This document provides information on various types of hepatitis. It discusses hepatitis A, B, C, D, and E. Key points include: hepatitis A is transmitted fecal-orally and does not cause chronic infection; hepatitis B can become chronic and is transmitted through blood/bodily fluids; hepatitis C often becomes chronic and is transmitted through blood exposure; hepatitis D requires hepatitis B for transmission; and hepatitis E is transmitted fecal-orally similar to hepatitis A and does not cause chronic infection. The document also outlines symptoms, diagnostic tests, treatment options, and prevention measures for each type of viral hepatitis.

2. HEPATITIS
A general term that means inflammation of the liver
Inflammation of the liver :
Infection
Exposure to alcohol
Certain medication
Chemical
Poison
Disorder of the immune system

3. HEPATITIS A
Liver inflammation caused by infection with HAV
Does not cause chronic
It heals completely
Develop lifelong immunity
Tend to occur in epidemic and outbreaks

4. VIROLOGY
HAV is an unenveloped
Ss RNA virus
Diameter 27 nm
It is not inactivated by ether and stable at -20 C and
low pH
As enterovirus type 72
Picornavirus

5. PATHOGENESIS
Replicate initially in the enteric mucosa
It can be demonstrated in feces for 10-14 days before
onset of disease
Multiplication in the intestine is followed by a period
of viremia with spread to the liver
Respon to replication in the liver :
Lymphoid cell infiltration
Necrosis of liver parenchimal cells
Proliferation of Kupffer cells

6. H A. CAUSES
Found in the stool of people with HAV
It is transmitted as fecal-oral
If food or drinking water becomes contaminated with
stool from an infected person
Can also be spread by eating raw or undercooked
shelfish collected from water that has been
contaminated by sewage

7. Increased Risk
Household contacts of people infected with HAV
International traveles
People who may come in to contact with HAV at
work
Workers in professions :
Health care
Food preparation
Sewage and waste water management

8. SYMPTOMS
Many people have no symptom
Sometime symptoms are so mild
Older people are more likely to have symptoms
Usually develop between 2-6 weeks after infection
Nausea
Vomitting – severe : dehydration
Diarrhea, especially in children
Low grade fever
Loss of appetite

9. Cont …
Rash
Tiredness, fatigue
Jaundice
Urine is dark brownish in color
Pain in area of liver

10. EXAMS and TESTS
Tes for liver function
Increase aminotransferase 1-3 weeks
Test for antibody to HAV
IgM anti-HAV
Large amount of vomiting
electrolytes

11. TREATMENT
No specific medicines to cure infection with HAV
Except to relieve symptoms
Prevent :
Passive immunization
 Immuneglobulin (ISG) effective when given within 2 W of
expossure
 Is protective if given before or during the incubation period
Active immunization :
 Formalin-killed vaccine are more promising, they have
efficacy in children

12. IMMUNITY
Antibody to HAV can be detected during early illness
when the virus is still found in feces
Most patients with symptom or signs of acute HA
already have detectable antibody in serum
Early antibody are predominantly IgM which can
detected for several weeks or months
During convalescence : IgG – are immune to
reinfection

13. Cont…
Sifat virus :
Autoclave
Air mendidih, 5 menit
Oven sterilisasi
Radiasi UV (1 menit)
Formalin
Klorin (10-15 ppm, 30 mnt)
Makanan dipanaskan > 85 C, 1 mnt

14. HEPATITIS B
Problem kesehatan global
2 milyar terinfeksi VHB
350 juta infeksi kronik
Tanpa interfensi 15-40% berkembang :
Sirosis hati
Karsinoma hepatoseluler

15. RISIKO KRONISITAS
NEONATUS : 90-95%
BALITA : 30-50%
DEWASA : 5-10% (90% SEMBUH)

16. VIRUS HEPATITIS B
Non sitopatik
Kerusakan hati :
Respon imun
Sitokin inflamasi
Hepadnaviridae
Ds-DNA dengan 3200 bp
Envelop : HBsAg
Precore/core : HBeAg, HBcAg

19. Cont …
Masa inkubasi 50-180 hr (rata-rata 2 bl)
Onset penyakit : perlahan
Kenaikan enzim aminotransferase 1-6 bl
Symptoms :
Appetite loss
Fatigue,
Nausea and vomiting
Low-grade fever
Muscle and joint aches
Yellow skin and dark urinee due to jaundice

20. TRANSMISI
DARAH, CAIRAN TUBUH
Blood transfusion
Contact with blood in health care setting
Had direct contact with blood of an infected person by
touching an open wound or been stuck with a needle
Had unsafe sex with infected person
Received a tatto or acupuncture with contaminated
instruments
Share needles during drug use, unsafe injections
Share personal item (toothbrushes, razor)
Perinatal (from mother to baby at birth)

