This document discusses viral hepatitis, focusing on hepatitis A, B, C, D, and E. It provides details on the definition, causes, epidemiology, transmission, signs and symptoms, diagnosis, treatment and prevention of each type of viral hepatitis. Key points include that hepatitis A, B, C, D and E viruses are the main causes of viral hepatitis in humans. They differ in their transmission routes, clinical presentations, risk of chronic infection and availability of treatment. Vaccination is an effective way to prevent hepatitis A and B infection.
Toxoid vaccines are vaccines that are made from the toxins (harmful chemicals) from bacteria. There are some bacteria that cause disease through releasing a protein called a toxin. Scientists can inactivate these toxins in the lab using a chemical called formalin (a solution of formaldehyde) and sterilized water, which are completely safe to use in small quantities in the human body. Once the toxin is inactivated, it’s called a toxoid, and it can no longer cause harm. The body learns how to fight off the bacteria’s natural toxin once exposed to the toxoid through producing antibodies that bind into the toxin like keys into a lock
This document provides information on immunization and immunity. It discusses active and passive immunity, different immunizing agents including vaccines, immunoglobulins, and antisera. It describes different types of vaccines and their use, routes of administration, immunization schedules, effectiveness of vaccines, and the cold chain system for vaccine storage and transport. Potential adverse reactions and precautions for immunization are also outlined. The document concludes with discussions on vaccination coverage and applications of active immunization.
The document provides a detailed history of vaccinations from ancient times through modern times. It describes key events such as Edward Jenner discovering the smallpox vaccine in 1796. It also summarizes the four main types of vaccines - live attenuated, inactivated, subunit, and toxoid vaccines - and provides examples of each. Common questions about vaccinations are addressed at the end related to safety, schedules, and specific vaccines.
The document discusses various vaccines including BCG, oral polio, DPT, measles, hepatitis B, tetanus toxoid, and rabies. It defines key terms like vaccine, toxoid, and immunity. For each vaccine, it describes aspects like dosage, administration method, schedule, storage requirements, effectiveness, complications and contraindications. The aim is to educate on different vaccine types and their proper use to induce immunity against diseases.
The document provides an overview of the history and development of vaccines. It discusses key events like Jenner's development of the smallpox vaccine in 1796 and the eradication of smallpox. It describes different types of vaccines including live-attenuated, inactivated, toxoid, subunit, conjugate, and DNA vaccines. The mechanisms of how vaccines work and produce immunity are also explained. The document traces the evolution of vaccines from whole organism approaches to modern techniques like recombinant DNA technology.
Killed bacterial vaccines against cholera, plague, typhus, and Q fever contain whole killed bacteria and are used to protect those exposed. Live attenuated bacterial vaccines like BCG against tuberculosis use live but weakened Mycobacterium bovis. Toxoid vaccines for diphtheria and tetanus contain inactivated toxins that have lost disease-causing ability but retained immunogenicity. Purified protein vaccines such as the acellular pertussis vaccine recommended for all children contain purified bacterial proteins. Capsular polysaccharide vaccines for pneumonia, meningitis, and H. influenzae conjugate the polysaccharide to a carrier protein to enhance the antibody response.
This document provides information on various vaccines including their composition, administration, and schedules. It discusses key details of vaccines for diseases like tuberculosis (BCG), polio, hepatitis B, diphtheria-pertussis-tetanus (DPT), influenza, rotavirus, pneumococcal pneumonia, measles, rubella, mumps, typhoid, varicella, human papillomavirus (HPV), and meningococcal infections. The goals, mechanisms of action, dosage, routes of administration, and protective effects of different vaccine types like live attenuated, killed, toxoid, subunit, and conjugate vaccines are outlined. National immunization schedules for infants, children, pregnant women, and adults are
Toxoid vaccines are vaccines that are made from the toxins (harmful chemicals) from bacteria. There are some bacteria that cause disease through releasing a protein called a toxin. Scientists can inactivate these toxins in the lab using a chemical called formalin (a solution of formaldehyde) and sterilized water, which are completely safe to use in small quantities in the human body. Once the toxin is inactivated, it’s called a toxoid, and it can no longer cause harm. The body learns how to fight off the bacteria’s natural toxin once exposed to the toxoid through producing antibodies that bind into the toxin like keys into a lock
This document provides information on immunization and immunity. It discusses active and passive immunity, different immunizing agents including vaccines, immunoglobulins, and antisera. It describes different types of vaccines and their use, routes of administration, immunization schedules, effectiveness of vaccines, and the cold chain system for vaccine storage and transport. Potential adverse reactions and precautions for immunization are also outlined. The document concludes with discussions on vaccination coverage and applications of active immunization.
The document provides a detailed history of vaccinations from ancient times through modern times. It describes key events such as Edward Jenner discovering the smallpox vaccine in 1796. It also summarizes the four main types of vaccines - live attenuated, inactivated, subunit, and toxoid vaccines - and provides examples of each. Common questions about vaccinations are addressed at the end related to safety, schedules, and specific vaccines.
The document discusses various vaccines including BCG, oral polio, DPT, measles, hepatitis B, tetanus toxoid, and rabies. It defines key terms like vaccine, toxoid, and immunity. For each vaccine, it describes aspects like dosage, administration method, schedule, storage requirements, effectiveness, complications and contraindications. The aim is to educate on different vaccine types and their proper use to induce immunity against diseases.
The document provides an overview of the history and development of vaccines. It discusses key events like Jenner's development of the smallpox vaccine in 1796 and the eradication of smallpox. It describes different types of vaccines including live-attenuated, inactivated, toxoid, subunit, conjugate, and DNA vaccines. The mechanisms of how vaccines work and produce immunity are also explained. The document traces the evolution of vaccines from whole organism approaches to modern techniques like recombinant DNA technology.
Killed bacterial vaccines against cholera, plague, typhus, and Q fever contain whole killed bacteria and are used to protect those exposed. Live attenuated bacterial vaccines like BCG against tuberculosis use live but weakened Mycobacterium bovis. Toxoid vaccines for diphtheria and tetanus contain inactivated toxins that have lost disease-causing ability but retained immunogenicity. Purified protein vaccines such as the acellular pertussis vaccine recommended for all children contain purified bacterial proteins. Capsular polysaccharide vaccines for pneumonia, meningitis, and H. influenzae conjugate the polysaccharide to a carrier protein to enhance the antibody response.
This document provides information on various vaccines including their composition, administration, and schedules. It discusses key details of vaccines for diseases like tuberculosis (BCG), polio, hepatitis B, diphtheria-pertussis-tetanus (DPT), influenza, rotavirus, pneumococcal pneumonia, measles, rubella, mumps, typhoid, varicella, human papillomavirus (HPV), and meningococcal infections. The goals, mechanisms of action, dosage, routes of administration, and protective effects of different vaccine types like live attenuated, killed, toxoid, subunit, and conjugate vaccines are outlined. National immunization schedules for infants, children, pregnant women, and adults are
Bacterial vaccines can be prepared from whole killed or live attenuated bacteria, as well as purified components like capsular polysaccharides or toxins. They work by stimulating the immune system to produce antibodies against the disease-causing bacteria. Bacterial vaccines are evaluated for safety, sterility, and potency to ensure they induce a protective immune response without adverse effects. Tests involve injecting the vaccines into laboratory animals and humans to measure antibody levels and check for contamination.
Vaccines work by exposing the immune system to agents that resemble disease-causing pathogens, causing the body to develop immunity to them. There are several types of vaccines, including live attenuated vaccines containing weakened live pathogens, inactivated vaccines containing killed pathogens, toxoid vaccines containing inactivated toxins, and subunit vaccines containing fragments of pathogens. Vaccines are administered through various routes such as intramuscular, subcutaneous, oral, intranasal, and intradermal injection depending on the vaccine. Proper vaccine storage, administration technique, and timing are important for vaccine effectiveness.
This document is a presentation on vaccines that was created by Sana Shaikh for a class. It includes an index listing the topics covered which are an introduction to vaccines, the history of vaccines including the work of Edward Jenner and Louis Pasteur, the production process for vaccines, and applications of specific vaccines for measles, polio, typhoid, hepatitis B, tetanus, and current research on vaccine adherence. The presentation provides overviews of the different vaccines discussed, including dosing schedules, and ends with a list of references.
