Prepared by-

Dr. S. M. Sagare
1
Definition-
Acute infection of liver caused by viruses like HAV,
HBV, HCV, HDV,HEV, EBV, Cytomegalovirus,
yellow fever virus & rubella virus etc.
Viral Hepatitis-
Hepatitis-A
Hepatitis-B
Hepatitis-C
Hepatitis-D
Hepatitis-E
Hepatitis-G
2
Also called as nfectious hepatitis, Epidemic
Jaundice
Definition-
Acute infectious disease caused by Hepatitis A
virus & characterized by
Fever, chills, headache
Fatigue, generalized weakness, aches & pains.
Followed by anorexia, nausea, vomiting, dark urine &
jaundice
3
Case Fatality Rate(CFR) <0.1%, morbidity is more
Endemic in most developing countries with major/minor
outbreaks
According to WHO- 10-50 persons/1,00,000 population are
affected
Out of total cases of hepatitis:
n children - 10-25 %
n adults - 1-5%
4
%he World is divided into-
Very low endemicity -
Norway,Sweden,Japanadults
Low endemicity -
USA,Canada,NZ,Australiaadolescents & adults
ntermediate endemicity -
Europe (Exclude G.Britain & Spain) - late childhood & early
adulthood
High endemicity - Africa, Asia (Exclude Japan) -early
childhood
n ndia -ncidence of HAV is not known
5
Endemicity
Disease
Rate
Peak Age
of InfectionTransmission Patterns
High Low to
High
Early
childhood
Person to person;
outbreaks uncommon
Moderate High Late
childhood/
young adults
Person to person;
food and waterborne
outbreaks
Low Low Young adults Person to person;
food and waterborne
outbreaks
Very low Very low Adults Travelers; outbreaks
uncommon
Global Patterns of
Hepatitis A Virus
Transmission
Agent factors-
. Agent
Hepatitis A virus RNA virus, non-enveloped,
27-28nm,spherical Enterovirus (%ype 72) of Picornaviridae family
Only one serotype
. Resistance-
Resistant to heat & chemicals
Not killed by routine chlorination
nactivated by - Disinfection by formalin, UV rays & boiling for 5
minutes/autoclaving

. Source of infection
Human Cases (Asymptomatic to severe cases)
No carrier state
V. nfective material
Faeces, Blood & serum during phase of viraemia
Virus Excretion- n faeces 2wks before & 1wk after
onset of jaundice

Age-
Affect any age
Children > adult
n ndia, 90% of healthy persons have e/o HAV infection by
the age of 10 years
Sex-
Both sexes are affected
mmunity-
After attack last for life
Second attack rare
Socioeconomic factors-
Poverty
lliteracy
Poor hygiene

Occurs throughout year

(But associated with periods of heavy rainfall)
Poor sanitation &
Overcrowding
10
11
Mode of transmission Mode of transmission
aeco aeco- -oral route oral route
Directly Directly person to person person to person
Indirectly Indirectly through contaminated water, through contaminated water,
food or milk food or milk
Parental route Parental route
Blood Blood & blood product & blood product
Contaminated Contaminated needle needle
Sexual transmission Sexual transmission
Among Among homosexual men because of oral homosexual men because of oral- -
anal anal contact contact
15-45 days (usually 25 to 30 days)
12
Symptoms
Fever, Chills
Headache, Fatigue, Generalized weakness
Aches & pains
Anorexia, Nausea, Vomiting
Dark urine
Signs
Jaundice - Yellowness of sclera, palate & skin
Liver/Spleen - enlarged, palpable & tender
Cholestatic Hepatitis A - tching, 'Clay Colour' stool
Fulminant Hepatitis - Flapping tremors(Rare complication)
13
Diagnosis
Demonstration of HAV particles or specific viral Demonstration of HAV particles or specific viral
antigens in the antigens in the faeces faeces
Demonstration of a rise in anti Demonstration of a rise in anti- -HAV HAV titre titre &&
Detection of Detection of gM gM antibody to HAV, antibody to HAV, gG gG Past infection Past infection
& immunity & immunity
%reatment
No specific treatment No specific treatment
Bed rest, high carbohydrate diet Bed rest, high carbohydrate diet
Avoidance of alcohol Avoidance of alcohol
