hepatitis-presentation. hepatitis-presentation

hepatitis-presentationHepatitis refers to inflammation of the liver, often caused by viral infections, toxins, autoimmune disorders, or certain medications. It is a significant global health issue, with millions of people affected annually. There are five main types of viral hepatitis: Hepatitis A, B, C, D, and E. Each has unique characteristics, modes of transmission, and clinical outcomes.

### 1. Types of Hepatitis

#### **Hepatitis A (HAV)**
Hepatitis A is caused by the Hepatitis A virus, which is primarily transmitted through the consumption of contaminated food or water, particularly in areas with poor sanitation. The infection is typically acute and does not lead to chronic liver disease. Hepatitis A is preventable with a vaccine, and the disease usually resolves on its own without long-term consequences. Symptoms include fever, fatigue, nausea, jaundice, and abdominal discomfort. Recovery takes a few weeks to months, and the body develops immunity after the infection.

#### **Hepatitis B (HBV)**
Hepatitis B is a serious liver infection caused by the Hepatitis B virus, which can be transmitted through exposure to infected blood, sexual contact, or from mother to child during childbirth. Unlike Hepatitis A, Hepatitis B can be acute or chronic. Chronic HBV infection can lead to liver cirrhosis, liver failure, or hepatocellular carcinoma (liver cancer). Vaccination is available and highly effective at preventing Hepatitis B. Treatment for chronic HBV includes antiviral medications that suppress the virus and reduce liver damage.

#### **Hepatitis C (HCV)**
Hepatitis C is mainly spread through blood-to-blood contact, typically through the sharing of needles or blood products. HCV is often chronic, and like Hepatitis B, it can lead to cirrhosis and liver cancer. Many people with Hepatitis C do not exhibit symptoms until significant liver damage occurs, making early detection challenging. However, advances in antiviral therapies have made Hepatitis C curable in many cases. These direct-acting antivirals (DAAs) target different steps in the virus's replication process, leading to high cure rates.

#### **Hepatitis D (HDV)**
Hepatitis D, or delta hepatitis, is a unique form of hepatitis that only occurs in individuals who are already infected with Hepatitis B. The Hepatitis D virus requires the Hepatitis B virus to replicate. Co-infection with HBV and HDV can lead to more severe liver disease and faster progression to cirrhosis or liver failure. There is no specific vaccine for Hepatitis D, but the Hepatitis B vaccine can prevent HDV infection by preventing Hepatitis B.

#### **Hepatitis E (HEV)**
Hepatitis E is typically transmitted via the fecal-oral route, similar to Hepatitis A. It is more common in areas with poor sanitation and contaminated water sources. Hepatitis E usually causes an acute infection that resolves on its own, though it can be more severe in pregnant women, where it may lead to fulminant hepatitis, a life-threatening conditio

1. Hepatitis
HIV/AIDS Program
Public Health Seattle & King County
[email protected]
http://www.metrokc.gov/health/apu
206/205-STDS (7837)

2. Hepatitis
inflammation of the liver
•Can have many causes
–drugs
–toxins
–alcohol
–viral infections (A, B, C, D, E)
–other infections (parasites, bacteria)
–physical damage

4. Liver
•Functions
–Stores sugar needed for energy
–Absorbs good nutrients
–Breaks down poisons (toxins) and drugs
–Makes important proteins that help build new
tissue and repair broken tissue
–Produces bile, which helps remove waste from
the body

5. Healthy Liver Cirrhosis Liver

6. Hepatitis Terms
•Acute Hepatitis: Short-term hepatitis.
–Body’s immune system clears the virus from
the body within 6 months
•Chronic Hepatitis: Long-term hepatitis.
–Infection lasts longer than 6 months because
the body’s immune system cannot clear the
virus from the body

7. Hepatitis A
•What is it?
–Infection of the liver caused by Hepatitis A
virus

8. Geographic Distribution of HAV
Infection
Anti-HAV Prevalence
High
Intermediate
Low
Very Low

9. Hepatitis A
•Incubation period
–30 days on average (range 15-50 days)
–infectious latter half of incubation period while
asymptomatic through 1 week after having
jaundice.