Prevention is better than any cure. Smallpox has been eradicated. Polio is largely controlled. Hepatitis A&B now largely preventable. Measles and rubella are targeted for elimination.
What is a vaccine? How are they developed and implemented? What is the public health effectiveness? What vaccines are in use? Learn the answers to these questions and so much more in this free report: Vaccine Fact Book 2013.
The document argues that vaccines are unsafe and ineffective, and that the pharmaceutical industry and government lie about this in order to perpetuate harm to human life. It provides 9 questions that pro-vaccine advocates are unable to answer to prove the safety of vaccines, such as requests for double-blind studies and evidence that vaccines target mutating viruses. The document claims that independent research shows vaccines are unsafe while research by drug makers and the government cannot be trusted.
The document discusses the history and types of vaccination. It describes how Edward Jenner observed that milkmaids exposed to cowpox did not get smallpox, leading him to develop the smallpox vaccine in 1796. Since then, vaccines have been developed for over 20 diseases and have saved millions of lives worldwide by training the immune system to recognize and fight pathogens. Vaccines can be live attenuated, inactivated, toxoid, subunit, polysaccharide or genetic based.
This document discusses various topics related to vaccinology and vaccine development. It begins with a brief history of vaccinology, mentioning key figures like Louis Pasteur and Edward Jenner. It then discusses different types of vaccines including live attenuated, inactivated/killed, subunit, recombinant, DNA, plant-based, peptide-based, conjugate, and T-cell vaccines. For each type, it provides examples and discusses advantages and disadvantages. The document concludes by mentioning therapeutic HPV vaccines that target the E6 and E7 oncoproteins.
There are several types of bacterial vaccines that work through different mechanisms of the immune system. Active immunization stimulates the body's own immune response by introducing an antigen from the bacteria. This induces long-term immunity through memory B and T cells. Passive immunization provides immediate, short-term protection by transferring pre-formed antibodies. Common bacterial vaccines include those targeting Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, diphtheria, tetanus, pertussis, Lyme disease, anthrax, tuberculosis, and typhoid fever. These vaccines contain inactivated toxins, purified proteins, capsular polysaccharides, or live attenuated bacterial strains.
The document discusses different types of bacterial vaccines. It begins by introducing active and passive immunity. Active immunity is induced by vaccines made from bacteria or their products, while passive immunity provides preformed antibodies from another source. The main types of bacterial vaccines discussed are whole-organism attenuated or killed vaccines, purified macromolecule vaccines like polysaccharides or toxoids, and subunit vaccines. Specific examples provided include vaccines for cholera, plague, typhus, pertussis, tetanus, diphtheria, hepatitis B, and human papillomavirus. Memory cells and immunological memory play an important role depending on the incubation period of the pathogen.
Vaccination involves stimulating immunity in the human body against specific diseases using modified or killed microorganisms. There are three main types of vaccines: killed vaccines using normal infections; attenuated vaccines using live but weakened virus particles; and subunit vaccines using purified virus components. Vaccination reduces susceptibility to infection, can slow or stop the spread of disease, and helps protect not only those vaccinated but also the wider community. However, some viruses mutate rapidly requiring new vaccines, vaccination involves costs and trained professionals, and both mild and severe side effects can occasionally occur.
The document summarizes future generation vaccines and their development. It discusses the need for vaccines against HIV, tuberculosis, malaria, dengue, and meningococcal diseases. For each disease, it outlines the disease burden, current vaccine development efforts including clinical trials, and the roles of organizations like WHO and PATH in accelerating vaccine development. The largest and most advanced vaccine clinical trials mentioned are for RTS,S malaria vaccine and Dengvaxia dengue vaccine.
The document discusses different types of vaccines, including:
- Live attenuated vaccines which use weakened live pathogens that cause immunity but not disease. Examples include measles, rubella, and yellow fever vaccines.
- Toxoid vaccines which use inactivated bacterial toxins to provide immunity against diseases caused by toxins like tetanus, diphtheria, and pertussis.
- Subunit vaccines containing purified antigen components rather than whole organisms, like hepatitis B and papilloma virus vaccines.
- Conjugated vaccines join bacterial capsular polysaccharides to proteins to enhance immune response against infections like Hib and pneumococcal.
- Recombinant vaccines produced through genetic engineering techniques
This document discusses the principles of vaccination. It covers:
- Active and passive immunity and how they are obtained naturally or artificially through vaccination or antibody transfer.
- The components of vaccines, including antigens, antibodies, and epitopes.
- The different types of vaccines such as live attenuated, inactivated, toxoid, subunit, and polysaccharide vaccines.
- How vaccines work to produce immunity through replication or exposure to antigens without causing disease.
- The development process, safety testing, and surveillance of new vaccines.
Live bacterial vaccines use live attenuated bacteria to induce immune responses against target pathogens. There are two types - those that combat the disease-causing organism directly, and those that assist in combating other organisms by inducing immune responses against heterologous antigens carried by the bacteria. Currently licensed live bacterial vaccines include typhoid, cholera, and tuberculosis vaccines. Virulence is attenuated through genetic modifications like gene deletions or making the bacteria auxotrophic. Recombinant bacterial vectors can also be used to deliver heterologous protein or DNA antigens from pathogens. Effective vectors exploit bacteria that invade mucosal tissues to stimulate mucosal and systemic immune responses.
This document discusses different types of vaccines and factors that can lead to vaccine failure. It describes several types of vaccines including live attenuated, inactivated/killed, toxoid, subunit, recombinant subunit, recombinant vector, DNA, and transitional vaccines. It compares advantages and disadvantages of different vaccine types. The document also lists numerous potential causes of vaccine failure, such as use of expired vaccines, improper storage, genetic resistance, health status of individuals receiving the vaccine, immunosuppression, mycotoxins, stress, genetics, administration errors, water quality, and presence of maternal antibodies or variants in the field.
Immunization involves deliberately inducing an adaptive immune response through vaccination. Vaccination uses killed or attenuated pathogens to provoke immunity without causing disease. The goals of vaccination are eradication and prevention of disease through complete or partial lifelong protection. Protection can be achieved through active immunization by administering live attenuated or inactivated pathogens/toxins/antigens, or through passive immunization by administering preformed antibodies. Effective immunization programs require assessing community needs, setting goals and strategies, estimating resources, and monitoring outcomes through delivery of vaccines at fixed sites, outreach, and mobile services.
This document defines vaccines as preparations made from weakened or killed pathogens that induce antibody formation and immunity. It describes three main types of vaccines: killed, live attenuated, and toxoids. The preparation, quality control, storage, and examples of common vaccines are outlined. Genetic engineering allows large-scale production of pathogen-derived polypeptides as subunit vaccines with advantages over traditional methods. Quality is ensured through testing for sterility, toxicity, and maximum levels of preservatives. Vaccines must be stored between 2-8°C and below -20°C if freeze-dried.
This document provides information on various viral and bacterial vaccines. It discusses the smallpox, rabies, yellow fever, influenza, polio, measles, mumps, typhus, and combination virus vaccines. For each it describes the source, preparation, storage, uses, and dose. It also covers bacterial vaccines for typhoid, cholera, pertussis, plague, and BCG. The document emphasizes that vaccines are prepared from viruses or bacteria grown in cells or egg embryos, then inactivated or attenuated before use. Combination vaccines provide protection against multiple diseases in a single shot.
There are 5 major hepatotropic viruses that can cause viral hepatitis: hepatitis A, B, C, D, and E viruses. Hepatitis A and E viruses are transmitted via the fecal-oral route while hepatitis B, C, and D viruses are transmitted via exposure to infected blood or body fluids. The presentation of viral hepatitis ranges from asymptomatic infection to acute symptomatic hepatitis and even acute liver failure in severe cases. Laboratory tests are used to diagnose viral hepatitis and help determine if infection is acute or chronic. There is no specific treatment for viral hepatitis but supportive care and vaccination can help prevent infection.
Bacterial vaccines can be prepared from whole killed or live attenuated bacteria, as well as purified components like capsular polysaccharides or toxins. They work by stimulating the immune system to produce antibodies against the disease-causing bacteria. Bacterial vaccines are evaluated for safety, sterility, and potency to ensure they induce a protective immune response without adverse effects. Tests involve injecting the vaccines into laboratory animals and humans to measure antibody levels and check for contamination.