Admission Admissioncholestasis cholestasis or or fulminant fulminant hepatitis hepatitis
14
1. Control of reservoir-
Difficult because of-
Large no. of sub-clinical cases
Faecal shedding during incubation period & early phase
of illness
Absence of specific treatment
Low socioeconomic profile of affected population
Notification
Complete bed rest
Disinfection (0.5% sodium hypochlorite) of
faeces & fomites
15
2. Breaking the channels of transmission-
Good personal & community hygiene e.g. hand
washing
Sanitary disposal of excreta
Prevention of contamination of water
Purification of water
16
3. Protection of Host-
Human immunoglobulin - 0.02 ml/kg, M
Given to -
Persons going in endemic area
Close personal contacts of patients
Control of outbreaks in institutions
Hepatitis A Vaccine - 2 doses, 6-18 months apart, M
nactivated OR live attenuated vaccine
Only 4 killed Hepatitis A vaccine available internationally
Four brandsHavrix, Vaqta, Epaxal & Avaxim
ndications (Age > 1 year)
i) Susceptible children
ii) Pt. with chronic liver diseases
iii) Homosexual or bisexual men
iv) Occupational risk of exposure
Combined vaccine -
nactivated Hepatitis A + Recombinant Hepatitis B
(Licensed since 1996 for children > 1 year)
Dose schedule-
3 doses 0,1,6 months
1
1
Hepatitis Hepatitis- - B B
1 1
20 20
Hepatitis Hepatitis- - B (Serum Hepatitis B (Serum Hepatitis) )
Definition Definition- -
Acute infectious disease caused by Acute infectious disease caused by
Hepatitis B virus & major pathology lies Hepatitis B virus & major pathology lies
in liver in liver
Usually acute self limiting infection Usually acute self limiting infection
Persistent carrier can occur Persistent carrier can occur
Progression to chronic active hepatitis Progression to chronic active hepatitis
or or hepatocellular hepatocellular carcinoma can occur carcinoma can occur
21 21
Public Health mportance Public Health mportance
In World In World--
- -Endemic throughout world especially in tropical & Endemic throughout world especially in tropical &
developing countries developing countries
- -> 2 billion people > 2 billion people-- e/o past or current infection e/o past or current infection
- -350 million 350 million --chronic carriers of the virus chronic carriers of the virus
- -60 60- -0% of all primary liver cancers 0% of all primary liver cancers
22 22
Public Health Public Health mportance mportance Contd Contd..
In In SEA region SEA region--
- -1/3 1/3
rd rd
of population infected of population infected
- -0 million HBV carriers 0 million HBV carriers
- -2 2 lakh lakh deaths due to HBV deaths due to HBV
In India In India-- HBsAg HBsAg carrier rate carrier rate
- -In hospital staff In hospital staff- -10.% 10.%
- -Voluntary blood donors Voluntary blood donors- -6% 6%
- -General population General population- -5% 5%
Incidence of post transfusion hepatitis Incidence of post transfusion hepatitis- -1 1- -30% 30%
23 23
Public Health mportance Public Health mportance
ased on the different ased on the different HsAg HsAg carrier carrier
rates rates
II) ) Type Type--1/ Low 1/ Low endemicity endemicity (<2 (<2%) %)
epal epal, Sri , Sri Lanka ( Lanka (Low Low HBsAg HBsAg carrier rate 0. carrier rate 0.- -11%) %)
II II) ) Type Type--2/ 2/ Intermediate Intermediate endemicity endemicity (2 (2--8%) 8%)
Bhutan Bhutan, India, Indonesia & Maldives , India, Indonesia & Maldives
( (Intermediate Intermediate HBsAg HBsAg carrier rate carrier rate 55- -%) %)
III III) ) Type Type--3/ High 3/ High endemicity endemicity (>8 (>8%) %)
Bangladesh, DPR Korea, Myanmar & Thailand Bangladesh, DPR Korea, Myanmar & Thailand
( (High High HBsAg HBsAg carrier rate carrier rate - -12%) 12%)
24 24
Epidemiological Factors Epidemiological Factors
Agent factors Agent factors- -
1) Agent 1) Agent- -