10. –Nausea
–Loss of appetite
–Vomiting
–Fatigue
–Fever
–Dark urine
–Pale stool
–Jaundice
–Stomach pain
–Side pain
A person may have all, some or none of these
Hepatitis A
•Symptoms

11. Hepatitis A
•How do you get it?
–Feces (stool) on hands that gets on food or in
water
–Contaminated shellfish
–Sex
•A person is most contagious 2 weeks before
they feel sick
•Not spread by kissing, sneezing, saliva

12. Hepatitis A
•Diagnosis and Treatment
–Blood test
–No medicine or treatment to make it go away
–Rest, fluids, treatment of symptoms
–Most people recover completely and become
immune to reinfection

13. Hepatitis A
•Prevention
–Shot of immune globulin up to 2 weeks after
exposure
–Good hand washing
–Cook food well
–Good diaper hygiene
–Only drink clean water
–VACCINE!!!

14. Hepatitis A
•Who needs immune globulin?
–Living with someone with Hep A
–Eaten food handled by someone with Hep A
–Sexual contact with person with Hep A
–Traveling to an area where Hep A is common
–Child or employee at a child care program
where someone else has Hep A

15. Hepatitis B
•What is it?
–Hep B is a serious disease caused by a virus
that infects the liver
–Can cause lifelong infection, cirrhosis (liver
scarring), liver cancer, liver failure and death

16. Geographic Distribution of Chronic HBV
Infection
HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low

17. Hepatitis B
•Incubation period
–60-90 days on average (range 45-180 days)
–infectious weeks before getting ill and for
variable period after acute infection
–chronic carriers remain infectious

18. –Nausea
–Loss of appetite
–Vomiting
–Fatigue
–Fever
–Dark urine
–Pale stool
–Jaundice
–Stomach pain
–Side pain
A person may have all, some or none of these
Hepatitis B
•Symptoms

19. Hepatitis B
•Who is at risk?
–Anyone can get it
–In the USA, 200,000 people get Hep B every
year
–5,000 people die every year of Hep B
–If you have had other kinds of Hepatitis, you
can still get Hep B

20. Hepatitis B Infections
200,000 per year
Asymptomatic Cases
100,000 (50%)
Symptomatic Cases
100,000 (50%)
Death
100 (0.05%)
Chronic Liver Disease
Death from Cirrhosis
3400 (1.7%)
Death-Primary Liver Cancer
800 (0.4%)
Hepatitis B Chronic Carriers
12-20,000 (6-10%)
Clear Virus; Healthy
170 - 182,000 (90-94%)

21. Hepatitis B
•Who is at highest risk?
–Injection drug users
–Sex partners of those with Hep B
–Sex with more than one partner
–Men who have sex with men
–Living with someone with chronic Hep B
–Contact with blood
–Transfusions, travel, dialysis

22. Hepatitis B
•How do you get it?
–Direct contact with blood or body fluids of an
infected person
•sharing injection equipment
•sex
•baby from infected mother during childbirth
•Hepatitis B is not spread by food, water or
casual contact

23. Hepatitis B
•Who is a carrier of Hep B virus?
–Some people with Hep B never fully recover
from the infection (chronic infection)
–They still carry the virus and can infect others
for the rest of their lives
–There are about 1 million carriers of Hep B in
the USA

24. 10%
90%
Chronically infected
Clear the infection
HEPATITIS B

25. Hepatitis B
•Diagnosis and Treatment
–Blood test
–There is no cure
–Interferon/Ribaviron

26. Hepatitis B
•What about Hep B and pregnancy?
–A woman with Hep B can give it to her baby at
birth
–Babies with Hep B can get very sick, can
develop chronic infection and spread Hep B,
can get cirrhosis or liver cancer
–Pregnant women should be tested for Hep B
–Babies should get Hep B vaccine at birth

27. Hepatitis B
•Who should get Hepatitis B vaccine?
–All babies, at birth
–All children 11-12 who have not had vaccine
–People at risk
•MSM
•Multiple sex partners
•Injection drug users
•People with jobs where exposure to blood might
happen

28. Hepatitis C
•What is it?
–Hep C is a liver infection caused by a virus
–Also known as non A, non B hepatitis

29. Hepatitis C
•Incubation period
–6-7 weeks on average (range 2-6months)
–infectious one or more weeks before getting ill
–chronic carriers remain infectious

30. –Nausea
–Loss of appetite
–Vomiting
–Fatigue
–Fever
–Dark urine
–Pale stool
–Jaundice
–Stomach pain
–Side pain
Hepatitis C
•Symptoms
3 out of 4 persons have no symptoms and can
infect others without knowing it

31. Hepatitis C
•Who is at risk?
–About 35,000 people get Hep C every year
•down from 180,000 in the 1980s
–About 3.9 million people in the USA are
infected with Hep C.
–It can cause liver failure, cirrhosis, liver cancer
–Responsible for 8,000 to 10,000 deaths/year.