Vaccines work by exposing the immune system to agents that resemble disease-causing pathogens, causing the body to develop immunity to them. There are several types of vaccines, including live attenuated vaccines containing weakened live pathogens, inactivated vaccines containing killed pathogens, toxoid vaccines containing inactivated toxins, and subunit vaccines containing fragments of pathogens. Vaccines are administered through various routes such as intramuscular, subcutaneous, oral, intranasal, and intradermal injection depending on the vaccine. Proper vaccine storage, administration technique, and timing are important for vaccine effectiveness.
This document is a presentation on vaccines that was created by Sana Shaikh for a class. It includes an index listing the topics covered which are an introduction to vaccines, the history of vaccines including the work of Edward Jenner and Louis Pasteur, the production process for vaccines, and applications of specific vaccines for measles, polio, typhoid, hepatitis B, tetanus, and current research on vaccine adherence. The presentation provides overviews of the different vaccines discussed, including dosing schedules, and ends with a list of references.
Prevention is better than any cure. Smallpox has been eradicated. Polio is largely controlled. Hepatitis A&B now largely preventable. Measles and rubella are targeted for elimination.
What is a vaccine? How are they developed and implemented? What is the public health effectiveness? What vaccines are in use? Learn the answers to these questions and so much more in this free report: Vaccine Fact Book 2013.
The document argues that vaccines are unsafe and ineffective, and that the pharmaceutical industry and government lie about this in order to perpetuate harm to human life. It provides 9 questions that pro-vaccine advocates are unable to answer to prove the safety of vaccines, such as requests for double-blind studies and evidence that vaccines target mutating viruses. The document claims that independent research shows vaccines are unsafe while research by drug makers and the government cannot be trusted.
The document discusses the history and types of vaccination. It describes how Edward Jenner observed that milkmaids exposed to cowpox did not get smallpox, leading him to develop the smallpox vaccine in 1796. Since then, vaccines have been developed for over 20 diseases and have saved millions of lives worldwide by training the immune system to recognize and fight pathogens. Vaccines can be live attenuated, inactivated, toxoid, subunit, polysaccharide or genetic based.
This document discusses various topics related to vaccinology and vaccine development. It begins with a brief history of vaccinology, mentioning key figures like Louis Pasteur and Edward Jenner. It then discusses different types of vaccines including live attenuated, inactivated/killed, subunit, recombinant, DNA, plant-based, peptide-based, conjugate, and T-cell vaccines. For each type, it provides examples and discusses advantages and disadvantages. The document concludes by mentioning therapeutic HPV vaccines that target the E6 and E7 oncoproteins.
There are several types of bacterial vaccines that work through different mechanisms of the immune system. Active immunization stimulates the body's own immune response by introducing an antigen from the bacteria. This induces long-term immunity through memory B and T cells. Passive immunization provides immediate, short-term protection by transferring pre-formed antibodies. Common bacterial vaccines include those targeting Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, diphtheria, tetanus, pertussis, Lyme disease, anthrax, tuberculosis, and typhoid fever. These vaccines contain inactivated toxins, purified proteins, capsular polysaccharides, or live attenuated bacterial strains.
The document discusses different types of bacterial vaccines. It begins by introducing active and passive immunity. Active immunity is induced by vaccines made from bacteria or their products, while passive immunity provides preformed antibodies from another source. The main types of bacterial vaccines discussed are whole-organism attenuated or killed vaccines, purified macromolecule vaccines like polysaccharides or toxoids, and subunit vaccines. Specific examples provided include vaccines for cholera, plague, typhus, pertussis, tetanus, diphtheria, hepatitis B, and human papillomavirus. Memory cells and immunological memory play an important role depending on the incubation period of the pathogen.
Vaccination involves stimulating immunity in the human body against specific diseases using modified or killed microorganisms. There are three main types of vaccines: killed vaccines using normal infections; attenuated vaccines using live but weakened virus particles; and subunit vaccines using purified virus components. Vaccination reduces susceptibility to infection, can slow or stop the spread of disease, and helps protect not only those vaccinated but also the wider community. However, some viruses mutate rapidly requiring new vaccines, vaccination involves costs and trained professionals, and both mild and severe side effects can occasionally occur.
The document summarizes future generation vaccines and their development. It discusses the need for vaccines against HIV, tuberculosis, malaria, dengue, and meningococcal diseases. For each disease, it outlines the disease burden, current vaccine development efforts including clinical trials, and the roles of organizations like WHO and PATH in accelerating vaccine development. The largest and most advanced vaccine clinical trials mentioned are for RTS,S malaria vaccine and Dengvaxia dengue vaccine.
The document discusses different types of vaccines, including:
- Live attenuated vaccines which use weakened live pathogens that cause immunity but not disease. Examples include measles, rubella, and yellow fever vaccines.
- Toxoid vaccines which use inactivated bacterial toxins to provide immunity against diseases caused by toxins like tetanus, diphtheria, and pertussis.
- Subunit vaccines containing purified antigen components rather than whole organisms, like hepatitis B and papilloma virus vaccines.
- Conjugated vaccines join bacterial capsular polysaccharides to proteins to enhance immune response against infections like Hib and pneumococcal.
- Recombinant vaccines produced through genetic engineering techniques
This document discusses the principles of vaccination. It covers:
- Active and passive immunity and how they are obtained naturally or artificially through vaccination or antibody transfer.
- The components of vaccines, including antigens, antibodies, and epitopes.
- The different types of vaccines such as live attenuated, inactivated, toxoid, subunit, and polysaccharide vaccines.
- How vaccines work to produce immunity through replication or exposure to antigens without causing disease.
- The development process, safety testing, and surveillance of new vaccines.
Live bacterial vaccines use live attenuated bacteria to induce immune responses against target pathogens. There are two types - those that combat the disease-causing organism directly, and those that assist in combating other organisms by inducing immune responses against heterologous antigens carried by the bacteria. Currently licensed live bacterial vaccines include typhoid, cholera, and tuberculosis vaccines. Virulence is attenuated through genetic modifications like gene deletions or making the bacteria auxotrophic. Recombinant bacterial vectors can also be used to deliver heterologous protein or DNA antigens from pathogens. Effective vectors exploit bacteria that invade mucosal tissues to stimulate mucosal and systemic immune responses.
This document discusses different types of vaccines and factors that can lead to vaccine failure. It describes several types of vaccines including live attenuated, inactivated/killed, toxoid, subunit, recombinant subunit, recombinant vector, DNA, and transitional vaccines. It compares advantages and disadvantages of different vaccine types. The document also lists numerous potential causes of vaccine failure, such as use of expired vaccines, improper storage, genetic resistance, health status of individuals receiving the vaccine, immunosuppression, mycotoxins, stress, genetics, administration errors, water quality, and presence of maternal antibodies or variants in the field.
Immunization involves deliberately inducing an adaptive immune response through vaccination. Vaccination uses killed or attenuated pathogens to provoke immunity without causing disease. The goals of vaccination are eradication and prevention of disease through complete or partial lifelong protection. Protection can be achieved through active immunization by administering live attenuated or inactivated pathogens/toxins/antigens, or through passive immunization by administering preformed antibodies. Effective immunization programs require assessing community needs, setting goals and strategies, estimating resources, and monitoring outcomes through delivery of vaccines at fixed sites, outreach, and mobile services.
This document defines vaccines as preparations made from weakened or killed pathogens that induce antibody formation and immunity. It describes three main types of vaccines: killed, live attenuated, and toxoids. The preparation, quality control, storage, and examples of common vaccines are outlined. Genetic engineering allows large-scale production of pathogen-derived polypeptides as subunit vaccines with advantages over traditional methods. Quality is ensured through testing for sterility, toxicity, and maximum levels of preservatives. Vaccines must be stored between 2-8°C and below -20°C if freeze-dried.
This document provides information on various viral and bacterial vaccines. It discusses the smallpox, rabies, yellow fever, influenza, polio, measles, mumps, typhus, and combination virus vaccines. For each it describes the source, preparation, storage, uses, and dose. It also covers bacterial vaccines for typhoid, cholera, pertussis, plague, and BCG. The document emphasizes that vaccines are prepared from viruses or bacteria grown in cells or egg embryos, then inactivated or attenuated before use. Combination vaccines provide protection against multiple diseases in a single shot.