- -Hepatitis B virus Hepatitis B virus- - 42 nm double stranded DA 42 nm double stranded DA virus virus
- -3 Morphological forms 3 Morphological forms- -a) Small spherical particles a) Small spherical particles
with dia. Of 22 nm b) Tubules of varying length & with dia. Of 22 nm b) Tubules of varying length &
dia. C) Dane particle dia. C) Dane particle- -Infectious Infectious part part
- -3 Antigens 3 Antigens- -
i i) Surface antigen/Australia antigen ) Surface antigen/Australia antigen- -HBsAg HBsAg Anti Anti- -HBs HBs
ii) A core antigen ii) A core antigen- -HBcAg HBcAg Anti Anti- -HBc HBc
iii) An e antigen iii) An e antigen- -HBeAg HBeAg Anti Anti- -HBe HBe
25 25
Epidemiological Factors Epidemiological Factors
Appearance Appearance of markers of markers- -
irst appears irst appears HBsAg HBsAg, ext , ext- -HBeAg HBeAg & DA & DA
polymerase polymerase
HBeAg HBeAg- -marker of virus replication & infectivity marker of virus replication & infectivity
Presence of e antigen Presence of e antigen --Patient is highly infectious Patient is highly infectious
Symptoms
HeAg
anti-He
Total anti-Hc
IgM anti-Hc
anti-Hs
HsAg
0 4 8 12 16 20 24 28 32 36 52 100
Acute Hepatitis B Virus nfection with
Recovery
%ypical Serologic Course
eeks after Exposure
Titre
IgM anti-HBc
Total anti-HBc
HBsAg
Acute
(6 months)
HeAg
Chronic
(Years)
anti-He
0 4 8 12 16 20 24 28 32 36 52
Years
eeks after Exposure
Titre
Progression to Chronic Hepatitis B Virus
nfection
%ypical Serologic
Course
2 2
ii) ii) Reservoir of infection Reservoir of infection- - Man (Cases & carriers), Man (Cases & carriers),
Persistent carrier Persistent carrier- -Presence of Presence of HBsAg HBsAg > 6 months > 6 months
iii) Infective material iii) Infective material- - Contaminated Blood, body Contaminated Blood, body
secretions like saliva, vaginal secretions & semen secretions like saliva, vaginal secretions & semen
iv) Resistance iv) Resistance- - destroyed by Sodium hypochlorite & destroyed by Sodium hypochlorite &
Autoclave for 30 Autoclave for 30- -60 minutes 60 minutes
iv) POC iv) POC- - Several months until disappearance of Several months until disappearance of
HBsAg HBsAg & appearance of surface & appearance of surface Ab Ab
2 2
Host factors Host factors
Age Age- - Endemic area Endemic area- -Infants & children, on Infants & children, on- -endemic endemic
area area- -20 20- -40 years, Acute hepatitis direct relation, 40 years, Acute hepatitis direct relation,
Chronic hepatitis inverse relation with age Chronic hepatitis inverse relation with age
Sex Sex- - common in both sexes common in both sexes
Risk group Risk group- - Recipients of blood transfusion, doctors, Recipients of blood transfusion, doctors,
health care personnel, lab technician, homosexuals, health care personnel, lab technician, homosexuals,
prostitutes, prostitutes, percutaneous percutaneous drug abusers, infants of drug abusers, infants of
HBV carrier mother, HBV carrier mother, immuno immuno- -compromised patients compromised patients
30 30
Mode of Mode of transmission transmission
Parental route Parental route
- -Infected blood & blood products Infected blood & blood products
- -Transfusions, dialysis Transfusions, dialysis
- -Contaminated syringe, needles, skin pricks, handling of Contaminated syringe, needles, skin pricks, handling of
infected blood. infected blood.
- -Surgical, dental procedures, tattooing, ear piercing, Surgical, dental procedures, tattooing, ear piercing,
nose piercing, circumcision etc nose piercing, circumcision etc
Perinatal Perinatal transmission transmission- -rom mother to rom mother to baby baby
Mothers who are HBeAg positive are much more likely to
transmit to their offspring than those who are not.
Perinatal transmission is the main means of transmission in high
prevalence populations.