32. Hepatitis C
•Who is at highest risk?
–Injection drug users
–Estimated that over 75% of injectors
nationwide have Hep C
–In Seattle/King County, 86%

33. Hepatitis C
–Shared injection equipment (60% of new infections)
–Blood transfusion before May, 1992 (now only 1 in
100,000 chance of transmission)
–Blood transfer (HCW, tattoo, piercing …)
–Sex? (HCV in semen and vf but only 1.5% rate of
transmission for long-term partners)
–Mother to child (<5%)
–10-20% of infections have no identifiable risk factors
•How do you get it?

34. Hepatitis C
•Diagnosis
–There is a blood test that screens for Hep C antibodies
(ELISA or RIBA)
–Antibodies usually develop within 3 months
–HIV+ persons may not develop detectable antibodies
–There is a PCR test (detects parts of actual virus) for Hep C
but it is not yet FDA approved
–If infected, liver enzyme tests or a liver biopsy can check
liver function

35. •What happens when you have Hepatitis C ?
–85% of people develop chronic infection (infected for
the rest of their life)
–Rapid progression, slow progression, no progression
•HCV subtype
•Alcohol consumption (alcoholics 3 times more likely to
develop cirrhosis after 20 years)
•age (older at time of infection more rapid)
•gender (men faster progression than women)
Hepatitis C

36. 85%
15%
Chronically infected
Clear the infection
HEPATITIS C

37. Hepatitis C
•Long term pathogenesis
–Over time progressive liver damage may occur
–20 -30 % of those infected will develop cirrhosis over 10
- 30 years
–Of those with cirrhosis 25-30% (5% of overall) will
develop end-stage liver disease or liver cancer
–Many live without symptoms for decades
–Others experience mild symptoms --intermittent fatigue,
nausea, and muscle aches

38. Hepatitis C
•Treatment
–Interferon/Ribaviron (suggest 40% “cure” rate)
–Peginterferon Alfa-2a (still in studies - not yet
FDA approved)

39. Hepatitis C
•What should a person do who has Hep C?
–Get regular medical care--tell doctor about ALL drugs
(including herbs)!!!
–Have a healthy diet (no iron supplements, reduce salt
intake, no large doses of vitamin A)
–Get needed rest
–No alcohol or Tylenol, cut back on other drug use
–Avoid chemical fumes and other environmental toxins
–Get vaccinated for A and B!!!

40. Hepatitis C
•What should a person do who has Hep C?
–Do not share injection equipment.
–Do not donate blood or plasma, organs or sperm
–Do not share toothbrushes, razors
–Cover areas of open skin
–Use safer sex?

41. Hepatitis C and HIV
•30 - 40% of HIV+ people in US also infected
with Hep C
•More rapid progression of Hep C (twice as fast)
•Little to no affect on HIV progression (still
inconclusive)
•Complications of medication regimens
•Increases risk of perinatal transmission

42. Hepatitis
A VirusB VirusC Virus
Symptoms
of
Initial
Infection
 Some people have no symptoms (especially HCV)
 Eyes or skin may turn yellow (jaundice)
 Loss of appetite
 Nausea, vomiting, fever, stomach or joint pain
 Fatigue (can last weeks or months)
 Dark urine & pale bowel movements
Chronic
Infection
(Infection for
life)
No chronic disease10% Chronic
Can cause:
Liver cell damage
Cirrhosis
Liver cancer
85% Chronic
Can cause:
Liver cell damage
Cirrhosis
Liver cancer
How is it
Spread?
 Fecal/ oral
 Contaminated
food and water
 Oral/Anal sexual
contact
 Blood and body
fluid contact
 Sex
 Needles
 Mother to baby
 Human bite
 Blood and body fluid
contact
 Needles
 Mother to baby
 Sex (minimal)
Vaccine Yes Yes No

43. Questions