2. H
E
P
A
T There is growing
I need to make
people aware of
T the severity of the
disease in the
I region. People
need to be extra
S careful.

3. INTRODUCTION TO HEPATITIS
SPEAKER:
AMMARA FAROOQUI

4. HEPATITIS
Inflammation of the liver
• Acute hepatitis
• Chronic hepatitis

5. CAUSES
• Autoimmune hepatitis
• Infections from viruses, bacteria, or
parasites
• Certain chemicals or poisonous organism
• Liver damage from alcohol, poisonous
mushrooms, or other poisons
• Medications: Acetaminophen
• Inherited disorders : cystic fibrosis ,
hemochromatosis, Wilson's disease

6. RISK FACTORS
• Intravenous drug use
• Overdosing on acetaminophen
• Engaging in risky sexual behaviors
• Eating contaminated foods
• Traveling to an area where certain
diseases are common
• Living in a nursing home or
rehabilitation center
• Having a family member who recently
had hepatitis A

7. Cont..
• Using or abusing alcohol
• Being an organ transplant recipient
• Having HIV or AIDS
• Having received a blood transfusion
• Being a newborn of a mother with hepatitis B or C
• Being a health care worker, because of blood
contact
• Receiving a tattoo
• Receiving contaminated blood, sweat, tears,
saliva, semen, vaginal secretions, menstrual blood
and breast milk.

8. PREVENTION
1. To prevent from Viral Hepatitis
• Vaccination
• Immune Globulin for Traveling Abroad
• Hand Washing
• Avoid Used Needles
• Protected Sex
• Avoid Sharing Certain Personal Items
• Wear Gloves When Handling Body
Fluids
• Avoid Contaminated Water and Food

9. 2. To prevent alcoholic hepatitis:
• Limit the amount of alcohol consumption.
3. To prevent toxic/drug-induced hepatitis:
• Be aware of the lethal contents of all
chemicals.
• Face the spray away from the body.
• Wear protective equipment if
applicable

10. VIRAL HEPATITIS
Hepatitis caused by viruses:
Hepatitis A virus (HAV) Hepatitis B Virus (HBV) Hepatitis C Virus (HCV)
Hepatiti Hepatiti
s D Virus s E Virus
(HDV) (HEV)

11. INTRODUCTION TO VIRAL
HEPATITIS
Hepatitis doesn't always
present symptoms
- Karen Gonzales
SPEAKER:
NOOR UL
AINN

14.  Called HAV
 Infected Food water
human waste ,
 Anal –oral contact
during sex .

15.  Called HBV
 STD.
 Injectedblood
sharing of
needles
unprotected sex
,tatoo.

16.  Called HCV.
 Direct contact with
blood.
 Unprotected sex.

17.  Cirrhosis [liver scaring ]
 Risk factor
 Older
 Male gender
 Heavy alcohol used.

18.  Called HDV.
 Already infected with
HBV.
 Infected blood
 Unprotected sex.
 Infected needles.

19.  Drinking water.
 Anal or oral sex.
 Similar to HAV.

20.  Newly discovered.
 Relative of HCV.
 HXV is unknown.

22.  Mild flu
 Rash
 Diarrhea
 Mild fever
 Abdominal
pain
 Vomiting
 Weightloss

23. Cont…
 Circulation problem
 Dark urine
 Dizziness
 Drowsiness
 Enlarged spleen
 Headache
 Hives
 Itchy skin
 Light closed feces
 Yellow skin .

24.  Difficulty
gaining weight.
 Growing normally.
 Mental development.

25.  Blood sample
 Tissue sample
 Albumin level
 Liver function
test
 Liver biopsy

26.  Tissuesample
 DNA test.
HEV DIAGNOSED
 RT-PCR TEST
 Immune electron
microscopy.

27. HEPATITIS A VIRUS
SPEAKER:
HIRA
ARSHAD

30. Hepatitis a infection is caused
by HAV (RNA single type of
serotype)
The first successful vaccine
Invented by maurice hillmen
at merk.

31. hepatitis a vaccine is
available as
HAV(alone)
HAV with the combination of HBV
 HAVRIX(hepatitis a vaccine)
 VAQTA (hepatitis a vaccine)
 TWINRIX (with hepatitis B vaccine)

32. Product Havrix
Manufacture by GLAXOSMITHKLINE
Year licensed 1995
Havrix is sterile suspension
Inactivated virus for intramuscular
administration
A vaccine is whole killed hepatitis a virus.
It does not contain live virus so u cant get
hepatitis from vaccines.