31 31
Mode of Mode of transmission transmission
Sexual Transmission Sexual Transmission- -Male homosexual at a high Male homosexual at a high risk risk
Other routes Other routes
- -Horizontal transmission Horizontal transmission- -from child to child from child to child
- -Contact between children with skin conditions like Contact between children with skin conditions like
impetigo & scabies or cutes & grazes impetigo & scabies or cutes & grazes
32 32
ncubation Period ncubation Period
45 45- -10 days (6 wks to 6 months) 10 days (6 wks to 6 months)
Median incubation period Median incubation period - - <100 days <100 days
33 33
Clinical Features Clinical Features
ever ever
Malaise Malaise
Anorexia Anorexia
ausea ausea
Vomiting Vomiting
Dark urine Dark urine
Jaundice Jaundice
Chronic hepatitis Chronic hepatitis
Liver Cirrhosis Liver Cirrhosis
Hepatocellular Hepatocellular Carcinoma Carcinoma
34 34
Clinical Features Clinical Features
3 Possible presentations 3 Possible presentations- -
i) Sub i) Sub- -clinical infection clinical infection-- 30 30- -35% of cases 35% of cases
ii) Acute infection ii) Acute infection- - 60 60- -0% of cases 0% of cases
- -o signs in infants o signs in infants
- -Typical illness seen in 5 Typical illness seen in 5- -15% of children aged 1 15% of children aged 1- -5 years 5 years
- -Presents with Presents with- - anorexia, nausea, malaise, vomiting, anorexia, nausea, malaise, vomiting,
jaundice, dark urine, clay coloured stool & abdominal jaundice, dark urine, clay coloured stool & abdominal
pain pain
- -Liver/spleen Liver/spleen- - enlarged, palpable & tender enlarged, palpable & tender
Outcomes Outcomes- - I) Recovery in 5 I) Recovery in 5- -0% 0%
II) Chronic carriers in 5 II) Chronic carriers in 5- -10% 10%
III) ulminant disease in 1 III) ulminant disease in 1- -2% 2%
iii) Chronic infection iii) Chronic infection--
Chronic liver disease Chronic liver disease- -Chronic persistent hepatitis, chronic Chronic persistent hepatitis, chronic
active hepatitis or cirrhosis active hepatitis or cirrhosis
Risk factors Risk factors- -Renal disease, HIV infection & diabetes Renal disease, HIV infection & diabetes
Primary liver cell carcinoma Primary liver cell carcinoma
Diagnosis Diagnosis
Serological Serological markers markers are are used used Ior Ior the the diagnosis diagnosis oI oI acute acute
and and chronic chronic hepatitis hepatitis BB inIection inIection..
BsAg BsAg - - used used as as aa general general marker marker oI oI inIection inIection..
BsAb BsAb - - used used to to document document recovery recovery and/or and/or immunity immunity
to to BV BV inIection inIection..
anti anti- -Bc Bc IgM IgM - - marker marker oI oI acute acute inIection inIection..
anti anti- -BcIgG BcIgG - - past past or or chronic chronic inIection inIection..
BeAg BeAg - - indicates indicates active active replication replication oI oI virus virus and and
thereIore thereIore inIectiveness inIectiveness..
Anti Anti- -be be - - virus virus no no longer longer replicating replicating.. owever, owever, the the
patient patient can can still still be be positive positive Ior Ior BsAg BsAg which which is is made made
by by integrated integrated BV BV..
36 36
%reatment %reatment
Symptomatic & supportive Symptomatic & supportive
High carbohydrate High carbohydrate diet & low fat & protein diet & low fat & protein
diet diet
Interferon Interferon & & Lamivudine Lamivudine- -claimed to be claimed to be
effective effective
Interferon Interferon - - for for HBeAg HBeAg + +ve ve carriers with carriers with
chronic active hepatitis. Response rate is 30 chronic active hepatitis. Response rate is 30
to 40%. to 40%.