There are 5 major hepatotropic viruses that can cause viral hepatitis: hepatitis A, B, C, D, and E viruses. Hepatitis A and E viruses are transmitted via the fecal-oral route while hepatitis B, C, and D viruses are transmitted via exposure to infected blood or body fluids. The presentation of viral hepatitis ranges from asymptomatic infection to acute symptomatic hepatitis and even acute liver failure in severe cases. Laboratory tests are used to diagnose viral hepatitis and help determine if infection is acute or chronic. There is no specific treatment for viral hepatitis but supportive care and vaccination can help prevent infection.
Viral hepatitis :- Pathophsiology of Hepatitis BSHIVPAL
This document summarizes the pathophysiology of viral hepatitis. It describes the main hepatitis viruses (A, B, C, D, E), their epidemiology, symptoms, structure, diagnosis and treatment. Over 1.3 million people die each year from hepatitis B and C infections. The viruses are transmitted through bodily fluids and cause inflammation of the liver. Diagnosis involves liver function tests and detecting viral markers in blood. Treatment depends on the virus but may include antiviral drugs and vaccination.
This document provides an introduction and overview of hepatitis and the classification of hepatitis viruses. It discusses the five main hepatitis viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). For each virus, it covers key aspects like transmission route, pathogenesis, clinical presentation, diagnosis, and prevention. The document is intended to define hepatitis, classify the different hepatitis viruses, and provide essential details about each viral type.
This document provides an introduction and overview of hepatitis classification and viruses. It discusses the following key points:
1. Hepatitis is defined as inflammation of the liver caused by viruses. There are 5 main hepatitis viruses - Hepatitis A, B, C, D, and E viruses. Hepatitis B is the only DNA virus, while the others are RNA viruses.
2. The viruses are classified based on their nucleic acid and transmitted through different routes. Hepatitis A and E are transmitted via the fecal-oral route, while Hepatitis B, C, D are blood-borne.
3. Each virus is then discussed in more detail covering features like morphology, epidemiology, pathogenesis, diagnosis, and
The document provides information about hepatitis B and C, including:
- Hepatitis B and C are major global health problems, infecting hundreds of millions of people worldwide.
- Transmission occurs through contact with infected blood or bodily fluids, especially from infected mothers to babies during childbirth or from shared needles.
- Symptoms can range from mild to severe liver damage. While most adults recover from hepatitis B, chronic infection is more common in children and can lead to serious complications like liver cancer.
The document discusses infectious hepatitis and its management. It defines different types of hepatitis including acute, chronic, and fulminant hepatitis. It describes the etiology of hepatitis including viral causes from Hepatitis A, B, C, D, E and other non-viral causes. It provides details about Hepatitis A including epidemiology, transmission, clinical features, diagnosis, treatment and prevention. It also provides details about Hepatitis B including epidemiology, transmission, at risk groups, pathogenesis of acute and chronic infection, diagnosis, treatment approach and management of chronic hepatitis B.
Hepatitis is inflammation of the liver that can be caused by several viruses. The document discusses hepatitis A, B, C, D, E, and G. It covers the causative agents of each, their modes of transmission including fecal-oral and blood-borne routes, associated signs and symptoms, diagnosis, treatment and prevention including immunizations and hygiene practices.
Management of Viral Hepatitis in Immunocompromised PatientsMohammed A Suwaid
The patient has type 2 diabetes and a history of brain tumor surgery and radiation therapy. He now presents with fatigue, joint pains, abdominal discomfort, and jaundice. Tests confirm acute hepatitis B infection. Treatment with antiviral medication is generally not needed for acute hepatitis B in immunocompetent patients, as 95-99% recover spontaneously. However, in immunocompromised individuals like this patient, antiviral therapy with lamivudine may be recommended to prevent potential complications or fulminant hepatitis given his underlying conditions and treatments.
Viral hepatitis refers to inflammation of the liver caused by viruses. The five main types are Hepatitis A, B, C, D, and E. Hepatitis A is transmitted through the fecal-oral route while Hepatitis B, C, and D are transmitted through blood or bodily fluids. Acute viral hepatitis causes symptoms for less than 6 months while chronic hepatitis lasts over 6 months and can lead to cirrhosis or liver cancer over time if left untreated.
Hepatitis is inflammation of the liver that can be caused by viruses, alcohol, drugs, toxins, and autoimmune diseases. There are 5 main types of viral hepatitis: Hepatitis A, B, C, D, and E. Hepatitis A and E are typically acute but Hepatitis B, C, and D can be acute or chronic. Chronic hepatitis B and C can lead to cirrhosis and liver cancer. Treatment depends on the cause but involves rest, proper nutrition, fluid maintenance, immunoglobulins, antivirals, and vaccination. Patient education focuses on prevention, risk factors, and symptom monitoring.
Hepatitis is inflammation of the liver that can be caused by viruses, alcohol, drugs, toxins and autoimmune diseases. There are 5 main types of viral hepatitis: Hepatitis A, B, C, D and E. Hepatitis A and E are typically acute but Hepatitis B, C and D can be acute or chronic. Chronic hepatitis B and C can lead to cirrhosis and liver cancer. Symptoms are similar to the flu. Treatment depends on the cause but involves rest, proper nutrition, fluid maintenance and medications to treat the virus in some cases. Education is important to prevent transmission.
Hepatitis is inflammation of the liver that can be caused by infectious agents like viruses or bacteria, as well as non-infectious causes such as alcohol, drugs, autoimmune diseases, and metabolic disorders. Hepatitis B is a major global health problem, with the highest prevalence in the Western Pacific and African regions. In Nepal, the prevalence of Hepatitis B is estimated to be 0.9% on average. It is transmitted parenterally or sexually and can be acute or develop into chronic infection. Diagnosis involves liver function tests and detecting serum markers. Treatment depends on the stage of infection, while prevention involves immunization, safe injection practices, and health education.
Hepatitis C virus causes hepatitis C, an inflammation of the liver. It is a small enveloped RNA virus that is transmitted through exposure to infectious blood, such as receiving contaminated blood transfusions, injections with unclean needles, or from an infected mother to her baby during childbirth. There is currently no vaccine for hepatitis C, but chronic cases are treated with pegylated interferon and ribavirin medications. New oral protease inhibitor drugs are also being used to treat genotype 1 hepatitis C infections.
The document discusses hepatitis B virus (HBV) infection and the hepatitis B vaccine. Some key points:
- HBV is a major global health problem that can cause acute and chronic liver disease. It is transmitted through blood and bodily fluids.
- The hepatitis B vaccine is highly effective and provides long-lasting protection against HBV infection. It has been part of routine infant vaccination programs worldwide since the 1990s.
- Vaccination is also recommended for at-risk groups like healthcare workers, injection drug users, and those with multiple sexual partners to prevent HBV transmission.
The document summarizes viral markers for hepatitis viruses. It discusses IgM and IgG antibodies for hepatitis A virus which indicate acute or past infection. It describes the hepatitis B surface antigen and different hepatitis B virus antigens and antibodies that indicate different stages of hepatitis B infection. It also provides global burden statistics for hepatitis B and C and discusses laboratory tests for diagnosing hepatitis C infection including antibody, RNA and viral load tests.
Hepatitis is generally refer to inflammation of liver, it is resulted from infectious causes (such as viral, bacterial and fungal causes ) or noninfectious ( such as alcohol drugs, autoimmune diseases and metabolic diseases) , in this research , I’m going to focus on viral hepatitis because it is the most common cause of acute hepatitis in USA ( 50% of cases ).
The commonness and important viruses that cause viral hepatitis are (A,B,C,D,E) types, approximately 4.4 million Americans are currently living with chronic hepatitis B and C.
Direct thrombin inhibitors (DTIs) directly inhibit thrombin to delay clotting and are used for conditions like heparin-induced thrombocytopenia (HIT). There are three types of DTIs depending on how they interact with thrombin. The most clinically used DTIs include argatroban, bivalirudin, and dabigatran etexilate. Argatroban is administered intravenously and its dosage is titrated based on monitoring of activated partial thromboplastin time. It is approved for treating HIT and preventing clotting during percutaneous coronary intervention.