21. MARKER SEROLOGIK
HBsAg :
petanda serologik pertama muncul
Terdeteksi 1-12 W pascainfeksi
Mendahului gejala klinik
Persisten > 6 bl : infeksi kronik
Anti-HBs :
Marker sembuh infeksi VHB
Persist lifelong

22. MARKER SEROLOGIK
HBeAg :
Marker risiko penularan
Replikasi virus
Muncul 3-6 W pascainfeksi
Anti-HBe :
Remisi penyakit

23. MARKER SEROLOGIK
Anti-HBc :
IgM anti-HBc dengan HBsAg : marker infeksi akut virus
hepatitis B
IgG anti-HBc dengan HBsAg : penderita kronik VHB

26. PREVENTION
VAKSINASI :
Bayi dari ibu HBsAg imunisasi dalam 12 jam stl lahir
People who are at high risk : health care workers
Protection at least 20 years and should be lifelong
UJI SARING DARAH
Avoid sexual contact with person who has acute or
chronic hepatitis B :
Using condoms consistently and properly

27. TREATMENT
There is no specific treatment for acute hepatitis B
Replacement of fluids
Adequate nutritional balance
Chronic hepatitis B :
Interferon
Anti-viral agent : lamivudin, adefovir
Patients with cirrhosis : liver transplants

28. HEPATITIS C
Usually becomes chronic (up to 85%)
Chronic infection with HCV : liver failure
First enters the body, usually are no symptoms
Most common 40-60 years of age
Risk factor for liver cancer

29. VIROLOGY
RNA virus
A member of flaviviridae
Outer coat : envelope contain enzyme and protein
that allow the virus to reproduce within the cells of
the liver
There are 6 different strain (genotypes)
Genotyping is important to guide treatment
Genetic diversity is one reason : difficult to develop
an effective vaccine

30. Liver Damage ?
Presence of HCV : trigger the human immune system
cause inflammation
Prolong inflammation may cause scarring : cirrhosis
The liver to perform its normal function : liver failure

34. TRANSMISSION
Needles shared
Needle-sticks in health care workers (average risk 1.8
– 10.0 %)
< 1992 --- acquired the infection from transfusions of
blood
HCV also can be passed from mother to unborn child
(4%)
Sexual intercourse
Instruments or sharp tool have been reused

35. Prevent of Transmission
Avoiding needle sharing
Safe needle-usage
Person with SMP should use barrier precaution
Screening test for blood products
Not share razors or tootbrushes with others

36. SYMPTOMS
75 % people have no symptoms when the first
acquired HCV infection
25 % may complaint fatigue, loss of appetite, muscle
aches or fever
Jaundice is rare at this early stage of infection
As cirrhosis develop, symptoms increase and
include :
Weakness
Loss of appetite
Weight loss
Breast enlargement in men

37. Cont …
A rash on the palms
Difficulty with the clotting of blood
Spider-like blood vessel on the skin
RISK FACTOR FOR SEVERAL DISEASE
Drinking alcohol
 Acquiring other HV

38. Diagnostic Tests for HCV
Antibody to HCV using ELISA, confirm with
Recombinant Immunoblot Assay (RIBA)
Molecular test for HCV RNA is useful in determining
whether or not a patient has circulating virus in the
blood (viremia)
RNA testing is more sensitive
HCV RNA becomes detectable 1-3 weeks after exposure
Helpful to assess a patients virologic response to
treatment antiviral therapy

39. Receive antiviral ?
HCV infection and persistent elevation ALT
High levels of HCV RNA in the blood
HCV infection and evidence of fibrosis on liver biopsy
HCV infection and evidence of at least moderate
inflammation and necrosis on liver biopsy

41. PENCEGAHAN
Tidak ada vaksin
Ditujukan kepada :
Transfusi darah
Pengendalian infeksi pd pelayanan kes
Pekerja sek komersial

42. Hepatitis D
Terdeteksi antigen delta dan antibodi pada beberapa
infeksi HBV
HDV membutuhkn selubung HBsAg untuk transmisi
Sering dihubungkan dg hepatitis berat pada pasien
HBsAg positif
Vaksinasi HBV tidak melindungi pembawa HBsAg
dar superinfeksi HDV

43. Hepatitis E
Virus RNA untai tunggal
Ditemukan di New Delhi 1955 pada kontaminasi
suplai air minum
Ditularkan fekal-oral (NANB )
Tidak pernah menjadi kronik
Tidak bersifat onkogenik
Stabil panas