3 3
Prevention & Control Prevention & Control
Active immunization Active immunization
Hepatitis B Vaccine Hepatitis B Vaccine
i i) Plasma Derived Vaccine ) Plasma Derived Vaccine- - ( (Hepavax Hepavax- -B, B, Hepaccine Hepaccine- -B) B)
- -ormalin inactivated sub ormalin inactivated sub- -unit viral vaccine unit viral vaccine
- -Given IM, 1 ml Given IM, 1 ml
- -3 doses, 0,1,6 months 3 doses, 0,1,6 months
- -Booster Booster- -33- -5 5 years years
ii) RDA ii) RDA- -Yeast Derived Vaccine Yeast Derived Vaccine- -
( (Engerix Engerix- -B, B, Hepavax Hepavax- -Gene, Gene, Euvax Euvax- -B) B)
- -Recombinant DA vaccine Recombinant DA vaccine
- -Cultures of yeast cloned with Cultures of yeast cloned with HBsAg HBsAg ss- -gene gene
- -Safe & effective Safe & effective - -Cost Cost- -effective effective - -Stored at 2 Stored at 2- -
00
C C
- -Dose Dose- - 10 10- -20 micrograms, 0,1,6 months, Children 20 micrograms, 0,1,6 months, Children
< 10 yrs < 10 yrs- -Half dose Half dose
- -Site Site- -Deltoid muscle not in Deltoid muscle not in gluteal gluteal region, region,
Children Children <2 yrs <2 yrs- -Anterolateral Anterolateral aspect of thigh aspect of thigh
3 3
Hepatitis B Vaccine Hepatitis B Vaccine
Schedule Schedule- - In Children In Children
- -At birth, 6, 10 & 14 weeks or At birth, 6, 10 & 14 weeks or
- -At birth, 6, 14 weeks At birth, 6, 14 weeks
- -Booster at 1 months Booster at 1 months
In Adults In Adults- - 0,1,6 months 0,1,6 months - -Booster every 5 yearly Booster every 5 yearly
Indications Indications- -
Persons with High Persons with High- -risk sexual risk sexual behaviour behaviour
Partners & household contacts of Partners & household contacts of HBsAg HBsAg positive positive
Injecting drug users Injecting drug users
Persons who require blood or blood products Persons who require blood or blood products
Recipient of organ transplantation Recipient of organ transplantation
Occupational risk Occupational risk- - Health care workers, Doctors Health care workers, Doctors
International travelers to HBV endemic countries International travelers to HBV endemic countries
3 3
Efficacy Efficacy of Hepatitis B Vaccine of Hepatitis B Vaccine- -5 5- -5% 5%
Duration Duration of protection of protection- -12 years 12 years
Adverse reactions Adverse reactions- -
ever & pain at the site of injection ever & pain at the site of injection
Rare Rare- - Anaphylaxis, GBS & Multiple sclerosis Anaphylaxis, GBS & Multiple sclerosis
Contraindications Contraindications- -
Anaphylaxis to previous dose of HBV Anaphylaxis to previous dose of HBV
Pregnancy & lactation is Pregnancy & lactation is OT OT contraindication contraindication
Combined vaccines Combined vaccines- -
Recombinant vaccine is combined with Recombinant vaccine is combined with- -
i) i) HAV vaccine (Twinrix) HAV vaccine (Twinrix)
ii) ii) DPT (Tritanrix DPT (Tritanrix- -HB) HB)
iii) iii) DTaP (Infanrix DTaP (Infanrix- -HB) HB)
iv) iv) HiB (Comvax) HiB (Comvax)
40 40
Passive Immunization Passive Immunization- -
Hepatitis B immunoglobulin (HBIG) Hepatitis B immunoglobulin (HBIG)
or immediate protection or immediate protection
a) Surgeons, nurses or laboratory workers a) Surgeons, nurses or laboratory workers
b) ewborn infants of carrier mothers b) ewborn infants of carrier mothers
c) Sexual contacts of acute hepatitis B patient c) Sexual contacts of acute hepatitis B patient
- -Given within 6 hrs, not later than 4 hrs Given within 6 hrs, not later than 4 hrs
- -Dose 0.05 to 0.0 ml/kg Dose 0.05 to 0.0 ml/kg
- -Two doses given 30 days apart Two doses given 30 days apart
- -Passive protection for 3 months Passive protection for 3 months
41 41
Passive Active immunization Passive Active immunization
Indications Indications- -
- -Persons exposed to blood of hepatitis B Persons exposed to blood of hepatitis B
patients patients
- -ewborn babies of carrier mothers ewborn babies of carrier mothers
Dose Dose
- - HBIG (0.05 HBIG (0.05- -0.0 ml/Kg) within 24 hrs + 0.0 ml/Kg) within 24 hrs +