HIV is a virus that weakens the immune system by destroying CD4 cells. It can lead to AIDS if not treated. The document discusses HIV/AIDS including definitions, epidemiology in India, risk factors, transmission methods, the virus life cycle, stages of infection, signs and symptoms, diagnosis, and treatment approaches. It provides an overview of HIV from introduction through various treatment strategies and guidelines in India.
The document provides information on malaria, including:
1. Malaria is a potentially fatal disease spread by mosquito bites and caused by Plasmodium parasites. It was previously known as marsh fever due to its link to marshes.
2. Key events in the history of malaria include the discovery of the parasite in 1880, identification of mosquito transmission in 1881, and establishment of the WHO's eradication campaign in 1955 and Roll Back Malaria partnership in 1998.
3. Malaria remains a major global health problem, with over 200 million cases and 600,000 deaths estimated in 2021. Children under 15 and pregnant women are most vulnerable to infection and severe disease.
This document discusses how pharmacokinetics are altered in patients with impaired kidney function or uremia. It notes that drug absorption from the GI tract, distribution in the body, metabolism, and excretion can all be impacted. Specifically, it states that bioavailability may increase due to changes in GI motility and blood flow, while distribution can change with fluid status alterations. Metabolism and excretion are also reduced due to impaired kidney function. As a result, drug levels in the bloodstream may increase, potentially causing toxicity issues. The document emphasizes that dosing guidelines must account for a patient's remaining renal function and clearance.
Renal impairment occurs when kidney function decreases due to disease, injury, or drug intoxication. The kidneys are responsible for fluid balance, electrolyte balance, and removing drugs and metabolites from the body. Common causes of renal impairment include hypertension, diabetes, nephritis, and certain drugs. When kidney function decreases, drug pharmacokinetics are altered as the elimination rate constant and half-life change, requiring special dosing considerations.
Cellular adaptations allow cells to change in response to environmental stresses or injuries. There are five main types of cellular adaptations: atrophy, hypertrophy, hyperplasia, metaplasia, and dysplasia. Atrophy involves cells decreasing in size in response to reduced demands. Hypertrophy is an increase in cell size to meet greater demands. Hyperplasia is an increase in cell number. Metaplasia is when cells change from one type to another. Dysplasia refers to abnormal cell development occurring with metaplasia or hyperplasia, typically in response to prolonged irritation.
The patient, a 77-year-old male, was admitted to the hospital with cough, hemoptysis, decreased appetite and a history of pulmonary tuberculosis with secondary pneumonia caused by Candida and Klebsiella. Over nine days in the hospital, various tests were performed and the patient was treated with antibiotics. The patient was ultimately diagnosed with pulmonary tuberculosis and secondary pneumonia based on his symptoms, medical history and test results.
A 69-year-old male was admitted with right knee pain, nausea, and vomiting. Examination found pain in the right knee and osteoarthritis of the right knee was assessed at grade 3. Investigations including x-rays and blood tests were performed. The patient was given various medications including injections of Magnexforte, Pantocid, Tramadol, Zofer, Trenexia, Clexane, and Dynaparaque to reduce pain and anxiety and provide a comfortable environment for recovery.
Thin layer chromatography is a technique used to separate mixtures and identify compounds. It involves coating a stationary phase like silica gel onto a glass or aluminum plate, spotting the sample mixture, and developing in a mobile phase solvent. Key steps include preparing the stationary phase slurry, coating and activating plates, applying sample spots, and developing the plate in a chromatography chamber to separate compounds by polarity. Visualization agents are then used to detect separated components on the plate. TLC is useful for analytical purposes due to its low cost, simplicity, and sensitivity.
Paper chromatography is a technique used to separate mixtures into individual compounds based on their migration rates across paper. It works by applying a sample to a paper strip, then placing the strip in a sealed container with a solvent. Each compound travels up the paper at a different rate based on properties like polarity. This separates the compounds into distinct bands or spots when dried. Paper chromatography can be used to analyze organic and inorganic substances through various techniques that differ in the stationary and mobile phases used and the solvent application method. It is a simple, inexpensive analytical tool.
This document discusses type III or immune complex-mediated hypersensitivity and type IV or delayed type hypersensitivity. Type III involves large antigen-antibody complexes forming in the blood and depositing in tissues, potentially causing inflammation and diseases like serum sickness, glomerulonephritis, and rheumatoid arthritis. Type IV is T cell-mediated and can cause contact hypersensitivity reactions or tuberculin type hypersensitivity after 48-72 hours, mediated by T cells and macrophages rather than antibodies.
This document discusses the significance of toxoids in active immunity. It defines key terms like vaccines, toxoids, live vaccines, attenuated live vaccines, inactivated vaccines, polysaccharide vaccines, and surface antigen vaccines. It explains that toxoids create immunity to the toxins produced by pathogens rather than the pathogens themselves. Various routes of administration are outlined including subcutaneous, intramuscular, oral, intradermal, and intranasal. Vaccination schedules for primary vaccination and booster doses are also summarized.
This document summarizes immunodeficiency disorder and HIV/AIDS. It defines AIDS as being acquired, weakening the immune system through CD4+ cell deficiency. HIV is described as a human immunodeficiency virus that infects and attacks human immune cells like CD4+ T cells. The stages of HIV infection are outlined from acute infection with fever and rash, to the chronic phase with falling CD4+ counts and opportunistic infections, and finally AIDS when the immune system has been severely damaged. The pathogenesis of HIV is explained as it binds to CD4+ receptors, integrates into the host cell DNA, and uses the cell's machinery to replicate and infect other cells.
Kwashiorkor is a form of severe protein malnutrition typically affecting young children in tropical countries. It is caused by a diet deficient in protein but with sufficient calories. Key signs include edema, growth retardation, hair changes, and muscle wasting. Laboratory findings show reduced total plasma and serum albumin levels. The pathophysiology involves decreased synthesis of visceral proteins like albumin from low protein intake, leading to fluid accumulation and impaired liver function. Poverty, lack of nutrition education, infections, and aflatoxin poisoning can precipitate the condition.
This case study presents information on a 48-year old female patient admitted with a history of hypertension, diabetes, and sudden palpitations and weakness. Examination found bipedal edema, dilated left ventricle, severely reduced left ventricular systolic function, and mild myocardial infarction. The patient was assessed as having congestive heart failure with an ejection fraction of 30%. The treatment plan was to improve quality of life, relieve shortness of breath, reduce hospital stay, and treat hyperglycemia. Medications prescribed included torsemide, spironolactone, telmisartone, carvedilol, atorvastatin, pantoprazole, ceftriaxone, paracetamol,
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
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Viral hepatitis
Definition: Hepatitis is a condition where the inflammation of the liver occurs
that can be caused by viruses, medications and immunological abnormalities.
Hepatitis is of different types based on types of viruses causing it. There are as
follows:
Hepatitiscaused by common viruses:
1. Hepatitis A, caused by hepatitis A virus (HAV)
2. Hepatitis B, caused by hepatitis B virus (HBV)
3. Delta hepatitis, caused by hepatitis D virus (HOV)
4. Hepatitis C, caused by hepatitis C virus (HCV)
5. Hepatitis E, caused by hepatitis E virus (HEV)
Hepatitiscaused by other viruses:
1. Cytomegalovirus
2. Epstein-Barr virus
3. Herpes simplex virus
4. Yellow fever virus
5. Hepatitis G virus
HEPATITIS A
Aetiology
Caused by hepatitis A virus (HAV), aRNA virus belonging to the
picomavirus group.
HAV survives on human hands and fomites, and requires temperatures
higher than 185°F (85°C) for inactivation.
It is resistant to freezing, detergents and acids, but it is inactivated by
formalin and chlorine.
Epidemiology
1. Incubation period is 30 days (15-45 days).
2. HAV infection has a worldwide distribution, and infections can be
sporadic or occurin epidemic outbreaks.
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3. The incidence of acute cases and the seroprevalence vary according to the
hygiene, sanitation, housing, and socioeconomic standards of the region,
with seroprevalences as low as about 13% in Sweden but up to 100% in
many developing countries.
4. In developing countries, infection generally occurs at a young age, and
most of the population has been exposed and is protected after age 10
years.
5. In developed countries, however, infection can occurat any age, and the
prevalence of exposed, immune subjects slowly increases with age.
6. In the United States, the incidence of acute hepatitis A has declined from
12.0 cases per 100,000 individuals in 1995 to 1.0 case per 100,000
individuals in 2007.
