phylogenetic analysis
Genotype 1 and 4 has a poorer prognosis and response to
interferon therapy,
In Hong Kong, genotype 1 accounts for around 67% of cases
and genotype 6 around 25%.
30. Terminology
Family Genus Species Genotype Subtype Quasispecies
Term Definition % Nucleotide
Similarity
Genotype Genetic heterogeneity among 65.7-68.9
different HCV isolates
Subtype Closely related isolates within each 76.9-80.1
of the major genotypes
Quasispecies Complex of genetic variants within 90.8-99
individual isolates
31. Hepatitis C - Clinical
Features
Incubation period: Average 6-7 wks
Range 2-26 wks
Clinical illness (jaundice): 30-40% (20-30%)
Chronic hepatitis: 70%
Persistent infection: 85-100%
Immunity: No protective
antibody
response identified
32. Chronic Hepatitis C Infection
The spectrum of chronic hepatitis C infection is
essentially the same as chronic hepatitis B
infection.
All the manifestations of chronic hepatitis B
infection may be seen, albeit with a lower
frequency i.e. chronic persistent hepatitis, chronic
active hepatitis, cirrhosis, and hepatocellular
carcinoma.
33. Hepatitis C Virus Infection
Typical Serologic Course
anti-
HCV
Symptoms
Titr
e
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4
Mont Years
hsTime after
Exposure
34. Risk Factors Associated
with Transmission of HCV
Transfusion or transplant from infected donor
Injecting drug use
Hemodialysis (yrs on treatment)
Accidental injuries with needles/sharps
Sexual/household exposure to anti-HCV-positive
contact
Multiple sex partners
Birth to HCV-infected mother
35.
36. Laboratory Diagnosis
HCV antibody - generally used to diagnose hepatitis C
infection. Not useful in the acute phase as it takes at least 4
weeks after infection before antibody appears.
HCV-RNA - various techniques are available e.g. PCR and
branched DNA. May be used to diagnose HCV infection in
the acute phase. However, its main use is in monitoring the
response to antiviral therapy.
HCV-antigen - an EIA for HCV antigen is available. It is
used in the same capacity as HCV-RNA tests but is much
easier to carry out.
37. Prognostic Tests
Genotyping – genotype 1 and 4 have a worse prognosis overall and
respond poorly to interferon therapy. A number of commercial and in-
house assays are available.
Genotypic methods – DNA sequencing, PCR-hybridization e.g. INNO-
LIPA.
Serotyping – particularly useful when the patient does not have detectable
RNA.
Viral Load – patients with high viral load are thought to have a poorer
prognosis. Viral load is also used for monitoring response to IFN
therapy. A number of commercial and in-house tests are available.
38. Treatment
Interferon - may be considered for patients with
chronic active hepatitis. The response rate is
around 50% but 50% of responders will relapse
upon withdrawal of treatment.
Ribavirin - there is less experience with ribavirin
than interferon. However, recent studies suggest
that a combination of interferon and ribavirin is
more effective than interferon alone.
39. Prevention of Hepatitis
C
Screening of blood, organ, tissue donors
High-risk behavior modification
Blood and body fluid precautions
41. Hepatitis D Virus
The delta agent is a defective virus which
shows similarities with the viroids in plants.
The agent consists of a particle 35 nm in diameter
consisting of the delta antigen surrounded by an
outer coat of HBsAg.
The genome of the virus is very small and consists
of a single-stranded RNA
42. Hepatitis D - Clinical Features
Coinfection
– severe acute disease.
– low risk of chronic infection.
Superinfection
– usually develop chronic HDV infection.
– high risk of severe chronic liver disease.
– may present as an acute hepatitis.
43. Hepatitis D Virus Modes
of Transmission
Percutanous exposures
injecting drug use
Permucosal exposures
sex contact
44. HBV - HDV Coinfection
Typical Serologic Course
Symptoms
ALT
Elevated
Titre
anti-HBs
IgM anti-HDV
HDV RNA
HBsAg
Total anti-HDV
Time after Exposure
45. HBV - HDV Coinfection
Typical Serologic Course
Symptoms
ALT
Elevated
Titre
anti-HBs
IgM anti-HDV
HDV RNA
HBsAg
Total anti-
HDV
Time after Exposure
46. HBV - HDV
Superinfection Course
Typical Serologic
Jaundice
Symptoms
Total anti-HDV
ALT
Titre
HDV RNA
HBsAg
IgM anti-HDV
Time after
47.
48. Hepatitis D - Prevention
HBV-HDV Coinfection
Pre or postexposure prophylaxis to prevent
HBV infection.
HBV-HDV Superinfection
Education to reduce risk behaviors among
persons with chronic HBV infection.
50. Hepatitis E Virus
Calicivirus-like viruses
unenveloped RNA virus, 32-34nm in
diameter
+ve stranded RNA genome, 7.6 kb in
size.
very labile and sensitive
Can only be cultured recently
51. Hepatitis E - Clinical Features
Incubation period: Average 40 days
Range 15-60 days
Case-fatality rate: Overall, 1%-3%
Pregnant women,
15%-25%
Illness severity: Increased with age
Chronic sequelae: None identified
52. Hepatitis E Virus Infection
Typical Serologic
Course Symptoms
ALT IgG anti-HEV
Titer IgM anti-HEV
Virus in stool
0 1 2 3 4 5 6 7 8 9 1 1 1 1
0 1 2 3
Weeks after
53. Hepatitis E -
Epidemiologic Features
Most outbreaks associated with faecally contaminated drinking
water.
Several other large epidemics have occurred since in the Indian
subcontinent and the USSR, China, Africa and Mexico.
In the United States and other nonendemic areas, where
outbreaks of hepatitis E have not been documented to occur, a
low prevalence of anti-HEV (<2%) has been found in healthy
populations. The source of infection for these persons is
unknown.
Minimal person-to-person transmission.
54.
55. Prevention and Control Measures for
Travelers to HEV-Endemic Regions
Avoid drinking water (and beverages with ice) of
unknown purity, uncooked shellfish, and
uncooked fruit/vegetables not peeled or prepared
by traveler.
IG prepared from donors in Western countries
does not prevent infection.
Unknown efficacy of IG prepared from donors in
endemic areas.
Vaccine?