Hepatitis B Vaccine (1 ml) 1 Hepatitis B Vaccine (1 ml) 1
st st
dose within dose within
days of exposure days of exposure
- -22
nd nd
& 3 & 3
rd rd
dose 1 & 6 months after first dose dose 1 & 6 months after first dose
Other measures Other measures
- -Screening of blood donors Screening of blood donors
- -Sterilization of instruments Sterilization of instruments
- -Personal hygiene Personal hygiene
- -Barrier contraceptive Barrier contraceptive
42 42
epatitis epatitis- - C C
Identified in the year 1 Identified in the year 1
Public Health Importance Public Health Importance- -
- - In In World World
- -According to WHO According to WHO- - 3% of Worlds population is 3% of Worlds population is
infected with HCV infected with HCV
- -Around 10 million individuals are chronic Around 10 million individuals are chronic
carriers & carriers & at risk of developing liver cirrhosis at risk of developing liver cirrhosis
& & cancer cancer
- -In In India India
- -Prevalence Prevalence of of carriersv carriersv- -22% %
- -42% of patients with 42% of patients with hepatocellular hepatocellular carcinoma carcinoma
had markers of HCV infection had markers of HCV infection
43 43
epatitis epatitis- - C C Contd Contd. .
Agent Agent- - HCV, 50 HCV, 50- -60 nm, single stranded, RA 60 nm, single stranded, RA virus virus
Transmission Transmission- -
Transfusion or transplant from infected donor Transfusion or transplant from infected donor
Voluntary blood donors have a very high prevalence of Voluntary blood donors have a very high prevalence of
HCV infection HCV infection
50% of cases are related to IVDUs who share needles 50% of cases are related to IVDUs who share needles
Hemodialysis Hemodialysis (yrs on treatment) (yrs on treatment)
Accidental injuries with needles/sharps Accidental injuries with needles/sharps
Sexual/household exposure to anti Sexual/household exposure to anti- -HCV HCV- -positive contact positive contact
Multiple sex partners Multiple sex partners
Birth to HCV Birth to HCV- -infected mother infected mother
Incubation period: Incubation period: Average 6- wks
Range 2-26 wks
Clinical illness (jaundice): Clinical illness (jaundice): 30-40% (20-30%)
Chronic hepatitis: Chronic hepatitis: 0%
Persistent infection: Persistent infection: 5-100%
Immunity: Immunity: o protective antibody
response identified
epatitis C - CIinicaI Features
45 45
epatitis epatitis- - C C Contd Contd. . .. ..
Lab Lab. Diagnosis . Diagnosis-- Ab Ab by ELISA, by ELISA, Immunoblot Immunoblot assay assay
Treatment Treatment- -
Symptomatic Symptomatic, ,
Interferon Interferon & & ribavirin ribavirin--claimed to be useful claimed to be useful
Prevention Prevention- -
Screening of blood donors compulsory from 1 Screening of blood donors compulsory from 1
st st
July July
1 1
Health care workers are at risk Health care workers are at risk- -Universal Universal
precautions precautions
Health Education Health Education Programme Programme
46 46
eIta epatitis (epatitis eIta epatitis (epatitis
Always occurs in association with hepatitis B Always occurs in association with hepatitis B
(carrier state) (carrier state)
Agent Agent- - HDV, defective RA virus, 36 nm HDV, defective RA virus, 36 nm
spherical particle spherical particle
Reservoir of infection Reservoir of infection- - Man, Occur as co Man, Occur as co- -
infection or super infection or super- -infection infection
I.P. I.P.- - 45 45- -10 days 10 days
Mode of Mode of transmission, transmission, its prevention & its prevention &
control control are identical are identical to those of hepatitis B to those of hepatitis B
Immunization against hepatitis B also Immunization against hepatitis B also
protects against delta infection protects against delta infection
4 4
epatitis epatitis- - E E
Discovered in 10 Discovered in 10
Public Health Importance Public Health Importance --
Most outbreaks associated with Most outbreaks associated with faecally faecally contaminated contaminated
drinking water. drinking water.