Transimission
1. Oral-fecal route, (most often directly from person to person or through
the ingestion of fecally contaminated food or wate)
2. Blood transfusion
3. High-risk groups for acute hepatitis A include travelers to developing
countries, children in day care centers and their parents, men who have
sex with men, injection drug users, hemophiliacswho receive plasma
products, and persons in institutions.
Signsand symptoms
1. The preicteric phase brings nonspecific influenza-like symptoms
consisting of anorexia, nausea, fatigue, and malaise
2. Abrupt onset of anorexia, nausea, vomiting, malaise, fever, headache, and
right upper quadrant abdominal pain with acute illness
3. Icteric hepatitis is generally accompanied by dark urine, acholic (light
colored) stools, and worsening of systemic symptoms
4. Pruritus is often a major complaint of icteric patients
Physical examination
a. Icteric sclera, skin, and secretions
b. Mild weight loss of 2–5 kg
c. Hepatomegaly
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Laboratory tests
1. Positive serum immunoglobulin M anti–hepatitis A virus
2. Mild elevations of serum bilirubin, γ-globulin, and hepatic transaminase
(ALT [alanine transaminase] and aspartate transaminase [AST]) values to
about twice normal in acute anicteric disease
3. Elevations of alkaline phosphatase, γ-glutamyl transferase, and total
bilirubin in patients with cholestatic illness
Prevention
1. Prevention of hepatitis A infection can be achieved through
immunoprophylactic measures.
2. Immuno prophylaxis may be passive, active, or a combination of both. In
passive immunization, temporary protective antibody in the form of
immunoglobulin is administered.
3. In active immunization, a vaccine is administered to induce the formation
of protective antibody.
4. Prophylaxis can be administered before (pre-exposure prophylaxis) or
after exposure (postexposureprophylaxis).
Pre-Exposure Prophylaxis
Immunoglobulin
1. Before hepatitis A vaccine was available, the sole therapy for pre
exposure prophylaxis of hepatitis A infection was immunoglobulin.
2. Although passive immunization with immunoglobulin alone is highly
effective in preventing HAV infection,
3. The duration of protection is short.
4. When used for pre-exposure prophylaxis
5. A dose of 0.02 mL/kg of immunoglobulin administered intramuscularly
(IM) confers protection for less than 3 months, and an IM dose of 0.06
mL/kg confers protection for 5 months or longer for travellers.
Vaccine
1. Active immunization with hepatitis A vaccine has largely supplanted the
use of immunoglobulin for pre-exposure prophylaxis of infection caused
by HAV.
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2. Formulations of inactivated hepatitis A vaccine available in the United
States include Havrix and Vaqta.
3. Both vaccines are formalin-inactivated preparations of attenuated HAV
strains. The manufacturers use differing units to express antigen content
of their respective vaccines.
4. Havrix dosages are expressed in ELISA units, and Vaqta dosages are
expressed as units of hepatitis A antigen.
Dosing Regimen
1. Havrix is availablein two formulations that differ according to age:
(i) For persons 12 months to 18 years of age, 720 ELISA units
(0.5 mL) per dosein a two-doseschedule and
(ii) For persons older than 19 years of age, 1,440 ELISA units
(1.0 mL) per dosein a two-doseschedule.
a. This vaccine is usually injected IM into the deltoid muscle with a
boosterdoseadministered 6 to 12 months later.
b. The pediatric Havrix formulation (three-dose schedule) is no longer
available.
2. Vaqta is available in two formulations, and the formulations differ
according to the person’s age:
(i) For persons 12 months to 18 years of age, 25 units (0.5 mL)
in a two-dose schedule
(ii) For persons older than 19 years of age, 50 units (1.0 mL) per
dose in a two-dose schedule.
a. This vaccine is usually injected IM into the deltoid muscle with a
boosterdoseadministered 6 to 18 months later.
Combination Vaccine
The US Food and Drug Administration (FDA) has also licensed a
combined HAV and HBV vaccine (Twinrix) for use in persons aged 18
years or older. Twinrix is composed ofthe same antigenic components
used in Havrix and Engerix-B.
Each doseof Twinrix contains at least 720 ELISA unitsof inactivated
HAV and 20 mcg of recombinantHBsAg. Traceamounts of thimerosal
(<1 mcg) are also present from the manufacturing process.Primary
immunization consists of three doses, given on a 0-, 1-, and 6- month
schedule, the same that is used for single-antigen hepatitis B vaccine.
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Any person18 years of age or older having an indication for both
hepatitis A and hepatitis B vaccine can be given Twinrix, including
patients with chronic liver disease, users of illicit injectable drugs, men
who have sex with men, and persons with clotting factor disorders who
receive therapeutic blood products.
For international travel, hepatitis A vaccine is recommended; hepatitis B
vaccine is recommended for travelers to areas of high or intermediate
hepatitis B endemicity who plan to stay for longer than 6 months and
have frequent close contactwith the local population.
At 1 month after completion of the three-dose series, seroconversion for
anti-HAV (titer>20 milli-international units/mL) was elicited in 99.9% of
vaccines, and protective antibodies against HBsAg (anti-HBs>10 milli-
international units/mL) were elicited in 98.5% of vaccinees.
The persistence of anti-HAV and antibody to HBsAg (anti-HBs) after
administration is similar to that after single-antigen hepatitis A and B
vaccine administration at 4-year follow-up.
Observed adverse effects were generally similar in type and frequency to
those reported after vaccination with monovalent hepatitis A and B
vaccines.
VIRUS HAV HBV HCV HDV HEV
Genome RNA DNA RNA RNA RNA
Family Picornavirus Hepadnavirus Flavivirus Satellite Hepeviridae
Size (nm) 27 42 30-60 40 32
Incubation (days)
[mean]
15–50 [30] 45–180[80] 15–160 21–140[35] 15–65 [42]
Transmission
Oral
Percutaneous
Sexual
Perinatal
Common
Rare
No
No
Rare
Common
Common
Common
Rare
Common
Common
Rare
No
Common
Common
Common
Yes, common
Unknown
No
Rare
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Onset Sudden Insidious Insidious Insidious Sudden
Clinical illness 70%-80% adults
5%children
10%–15% 5%–10% 10% 70%–80%adults
Icteric presentation
Children
Adults
<10%
30%
30%
5%–20%
25%
5%–10%
Unknown
25%
Unknown
Common
Peak alanine aminotransferase
(ALT) (units/L)
800–1,000 1,000–1,500 300–800 1,000–1,500 800–1,000
Incidence of acute liverfailure (%) <1 <1 <1 2–7.5 <1; higher in
pregnant women
Serum diagnosis
Acute infection
Chronic infection
Anti-HAVIgM HBsAg, anti-HBc
IgM
HBsAg
Anti-HBc IgG
HCV-RNA (anti-
HCV)
Anti-HCV(ELISA)
RIBA
Anti-HDVIgM
Anti-HDVIgG
Anti-HEVIgG
(seroconversion)
NA
Viral markers HAV RNA HBV DNA
DNA polymerase
HCV RNA HDV RNA Viruslike particles
Immunity Anti-HAV, IgG Anti-HBs NA NA Anti-HEVIgG
Case-fatality rate 0.1%–2.7%
0.15%–1.7%
1%–3% 1%–2% <1% coinfect 0.5%–4%
1.5%–21% pregnant
women
Completerecovery >97% 85%–97% 50% 90% 99%
Incidence of
chronic infection
0% 2%–7%
>90% neonates
50% 80% superinfect
≤5% coinfection
0%
Carrier state No Yes Yes Yes No
Risk of hepatocellular
Carcinoma
No Yes Yes Yes No
Drug treatment None Pegylated
interferon,
interferon,
tenofovir,
entecavir,
adefovir,
telbivudine,
lamivudine
Pegylatedinterferon
+
ribavirin, pegylated
interferon,
interferon,
telaprevir,
boceprevir
Pegylatedinterferon,
interferon
None
*ELISA, enzyme-linked immunosorbent assay; NA, not applicable; RIBA0, recombinant immunoblot assay.*
Hepatitis B
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Aetiology
a. Caused by hepatitis B virus (HBY), belonging to the group of
hepadna viruses.
b. HBY comprises a surface envelope [antigen expressed on it is
called hepatitis B surface antigen (HBsAg)] and a nucleocapsid
core containing DNA [antigen expressed on its surface is called
hepatitis B core antigen (HBcAg), while another soluble antigen in
the nucleocapsid is called hepatitis Be antigen (HBeAg)].
