Dr.WAN NEDRA Sp.

A
Child Health Dept.
School of Medicine
University of YARSI

 organ paling
besar
Fungsi utama:
1. Regulasi
Metabolite
dalam dara
2.Detoxikasi

Spleen

Unconj
bilirubin

Old
Erythrocytes
Small amount
entero-hepatic
circulation

Conj.
bilirubin
Urobilinogen

Regenerate jk
terjadi kerusakan
HEPATITIS
Inflammasi &
necrosis
Infeksi & non Inf

Stercobiline

MASALAH:
MEDICO-PSYCHO-SOSIO-ECONOMICS
Morbidity - mortality
Epidemiology endemic area
carrier rate - transmission rate
Therapeutics ?
Quality of life?
Prevention - !!!

OBJECTIVES:
PRINCIPLES - MANAGEMENT
Epidemiology, virology, patophysiology:
Diagnosis DINI
Supportive & monitoring
Detection dini:
fulminant, chronicity
Prevention of spreading
Pengobatan Antivirus

HEPATITIS A - G
HAV

HBV

HCV

Virus

Picorna

Hepadna Flavi

Inkubasi

15-40 hr 50-160hr 1-5 bln

Onset

Akut

HGV
Flavi
? 2 mg

Subklinik Subklinik Akut/sub

Oral-fekal

(++)

(-)

(-)

(-)

Parenteral

Jarang

(++)

(++)

(++)

Kronisitas

(-)

(+)

(+)

(+)

HEPATITIS A (HAV)
HEAT STABLE VIRUS

HEPATITIS A (HAV)
PROLONG, RELAPSING,
LIVER FAILURE (0.1%)

Complication in chronic liver disease 8x

Self
limiting
disease
Single
exposure
Long life
immunity
Endemic - young children reservoir
Morbidity mortality at older age

CTL

Hepatocyte

Receptor

Excretion in stool

HAV Pathogenesis

Excretion in
bile

HAV infection
Asymptomatic

Non icteric

Complication -

Relapsing

Icteric
Cholestatic

Resolved
Transplantation
Death

OUTCOME
HAV infection

Liver failure

SEROLOGIC DIAGNOSIS

Symptoms

Anti HAV total

ALT

HVA
stool

IgM-Anti HVA

Months of exposure

EPIDEMIOLOGI HEPATITIS A
Heat stable virus
Endemic - reservoir
Fecal-oral, kontak erat
High risk: children, CLD cases, etc
Susceptible: High sosio-economic population

PENCEGAHAN
HEPATITIS A
Hygiene - sanitation
Proper cooking, hand washing, septic tank,diapers, etc
Isolate index case
Immunization
Pre-post exposure
(activepassive)

IgM anti HAV (+)

PT/INR
INR < 2
Repeat LFTs 57 d

INR > 2
Not improved
(clinic-laboratory)

Improved

Repeat LFT 6wk

Normal
No follow up

Abnormal

Refer

PENCEGAHAN
VAKSIN HVA
Inactivated, safe

Long immunity
Simultaneous other vaccine
Interchangeable
Serologic test:
pre- likely exposed
post- vaccination: (-)

Individual risk: Children,

CLD cases, IVDU,
homosexuals
multitransfused,
household contact,
traveler - low endemic
Professional risk: food
sector, health, sewage,
waste water, in contact
with children, lab-military
staff

Age
ys
<2

ROUTINE VS POSTEXPOSURE
PROPHYLAXIS
Routine immunization
Post-exposure

Individual Community
protection
Vaccine (-)

immunization
NHIG household
contact

2 18 Havrix 720 EU, Avaxim 160 Vaccine or

AU/ml, 2x (0, 6 12)
Vaccine & NHIG#
> 18

Havrix 1440 EU, Avaxim

160 AU/ml, 2x (0, 6 12)

None or Vaccine or
Vaccine & NHIG#

Protective anti HAV 20 mIU/ml

PRE-EXPOSURE PROPHYLAXIS
(TRAVELERS TO ENDEMIC AREA)

AGE
(ys)
<2

DURATION
protection

RECOMMENDATION

< 3 months

NHIG 0.02 ml/kg, 1x

3-5 months

NHIG 0.02 ml/kg, 1x

Long term
< 3 months

NHIG 0.06 ml/kg, repeat 5/12

Vaccine or NHIG (0.02 ml/kg)

3-5 months

Vaccine or NHIG (0.06 ml/kg)

Long term

Vaccine

Initial consultation:
consultation
- LFTs
- Anti HAV-IgM
- HBsAg

Bilirubin
> 6 mg/dl

Bilirubin
> 6 mg/dl

GGT cholestatic or
obstruction

Alanine transaminase
IgM HAV
(+)

Treat as
HAV

Refer

IgM HAV
()

Refer

Refer