Several other large epidemics have occurred since in the Several other large epidemics have occurred since in the
Indian subcontinent and the USSR, China, Africa and Indian subcontinent and the USSR, China, Africa and
Mexico. Mexico.
155 155- -56 56- -Delhi epidemic Delhi epidemic- -30,000 cases 30,000 cases
Kanpur epidemic Kanpur epidemic- -,01 cases ,01 cases
Mortality rate Mortality rate- -0.5%to 4% especially in pregnant women 0.5%to 4% especially in pregnant women
4 4
EV EV- -EpidemioIogicaI eterminants EpidemioIogicaI eterminants
Agent Agent factors factors
Agent Agent - -
Hepatitis Hepatitis E Virus ( E Virus (2 2- -nm nm to to 32 32- -nm) nm)
Single Single stranded of RA stranded of RA virus virus
Reservoir Reservoir -- rank/mild cases rank/mild cases
Source Source - - Human Human faeces faeces
POC POC - - Late incubation period & early part of Late incubation period & early part of
disease disease
Host factors Host factors
Age Age group group - - 15 15- -40 40 years years
Sex Sex - - Male > emale Male > emale
Environmental Environmental factors factors -- Summer Summer & Rainy & Rainy
season season
4 4
epatitis epatitis- - E E Contd Contd. .
Mode of transmission Mode of transmission- - aeco aeco- -oral route oral route
Incubation period Incubation period- - 22- - weeks weeks
C/ C/-- Same as that of HAV Same as that of HAV
Diagnosis Diagnosis-- Anti Anti- -HEV antibodies in the serum HEV antibodies in the serum
by ELISA by ELISA
Treatment Treatment- - o specific treatment o specific treatment
Prevention Prevention- -
- - Provision of safe drinking water & Provision of safe drinking water &
- - Adequate sewage disposal Adequate sewage disposal
- - Vaccine? Vaccine?
50 50
epatitis G epatitis G
HGV discovered in 16 HGV discovered in 16
Prevalence not known Prevalence not known
It infects either independently or with It infects either independently or with
HBV/HCV HBV/HCV
Agent Agent- -Hepatitis G virus, RA virus, Hepatitis G virus, RA virus,
flavivirus flavivirus
Association with blood transfusion Association with blood transfusion
Occur as mild jaundice or chronic hepatitis Occur as mild jaundice or chronic hepatitis
Sensitive to Interferon Sensitive to Interferon
51 51
Epidemiological & Clinical features of viral hepatitis Epidemiological & Clinical features of viral hepatitis
A, B & C A, B & C
Viral Hepatitis A Viral Hepatitis A Viral Hepatitis B Viral Hepatitis B Viral Hepatitis C Viral Hepatitis C
I.P. I.P. 10 10- -50 days 50 days 50 50- -10 days 10 days 40 40- -120 days 120 days
Age distribution Age distribution Children, Young Children, Young
adults adults
15 15- -2 yrs 2 yrs Adults Adults
Route of Route of
infection infection
Predominantly Predominantly
faeco faeco- -oral oral
Predominantly Predominantly
parental parental
Predominantly Predominantly
parental parental
Occurrence of Occurrence of
virus in blood virus in blood
2 wks before to 2 wks before to
<1wk after jaundice <1wk after jaundice
Months to years Months to years Months to years Months to years
Occurrence of Occurrence of
virus in stool virus in stool
2 wks before to 2 2 wks before to 2
wks after jaundice wks after jaundice
Absent Absent Probably absent Probably absent
ever >3 ever >3
oo
C C Common Common Less common Less common Less common Less common
Complications Complications Uncommon, o Uncommon, o
chronicity chronicity
Chronicity in Chronicity in
55- -10% 10%
Chronicity in Chronicity in
50% or more 50% or more
Mortality rate Mortality rate <0.5% <0.5% <1 <1- -2% 2% 0.5 0.5- -1% 1%
Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Type of Hepatitis
C E
53 53
54