Nucleocapsid core also bas DNA polymerase enzyme.
c. The correspondingantibodies are:
Anti-HBs
Anti-HBc
Anti-HBe.
d. HBsAg-positive serum containing HBeAg is more likely to be
highly infectious than HBeAg-negative or anti-HBe positive
serum.
Epidemiology
1. Incubation period is about 90 days (50--150 days). Hepatitis B is one of
the most common causes of chronic liver disease and hepatocellular
carcinoma worldwide.
2. Approximately one-third of the world’s population have serological
evidence of past or current infection with hepatitis B and approximately
350–400 million people are chronic HBsAg carriers.
3. It is estimated that 1.25 million people in the United States are
chronically infected with hepatitis B virus.
4. Approximately 78,000 people per year becomeacutely infected with the
hepatitis B virus in the United States.
5. Of those infected, 70% become symptomatic; 26% are hospitalized; 90%
of infants infected at birth, 30% of children infected at age 1 to 5 years,
and 6% of those infected over 5 years of age develop chronic infections;
and 1% from acute disease and 15% to 25% from chronic disease die
each year.
6. 14 Patients with cirrhosis are at a much greater risk for developing liver
cancer (12 to 300 times normal risk).
Transmission
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Transmitted through parenteral but occasionally non-parenteral
Transfusion of infected blood or blood products, injections with
contaminated needles, intravenous drug use with needle sharing, tattooing
and acupuncture.
Non-parenteral means of transmission include spread through bodyfluids
like saliva, urine, semen and vaginal secretions. However, this requires
close personal contact, sexual intercourse and male homosexuality.
Mother-to-child spread (perinatal transmission) is also common. It could
be either transplacental transmission or transmission at or soonafter birth.
Signsand symptoms
• Easy fatigability, anxiety, anorexia, and malaise
• Ascites, jaundice, variceal bleeding, and hepatic encephalopathy can
manifest with liver decompensation
• Hepatic encephalopathy is associated with hyperexcitability, impaired
mentation, confusion, obtundation, and eventually coma
• Vomiting and seizures
Physical examination
• Icteric sclera, skin, and secretions
• Decreased bowel sounds, increased abdominal girth, and detectable fluid
wave
• Asterixis
• Spider angiomata
Laboratory tests
• Presence of hepatitis B surface antigen for >6 months
• Intermittent elevations of hepatic transaminase (alanine transaminase [ALT]
and aspartate transaminase [AST]) and hepatitis B virus DNA >20,000 IU/mL
(105 copies/mL or 108 copies/L)
• Liver biopsies for pathologic classification aschronic persistent hepatitis,
chronic active hepatitis, or cirrhosis
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Prevention
Alterations in sexual behavior, screening of high-risk patients or settings (e.g.,
STD and HIV testing and treatment facilities, drug abuse treatment and
prevention settings, heath care settings targeting services to IV drug users, heath
care settings targeting services to men having sex with men, and correctional
facilities) and blood products, developing needle exchange programs, and
cultural outreach and education may have an impact on HBV transmission. The
goals of preventive therapy should be to identify all persons who require
immunoprophylaxis for the prevention of infection and provide long-term
protection through vaccination to decrease the risk of chronic HBV infection
and its subsequent complications, as well as minimizing adverse effects and cost
of therapy.
Pre-Exposure Prophylaxis
Manufactured using recombinant DNA technology, Recombivax HB (10 mg
HBsAg/mL) and Engerix-B (20 mg HBsAg/mL) are yeast-derived HBV
vaccines that induce an immunologic responsesimilar to the plasma-derived
vaccine (no longer used). Because P.G. will come in contact with potentially
infectious bodily secretions during her rotations, she should be immunized
against hepatitis B with either Recombivax HB or Engerix-B.
DOSING
REGIMEN
1. The
recommended doses
of available hepatitis
B vaccines are
shown below
2. HBV injection
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to the buttocks have a signifificantly higher responsewhen vaccinated in
the arm.
3. P.G. should be immunized with either Recombivax HB (10 mcg) or
Engerix-B (20 mcg) administered as a 1-mL IM injection in the deltoid
muscle.
Postexposure Prophylaxis
Percutaneous Exposure
After exposure to HBV, prophylactic treatment with hepatitis B vaccination and
possibly passive immunization with hepatitis B immunoglobulin (HBIG) should
be considered. The ACIP recommendations for postexposure immune
prophylaxis after hepatitis B exposure are shown in Table
Sexual Exposure
CASE77-9
1. Sexual transmission of HBV is an important cause of HBV infection,
accounting for approximately 30% to 60% of all new cases annually.
2. Passive immunization with a single 5-mL doseof HBIG was found
highly effective in preventing HBV infection after sexual exposure when
compared with a control globulin (with no anti-HBs activity).
3. The CDC recommends that susceptible persons exposed to HBV through
sexual contact with a personwho has acute or chronic HBV infection
should receive postexposureprophylaxis with 0.06 mL/kg of HBIG as a
single IM dosewithin 14 days of the last exposure.
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4. Patients also should receive the standard three-dose immunization series
with hepatitis B vaccine beginning at the time of HBIG administration.
Perinatal Exposure
1. In many Asian and developing countries, perinatal (vertical) transmission
accounts for most HBV infections.
2. Infants bornto HBV-infected mothers have a greater than 85% risk of
acquiring HBV during the perinatal period.
3. Of those who become infected, 80% to 90% becomechronic HBsAg
carriers. Although fulminant cases have been reported, most hepatitis
infections in neonates are asymptomatic.
4. Despite the usually innocuous initial disease, signifificant adverse
consequences are associated with chronic HBsAg carriage in neonates.
5. Chronic hepatitis B infection is associated with chronic liver disease and
has been clearly implicated as a major risk factor in the development of
primary HCC.
6. Screening pregnant women for the presence of HBeAg and
administration of HBIG and hepatitis B vaccine is 85% to 98% effective
in preventing HBV infection and the chronic carrier state.56,60,62 This
compares with a 71% effificacy rate for administration of HBIG alone.
7. Simultaneous administration of HBIG and hepatitis B vaccine does not
adversely affect the productionof anti-HBs in neonates.56,60,62 Infants
born to mothers who are HBsAg positive should receive simultaneous IM
injections of the appropriate doses ofhepatitis B vaccine and HBIG (0.5
mL) within 12 hours of birth.
8. The injections should be administered at separate sites. S.L. should
receive HBIG (0.5 mL) as soonas possible after birth, administered as an
IM injection and
9. 0.5 mL of either Recombivax HB (5 mcg) or Engerix-B (10 mcg) as an
IM injection at a separate site.
Hepatitis C
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Aetiology
• Previously called blood-bornenon-A, non-B hepatitis.
• It is a single-stranded RNA virus belonging to the family Flaviviridae.
• HCV has six genotypes. Chronic HCV 1 infection has poorresponseto
therapy. In India, HCV 3 is mostprevalent.
• HCV-RNA can be detected within a few days of infection, well before
the appearance of antibodies to HCV (anti-HCV).
Epidemiology
• Incubation period is 50 days (15-160 days).
Transmission
Transmission is through parenteral route.
More than 90% of cases of post-transfusion hepatitis are caused by HCV.
Also common in drug addicts.
Common sources of infection are blood and blood products capableof
transmitting hepatitis B, particularly coagulation factor concentrates.
Other modes include perinatal and sexual transmission.
Transmission of hepatitis C through needle-stick injury is 1-3%.
HCV is not transmitted by breastfeeding.
Nearly 80% develop chronic hepatitis.
Prevention by vaccine or immunoglobulin not possible.
Signsand symptoms
HCV RNA becomes detectable in the serum 3 to 7 days after exposure.
HCV RNA levels rise rapidly during the first weeks, followed by serum
aminotransferase levels 2 to 8 weeks after exposure.
Anti-HCV antibodies arise late in the course of acute hepatitis C and may
not be present at the onset of symptoms and serum aminotransferase
elevation.
After an incubation period that ranges from 15 to 120 days, acute
hepatitis C usually remains asymptomatic and is undiagnosed.