33. Manufactured by MERCK
Generic name: hepatitis a vaccine
Vaqta is inactivated whole virus vaccine
Derived from hepatitis A.

34. The vaccine is usually given by injections intra
muscular
By a health care professional , a series of 2 injections
is usually given
6 to 8 month period.

35. CHILDREN AND ADOLESCENTS.
Primary immunization for children (12 months to 18
years age)
Consist of a single 0.5ml and 0.5 ml booster dose
administered between 6 to 12 months …
ADULT DOSE.
Primary immunization for adults
Consist of a single 1ml dose
And 1ml booster dose administered
Between 6 to 12 months

37. Manufactured by.GSK
Main use .prevention of hepatitis A and B
IT Contains inactivated hepatitis a virus
and extract of hepatitis B virus.

38. TWINRIX adult is suitable for
adult aged 16 years and over
Twinrix children is
suitable for adolescents 1
to 5 years

39. Shake well before use ,thoroughly agitation
,TWINRIX is a slightly turbid white suspension
Use the sterile needles and sterile syringes .
TWINRIX administer by intra muscular
deltoid
Region, only as a 1ml dose only.
Do not administer by gluteal region, such
injection may result in a suboptimal
response

41. HEPATITIS B VIRUS
SPEAKERS:
RABIA BIBI
SUNDUS MUKHTAR

42. HBV (hepatitis B virus)
Genus : Orthohepadnavirus
Family : Hepadnaviridae
Arrangement: icosahedral
Diameter: 42nm
Type: enveloped partially double stranded
DNA virus
Heat and pH resistant
HBV virions are also known as Dane
particles.
almost 1.2 million people worldwide die
each year from HBV related diseases

45. Transmission of hepatitis B virus results from
exposure to infectious blood or body fluids
containing blood. Possible forms of transmission
include sexual contact, blood transfusions and
transfusion with other human blood products, re-
use of contaminated needles and
syringes, and vertical transmission from mother
to child (MTCT) during childbirth.

46. The first vaccine became available in
1981.
The vaccine contains :
HBsAg
It is produced by yeast cells, into which
the genetic code for HBsAg has been
inserted.
A course of three (3) vaccine injections is
given. Afterward an immune
system antibody to HBsAg is established
in the bloodstream. The antibody is
known as anti-HBsAg. This antibody and
immune system memory then provide
immunity to hepatitis B infection.

47. Acute hepatitis B does not require medication.
Chronic hepatitis B requires proper medication, currently,
there are at least six drugs available:
1. Interferon:
• Usually a good choice for young people
without serious liver disease.
• Treatment duration is relatively short (24
to 48 weeks) compared to other hepatitis B
therapies.
Side effects:
• Not available for people with failing livers.
• Most expensive compared to the other drugs.
• Pegylated interferon not approved for children.

48. 2. Lamivudine:
• Least expensive.
• One of the older hepatitis B drugs, so a lot is known about its safety.
• Might be helpful in treating HIV co-infection in combination with tenofovir.
• Approved for both children and adults.
Side effects:
• Often loses its effectiveness against the hepatitis B virus.
• Requires long-term treatment.

49. 3. Adefovir dipivoxil
• Can be used in patients with lamivudine-resistant
hepatitis B virus.
Side effects:
•Can be toxic to your kidneys at high doses.
•Requires long-term treatment.

50. 4. Entecavir:
• Has an extremely low rate of resistance.
• Might be helpful in patients with failing livers.
Side effects:
• A newer drug.
•Requires long-term treatment.

51. 5. Telbivudine:
• More powerful antiviral drug than lamivudine and adefovir.
Side effects:
• As likely as lamivudine to become resistant to hepatitis B virus.
• Requires long-term treatment.
• Not approved for children.

52. 6. Tenofovir:
• Excellent at treating regular and drug-resistant types of hepatitis B
virus.
•Treats both HIV and the hepatitis B virus.
Side effects:
• It's a relatively new drug for treating hepatitis B.
• Not approved for children.
• Requires long-term treatment.
• Regular monitoring of kidney function is necessary.

53. HEPATITIS C
VIRUS
SPEAKER:
ANAM
HASSAN

54. Hepatitis C virus (HCV or sometimes HVC) is
a small (55–65 nm in size), enveloped
,positive sense single-stranded RNA virus of
the family Flaviviridae.
 Hepatitis C virus is the cause of hepatitis
C in humans.