Nonspecific symptoms such as fatigue, low-grade fever, myalgias,
nausea, vomiting, or itching may be present.
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Jaundice occurs in only 20 to 30% of patients, usually 2 to 12 weeks after
infection.
Serum aminotransferase levels commonly exceed 10 times the upper limit
of normal in the acute stage, even in the absence of symptoms.
Fulminant hepatitis C has been reported but appears to be exceptional in
the absence of another chronic underlying liver disease
Diagnosis
Anti-HCV-appears after infection; disappears after recovery; persists in
chronic hepatitis C
HCV-RNA-after exposure, HCV-RNA becomes detectable in serum after
7-14 days, followed by aminotransferase elevation and later (after 4-10
weeks) by presence of antibodies.
Remains detectable in most, continuously or intermittently .
Prevention
Pre-Exposure Prophylaxis
1. No vaccines are effective against HCV, and current measures to prevent
hepatitis C infection have largely focused on identifying high-risk
uninfected persons and counseling them on risk reducing strategies to
prevent infection.
2. The CDC and the National Institutes of Health have published
recommendations that address these issues. Suggested primary preventive
measures are
In monogamous long-term relationships, transmission is rare.
Although HCV-positive individuals and their partners should be
informed of the potential for transmission.
It is recommended that sexual partners of infected patients should
be tested for antibody to HCV.
In households with an HCV-positive member, sharing razors and
toothbrushes should be avoided.
Covering open wounds is recommended.
Injection needles should be carefully disposed ofusing universal
precaution techniques.
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It is not necessary to avoid close contact with family members or to
avoid sharing meals or utensils.
Additionally, pregnancy is not contraindicated in HCV infected
individuals. Perinatal transmission from mother to baby occurs in
less than 6% of instances.
No evidence indicates that breast-feeding transmits HCV from
mother to baby
Babies born to HCV-positive mothers should be tested for anti-
HCV at 1 year.
It is important that clear and evidence-based information be
provided to both patients and physicians regarding the natural
history, means of prevention, management, and therapy of hepatitis
C.
Postexposure Prophylaxis
Immunoglobulin is no longer recommended for postexposureprophylaxis
of hepatitis C infection because it is not effective.
Delta Hepatitis
Aetiology
1. Caused by hepatitis D virus (HDV), which is a defective RNA
virus. The RNA genome is covered by an outer coat of HBsAg.
2. It has no independent existence. It requires HBV for replication
and expression.
3. HDV can infect a personsimultaneously with HBV (coinfection).
4. HDV can superinfect a person who is already a chronic carrier of
HBV (superinfection).
Epidemiology
Two epidemiologic patterns exist:
o Delta infection being endemic among those with hepatitis B,
predominantly transmitted by non-parenteral route, especially close
personal contact.
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o In non-endemic areas, delta infection is confined to persons
exposed frequently to blood and blood products, mainly
intravenous drug addicts and haemophiliacs.
Five percent of chronic HBV carriers, or 15 million to 20 million
individuals worldwide, are also infected with HDV.
The prevalence of HDV infection in HBV-infected patients varies
according to the geographic area because it is transmitted primarily
through parenteral exposure.
As a result, its prevalence is relatively higher in HBsAg-positive
intravenous drug users in Western countries, where approximately 8 to
12% of HBsAg-positive patients are infected with HDV.
By comparison, the prevalence of HDV has decreased substantially in
southern Europe, probably owing to universal HBV vaccination
programs, improvement in hygiene and living conditions, and
implementation of standard precautions to prevent HIV infection.
The incidence of HDV is increasing in Russia, eastern Europe, Japan, and
India.
Transmission
Transmitted by parenteral route.
Coinfection gives rise to severe acute hepatitis that is limited by recovery
from HBV infection.
Superinfection causes rapidly progressive chronic hepatitis, with episodes
of acute hepatitis.
It can cause fulminant liver failure and rapid progression to cirrhosis as
well as an increased risk of liver cancer.
Signsand symptoms
HDV can be acquired at the same time as HBV (coinfection) or by a
chronic HBsAg carrier (superinfection).
Coinfection is characterized by one or two episodes of acute hepatitis,
depending on the respective amounts of HBV and HDV present in the
inoculum; acute hepatitis can range from mild to fulminant.
In contrast, when chronic HBV carriers are superinfected by HDV, acute
hepatitis D is generally severe, often fulminant, and chronic.
Diagnosis
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o Delta antigen-occasionally detectable
o Anti-delta-initially of lgM type and later lgG type
o HOV-RNA-most reliable.
Prevention
Hepatitis D virus replication is dependent on HBV replication; therefore,
successfulimmunization with HBV vaccine also prevents HDV infection.
No immunoprophylactic therapies are available for patients with chronic
HBV infection who are also at risk for superinfection with HDV.
Prevention of HDV superinfection is based on behavioral modifification,
such as the use of condoms to prevent sexual transmission and needle
exchange programs to minimize transmission by IV drug use.
Treatment
The goal of treatment is to eradicate HDV along with HBV.
Hepatitis E
Aetiology
• Previously called epidemic or enterically transmitted non-A, non-B hepatitis.
• It is a single-stranded RNA virus.
Epidemiology
• Incubation period is 40 days (15-60 days).
• Primarily enteric mode of transmission.
• Accounts for epidemic, water-borne hepatitis; common in India.
• Commonly occurs after contamination of water supplies as after monsoon
flooding.
Diagnosis
• Anti-HEV-both lgM and lgG are present at onset
Prevention and treatment
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No immunoprophylactic measures exist for HEV disease, and effective
prevention strategies are dependent on improved sanitation in endemic
areas.
Travelers going to endemic areas should be educated regarding the risks
of drinking water, eating ice, or eating uncooked shellfish or uncooked
and peeled fruits and vegetables.
Drinking water should be boiled to inactivate HEV.
No vaccines or postexposureprophylaxis treatments are currently
available to prevent HEV infection.
However, results from a phase II randomized trial using 20 mcg of a
recombinant 56-kDa truncated open reading frame-2 vaccine in young
healthy men suggest that these agents could be effective in the prevention
of HEV infection.
Others have reported limited success with oral ribavirin (12 mg/kg daily
for 12 weeks) in a kidney and pancreas transplant recipient with chronic
HEV infection.
Clearly, an appropriately designed clinical trial is required to defifine the
role of ribavirin for chronic HEV infection.
Complications of Acute Viral Hepatitis
1. Fulminant hepatic failure
2. Relapsing hepatitis
3. Cholestatic hepatitis
4. Post-hepatitis syndrome
5. Aplastic anaemia
6. Polyarteritis nodosa
7. Transverse myelitis
8. Renal failure
9. Henoch-Schonlein purpura
10.Chronic hepatitis
11.Cirrhosis
12.Hepatocellular carcinoma
13.Myocarditis
14.Peripheral neuropathy
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Poor Prognostic Features
1. Marked increase in AST and ALT
2. Bilirubin >20 mg/dl
3. Liver not enlarged
4. Prolongation of prothrombin time by 5 seconds
5. Recurring attacks of hypoglycaemia
6. Renal failure
7. Associated conditions
8. HBV, HCV or HDV infection
Treatment
Rest
During the acute symptomatic period, complete rest and thereafter
gradual ambulation.
In high-risk patients (patients more than 50 years, pregnant and those
with other major diseases) rest is continued till symptoms and signs
have disappeared, and liver function tests have returned to near
normal.
Diet
Nutritious general diet of 2000-3000 kcal/day. In the initial stage, when
good diet is not tolerated, give a light diet, fruit drinks and glucose. There
is no need to avoid fatty diets, but most patients cannot tolerate these
diets.
Encourage good protein intake.
If vomiting is severe, intravenous fluids are given.
Drugs
Drugs should be avoided if possible (especially sedatives and hypnotics).
Alcohol to be avoided for next 6 months.
Oral contraceptives can be resumed after clinical and biochemical
recovery.
Antiviraldrugs
Some evidence suggests efficacy of interferon-a in patients with acute
hepatitis C infection in reducing the rate of chronicity.
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References :
1. Goldman%27sCecil Medicine, 24th Ed 2012
2. Dipiro 9th edition
3. essentials of internal medicine
4. Herifindel , 18E
5. kodakimble 10E
6. harrison’s principles of internal medicine, 20th edition