56. The Life Cycle of
Hepatitis C
The hepatitis C virus must attach to
and infect liver cells in order to
carry out its life cycle and
reproduce - this is why it is
associated with liver disease. While
little is known about the exact
natural processes of hepatitis C,
like other viruses, it must complete
eight key steps to carry out its life
cycle

58.  The hepatitis C virus is most
commonly transmitted through
exposure to infectious blood.
 receipt of contaminated blood
transfusions, blood products and
organ transplants;
 injections given with contaminated
syringes and needle-stick injuries
in health-care settings;
 being born to a hepatitis C-
infected mother.
 Hepatitis C may be transmitted
through sex with an infected
person.
 Hepatitis C is not spread through
breast milk, food or water or by
casual contact such as hugging,
kissing and sharing food or drinks
with an infected person.

59.  There is no vaccine currently
available for hepatitis C virus.
 Pegylated interferon and
ribavirin for chronic HCV.

60.  Two new oral medications that are
protease inhibitors, Boceprevir and
Telaprevir, were approved FDA in May
2011 for patients with HCV genotype
1. They will be used in combination
with pegylated interferon and
ribavirin. Boceprevir and Telaprevir
cannot be taken together and are not
monotherapies.

61. SPEAKER
BUSHRA KHAN

63. VIRION:
HDV virion is enveloped ,spherical ,ssRNA(-) with a diameter of about 22 nm .
Membrane proteins are originated from the HBV helper virus.

65.  bloodborne and sexual
 percutaneous (injecting drug
use, haemophiliacs)
 permucosal (sexual)
 Risk factors include:
 Abusing intravenous (IV) or
injection drugs
 Being infected while pregnant
 Carrying the hepatitis B virus
 Men having sexual intercourse
with other men
 Receiving many blood
transfusions.

67. Many of the medicines used to
treat hepatitis B are not helpful
for treating hepatitis D. Persons
with long-term HDV infection
may receive a medicine called
alpha interferon for up to 12
months. A liver transplant for
end-stage chronic hepatitis B
may be effective.

69. No vaccines exist against HDV; however,
vaccination against HBV of patients who
are not chronic HBV carriers, provides
protection against HDV infection.

70. HEPATITIS E
VIRUS
SPEAKER:
MADIHA AHMED

74. Hepatitis E Virus
(Hepeviridae family)
VIRION:
Non-enveloped, spherical, 32-34 nm in diameter. RNA genome is enclosed within
a capsid composed of 60 capsid proteins, assembled into T=1 isometric
icosahedral particle.

75. GENOME:
Monopartite, linear, ssRNA(+) genome . The 5’ end is capped and the 3’
terminus is polyadenylated.
GENE EXPRESSION:
ORF1 encodes nonstructural proteins; ORF2 encodes capsid protein; ORF3
encodes small immunogenic protein.

79. By Oral,Fecal route. Zoonotic & Fomite.
Host : Human, pig, monkey,
some rodents,& chicken.

81. INFECTION :
Secondary site
: hepatocytes &
possibly cells in
biliary tract.
Primary site
: possibly the
intestinal
tract.

83. Treatment options for chronic hepatitis
include:
 The first step in the treatment is reduction of immuno
supression medication in 16 solid organ transplant recipients
with chronic hepatitis E ,led to clearance of HEV in 4 cases
(25%) .
 A second possible treatment option is administration of
pegylated -interferon α with ribavirin.
 Treatment durations varied between 3 and 12 months.
 Ribavirin has also been used in a not -transplanted patient
with severe acute hepatitis E who showed rapid improvement
of symptoms and liver function tests during treatment .

85. No commercial HEV vaccine is currently available. A
vaccine developed by GSK & the Walter Reed Army
Institute that was successfully tested in a Phase II
study
(Shrestha 2007). However, this vaccine has not been
further developed.

86. A group from China reported data recently from a very large successful Phase III vaccine trial (Zhu 2010)
. This trial included almost 110,000 individuals who received either a recombinant HEV vaccine (“HEV 239”)
or placebo. The vaccine efficacy after 3 doses was 100%. Moreover, the efficacy of this vaccine needs to be
evaluated in special risks groups such as patients with end-stage liver disease or immuno suppressed
individuals. It is also unknown if HEV -239 also protects from HEV genotype 3 infection (Wedemeyer and
Pischke 2011)